I was wondering if you had to decide at the time of the mastectomy with immediate placement of tissue expanders what shape implant you want. Does the surgeon need to know when creating the "pocket" in order to choose a round vs anatomical expander?
What Shape is the Pocket Created with the Expander and Does It Affect the Type of Implants?
Doctor Answers (7)
The final implant chosen for breast reconstruction can be made up until the time of its placement. It should not impact the expander choice.
Tissue Expander Reconstruction
I do think that some expander shapes are better for some patients than others...
On the other hand, there are going to be some limits on the shape of the reconstructed breast that have little to do with the choice of expander or implant- explaining why patients who's surgeons (mastectomy and plastic surgeon) communicate well get better outcomes.
To answer your question more directly however, no- you do not need to choose the implant at the time of your mastectomy and expander placement. It is important to understand, however, that (as I often tell breast augmentation patients) the appropriate way to select an implant has a bit to do with the patient's desired outcome, but even more to do with identifying the implant most appropriate for the patient's body dimensions.
Pocket Dimensions in Breast Reconstruction
I am of opinion that the purpose of the expander is to maintain space and increase the amount of available skin. The choice of the implant size and shape can be determined prior to the exchange of the expander for the permanent implant. The pocket shape is tailored at surgery internally to achieve the best aesthetic result.
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first you have options in Breast Reconstruction you have to dicuss with your Plastic surgeon.
Your Plastic surgeon Should be talking and PLANING with your breast surgeon as to what type of mastectomy will be performed, skin sparing, nipple sparing, classical mastectomy. Also would you need chemotherapy, or most important Radiation Therapy.
the expander shape and volume then is considered and the opposite breast shape size need for surgery is cosidered then the tissue expander is choosen accordingly.
Best Choice of Tissue Expander then Implant in Breast Reconstruction surgery
To create the best possible breast, the Plastic surgeon must communicate both with his patient and the Breast surgeon performing the mastectomy. The patient needs to understand what can and cannot be accomplished in breast reconstruction as well as her options. On the other hand, to try and recreate the patient's wishes, the Plastic surgeon must make sure that the General Surgeon cooperates in the design and placement of the scar and the preservation of the under the breast fold.
Technically, the expander will create a pocket which would allow the placement of a narrow range of like-shaped breast implants. Another option may be an immediate breast creation with an implant and a sling / hammock (Alloderm or Strattice by LifeCell) as the definitive operation without the need for expansion and another operation for expander removal and implant placement.
Talk to your Plastic surgeon.
Shape is the pocket created with the expander
Interesting question. Shows you are thinking out of the box. Usually the expender stretches the pocket in an irregular but constant pattern. Whether it is formed for the tear drop or round permanent implant does not really matter. The scar capsular fibrosis will form around the implant to help form the shape. remember reconstruct is to add quality to life not make a perfect result.
From MIAMI Dr. B
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