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?

Doctor Answers (13)

One to two months after they are fully expanded.

+3

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.


Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Keep on going with the tissue expanders

+2

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 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!

Kenneth R. Francis, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 32 reviews

Expanders can stay in indefinitely

+2

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.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 8 reviews

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Shrinkage

+1
It would be interesting to hear with more clarity what happened to your daughter, often weight-loss can make the breast implants seem smaller.
It sounds to me like your tissue expander may be too small now and I would communicate with your board-certified plastic surgeon exactly what you think you want. It is one of the main reasons to have that spacer in there so that you can communicate accurately. Lateraling to the vernacular of ABC or D cups confuses things. Simply look at your chest and wear a few outfits, do they need to be bigger or smaller... Then go from there.  Best wishes!

Ricardo A. Meade, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 60 reviews

How long should expanders be in place

+1
I typically place a tissue expander either at the time of mastectomy (immediate reconstruction) or at a later date (delayed reconstruction).  After that I usually wait 3 weeks before starting expansion and then see the patient every 2 weeks for further expansion.  When we get to the size they want we would then over inflate 60-100 cc depending on the volume of the implant.  This allows more movement and a more natural feel when we switch to an implant 3 months later.
Everyone is different.  Some people need more time to expand.  This is most commonly seen in patients that had radiation.  

Rodger Shortt, FRCSC
Toronto Plastic Surgeon
5.0 out of 5 stars 15 reviews

How long can tissue expanders be in place!

+1
Usually between 3 and 4 months. I feel this gives adequate time for the capsule around the implant to mature.  This allows for a change in the pocket if necessary at the time of exchange.Please find an experienced Board Certified Plastic Surgeon and member of the Aesthetic Society using the Smart Beauty Guide. These Plastic Surgeons can guide you on all aspects of facial surgery, breast augmentation and body procedures including tummy tucks or mommy makeovers!


Robert Whitfield, MD, FACS
Austin Plastic Surgeon
5.0 out of 5 stars 14 reviews

How long do tissue expanders need to stay in place?

+1

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.

Dr. Gill

Paul S. Gill, MD
Houston Plastic Surgeon
5.0 out of 5 stars 40 reviews

Timing until 2nd stage of tissue expander breast reconstruction

+1

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!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

Expanders

+1

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.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.0 out of 5 stars 15 reviews

Breast expander timing

+1

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

Mahlon Kerr, MD, FACS
Austin Plastic Surgeon
5.0 out of 5 stars 90 reviews

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