Breast Reconstruction: Q&A
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How Long Should Tissue Expanders Be in Place?
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?
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9 Doctor Answers |
Asked by
Good Karma
in Indiana
+3
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.
+2
Keep on going with the tissue expanders
Karma,
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...
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+2
Tissue expanders a placeholder in skin sparing mastectomy
Good Karma,
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...
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+2
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....
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+1
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,...
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+1
Expanders
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.
Tampa Plastic Surgeon
+1
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
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+1
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.
+1
Tissue expansion before breast reconstruction implants
Good Karma,
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.
To achieve a C cup you will need at least a 450-500 or 600 cc breast implant, depending on the thickness of the skin flaps left behind...
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