What determines whether you have an expander to Breast implants instead of direct implant after mastectomy?
Factors in Considering Expanders and Breast Implants After Mastectomy?
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Expanders after mastectomy
The decision to use a tissue expander first, or an implant depends upon whether or not a skin sparing mastectomy was performed and comfort level of the surgeon.
Factors in Considering Expanders and Breast Implants After Mastectomy
The two most important factors to consider in distinguishing between immediate implant versus expanders after mastectomy are: the size you desire to be and the amount of skin left after mastectomy.
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The amount of tissue left and its condition
Immediate implant placement at mastectomy is sometimes possible especially if you are healthy, have a good general surgeon and have a skin-sparing mastectomy. It really depends upon the amount and condition of the tissue left after the mastectomy and tends to work better for smaller breasts with the need for smaller implants.
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Pros and cons
The main determinant is how much volume the skin can withstand. Whenever a mastectomy is done the skin has less blood supply. When you stretch the skin it also decreases the blood supply. So if the skin is stretched at the time of mastectomy and reconstruction it may net heal and can cause a variety of complicationa. Thereofr the expander is safer for wound healing after the surgery.
If however there is enough good skin and the patient is willing to accept a possible smaller breat size then implants can be placed at the time of mastectomy. Usually "sizers" are used to determine the maximum amount of fluid that the skin can withstand in the implant.
Breast reconstruction is complex
There are many factors to consider before deciding whether to use a tissue expander or go straight to an implant. The most important one is how much skin is left and what size the breast reconstruction is planned for. The less skin there is the more chance that you will need a tissue expander to achieve a proportionate size. The more skin there is after a mastectomy the more likely it is that going straight to an implant will work. Breast size is also important. The smaller the size, the more likely an implant will suffice. The larger the size, the more likely a tissue expander will be needed to achieve the desired size. Tissue expander/implant reconstruction has improved dramatically over the last 5-6years with the use of skin matrices that can provide better shape and more room for a larger implant or expander. Both the mastectomy as well as the reconstruction are important in what can be achieved with reconstruction. Getting a full consult with surgeons that work well together and are experienced in breast reconstruction will give you all the answers you need.
This decision can only be made after an extensive consultation about breast reconstruction
Breast reconstruction after mastectomy is one of the nicest things we can do for patients who unfortunately loose their breast to cancer or need to be removed to prevent cancer developing. The decision to have a breast reconstruction and what kind of reconstruction can only be made after an extensive consultation and examination.
There are a great number of choices from expanders followed by implantation of the final implant, to latissimus dorsi muscle flaps from the back with or with out skin paddles and implants, to rectus abdominus myocutaneous flap reconstruction with out implants to free flaps. All have their good points and problems. None of these choices would be right for everyone. It depends on the patient's anatomy, weight, and availability of the tissue and what the patient is willing to endure.
Make an appointment with one or more board certified plastic surgeons and make sure that the consultation includes a discussion of all of these possibilities and why one is or is not better in your case. Do not let the surgeon decide for you with out a full discussion of all the possibilities.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.