How Long Should Tissue Expanders Be in Place?
- Asked by Good Karma in Indiana
- 4 years ago
I had bi-lateral mastectomy and am in reconstruction now with tissue expanders. I heard the muscle contracts down and makes them smaller in the end. I had ductal carcinoma in situ in the right breast, and needed another lumpectomy to get clearer margins, and then have radiation. I chose mastectomy of both breasts and no radiation. Ductal carcinoma was found in Left breast tissue after surgery. I started expansion December 2008.
I have 450 cc in each breast and really want a nice full 36-38 C final look. I was a 34 C prior. I am 51 and want to make sure I expand long enough and large enough to complete process with good results. My daughter had implants done 2 years ago and her size went down about a year after surgery from a 32-34 D to large C. Was it muscle contraction? How long should the expanders be in place to insure that implants stay the same size?
One to two months after they are fully expanded.
To Good Karma,
Hi. I am not sure what happened to your daughter, but breast size typically does not shrink long term after implant insertion.
I expand patients weekly, and they tell me when we have reached the size they like. We then OVEREXPAND another 100cc's to stretch the tissues. Then we wait 1-2 months (we used to wait much longer, but now I don't think it matters), and replace the tissue expanders with implants of the size the patient chose.
Keep on going with the tissue expanders
I'm sorry that you needed mastectomies. A few general comments for informational purposes. The number in your bra size, e.g. 32, 34, 36, represents the circumference of your chest wall and will not change with your reconstruction. So, you should expect to keep your 34. Then, you will choose between a C and D cup, depending on whether your tissues are capable of expanding to that large a cup.
I usually expand to a volume 25-30% greater than the anticipated implant volume. In broad terms, a C cup would be about 350 cc, so expansion would be to 450-500 cc. This number, of course, is different for everyone depending on overall body habitus.
Also, it is almost impossible to overexpand. Once the expansion process is completed the expander is left in place for 6-8 weeks to allow the tissues to overcome their memory so they don't contract back down.
As far as your daughter is concerned, sometimes implants will compress the breast tissue or even indent into the chest wall resulting in an apparent decrease in size. It is not likely that they are leaking if both are involved. Good luck!
Tissue expanders a placeholder in skin sparing mastectomy
The way tissue expanders are used in breast reconstuction has changed a little as have the techniques in mastectomy for breast cancer today. In our practice in the Chicago area, most breast surgeons will save the skin of the breast when mastectomy is performed. The reconstructive plastic surgeon then has a goal of filling this form with either an implant, or at times the patient's own tissue as with an abdominal flap. The reconstruction is easier and the shape more predictable when the basic form is in place, ready to fill.
When a tissue expander is used in reconstruction, the expansion is taking place under the chest muscle (pectoralis) to give better upper coverage of the permanent implant. In some cases where the breast is small, the permanent implant can be placed right after mastectomy, though it is best to plan on an expander with most cases as the breast skin may be bruised or thin and not up to the challenge of covering the permanent implant immediately.
The tissue expander is in place through chemotherapy for most of our patients. There is no cause to rush expansion, just filling enough slowly to expand the pocket under the muscle and smooth out the skin over the surface. We do not overexpand, we will fully expand the skin out to a comfortable zone and this will give us an idea of just how full of an implant will be apppropriate. This can take the three months of chemo, though we can expand faster if treatments allow.
The expander will not look like a breast, or feel like one. Remember it is holding a space for us. We can leave it as long as we like, and the permanent implant can be placed at any convenient time in a patient's schedule.
Your own doctors techniques may differ, remember reconstructive surgery is as much art as a surgical procedure. Also keep in mind that breast reconstruction, or the treatment and rehabilation after cancer is a journey that takes time.
Best of luck,
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Expanders can stay in indefinitely
Tissue expanders stretch the skin to increase the surface area. The soft tissue should be as pliable as possible when the expanders are exchanged for implants. It also depends on what size and dimension implants are used after the expanders are removed. Usually, the implants are at, or slightly smaller than, the expander volume.
Your surgeon will determine when he thinks the tissues are ready to accept the implants you and he have chosen. The longer you want, the more pliable the tissues.
How long do tissue expanders need to stay in place?
I do not think it is common for the muscle to contract and cause change to the implant. This may have been related to swelling and the implant settling.
I typically recommend overfilling the expander by 10% once the patient reaches their goal volume. I then wait 4-6 weeks prior to doing the expander to implant exchange. I have seen very little problem with changes in size using this method.
I wish you a safe recovery and wonderful result.
Web reference: http://www.drpaulgill.com
Timing until 2nd stage of tissue expander breast reconstruction
What happened to your daughter is not a common one, and do not have an answer for this besides possibly difference in bras? You must take into account body habitus, height, weight, as well as the projection-type of implant used. A smaller woman will require much less volume (cc's) than a much larger and taller woman would. The chest girth in inches (36, 38, etc.) will not change as this is a measure of the chest circumference beneath the breasts. The cup size (B, C, D, etc.) is measured by the projection from the chest. Also, this is always variable, as not all bras are made standard and one brand may give a different cup size from another. Determining this value during your expansion process, if you are having tissue expanders placed initially, may be the easiest way, as you could see the size as it expands and determine for yourself when you are happy with the size in clothing. Your surgeon would then put in a similar volume upon the exchange of your expanders for the implants. I typically overexpand by 10% of the final volume, then wait at least 6 weeks until the 2nd stage for exchange of the expanders for implants. It certainly will take several months for swelling to go down and the implants to settle before seeing final results. Difference in size, or contour deformities, may be ameliorated with fat grafting to fix problems, such as that you stated above. Hope this helps...good luck!
Web reference: http://www.albertandresmd.com
I usually leave expanders in place after my final expansion for 6 weeks. Then plan to go back to the operating room to do the definitive breast reconstruction.
Breast expander timing
At my Austin, Texas area plastic surgery practice I start expansion at about 2-3 weeks after placement of the expanders and continue with weekly or every other week expansion until you reach a size you are happy with. Sometimes I overfill, it depends on the patient. I make you wait a minimum of four weeks once we reach the right size and then we remove the expanders and place implants. There are lots of variations on this protocol but this is what works for me. Good luck! Dr Kerr
Expanders and reconstruction
The process of tissue expansion can take a several months to reach the desired volume. I usually discuss with my patients the range of final implant volume that they want. I ask them to tell me during the expansion process at what volume are they happy with. Then I over inflate them a bit and exchange to an implant that matches their chest wall diameter and the volume that they liked.
Tissue expansion before breast reconstruction implants
I leave soft tissue expanders in as long as necessary to achieve the volume needed to accomodate the final breast impolant size that my patients desire.
You are correct that the skin and muscle tighten and constrict to a smaller size after the soft tissue expander is removed.
Consequently, I always over expand the tissue as much as possible.
I would possibly expand you to 1000 cc to compensate for the shrinkage after the expander is removed.
Of course you need to discuss this with your surgeon and follow his/her advice. They are familiar with your situation and can give you the best recommendation.
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.