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Does Shape of Tissue Expander for Breast Reconstruction Matter?

asked 1 year ago by Issaquah1202 in Issaquah, WA
Latest answer by Paul S. Gill, MD
Question viewed 424 times
Tags: expander

After radical mastectomy on left breast following cancer (but no chemo or radiation required), two plastic surgeons have recommended lat flap surgery followed by implant. One doctor suggested a "tear drop" (low profile) shaped tissue expander, while the other made no distinction of shape and would use what appears to be the typical round expander. Should I expect any difference in results following the implant?

15 answers to Does Shape of Tissue Expander for Breast Reconstruction Matter?

Radical Mastectomy Reconstruction

Radical Mastectomy involves removal of the pectoralis major muscle during the mastectomy. This is an extremely important barrier during implant reconstruction to protect the implant. If this is the case, I would recommend use of tissue from the back (LD) or abdomen (DIEP/TRAM) to help reconstruct the breast. Speak with your cancer surgeon to ensure that you had a radical mastectomy. It is much more common to undergo a modified radical mastectomy or simple... more

Paul S. Gill, MD
Houston Plastic Surgeon

www.drpaulgill.com

Why expander shape matters in breast reconstruction.

The goal of a tissue expander is to create a space for the permanent implant in the reconstructed breast. When you look at the natural shape of a breast, it has a tear-drop shape to it: More fullness in the lower pole of the breast than above. The expanders are shaped this way in order to either preserve that increased volume (as in a skin-sparing mastectomy) or the create more fullness inferiorly through expansion (as in a delayed or radical mastectomy). The implants themselves are usually... more

David Bogue, MD
Boca Raton Plastic Surgeon

Choice of tissue expander is guided by appearance of the opposite breast

Sorry to hear about your predicament. Given the history of a radical mastectomy, your reconstruction will require the "importation" of vascularized skin and muscle, hence the pedicled latissimus dorsi myocutaneous flap. In justifying the choice of tissue expander, I ask patients their opinion of their opposite breast. Is it too big and droopy, too small or just right? Since one of the goals of breast reconstruction is to produce symmetry, we need to be... more

Lavinia Chong, MD
Orange County Plastic Surgeon

Tissue Expander Shape- Does it Matter?

In general, the size and shape of the implant used for your reconstruction and the shape and size of the LD flap will influence the shape of the final reconstruction more than the shape of your tissue expander. If you are going to have an implant, I wonder, absent your history of radiation, why you need the LD flap? Furthermore, if you are going to go the route of a flap combined with an implant, you may want to explore the possibility of a reconstruction that uses only your own... more

David Greenspun, MD, MSc
New York Plastic Surgeon

Expander choice

I used to use the low profile expanders. I should add that all will work, provided you get enough stretch at the bottom of the breast. I tend to use the round ones now for the simple reason that the patient gets a better idea of how the implant will look as we proceed with the expansion.

David A. Lickstein, MD
Miami Plastic Surgeon

Tissue expander shape after mastectomy is important

One of the biggest advances in breast reconstruction has been the development of different profiles of tissue expanders. The reason for this is that the upper part of the breast area, where the pectoral muscle helps to cover the implant, expands much more easily than the lower half where the skin is adherent and there isn't good muscle coverage. So a round implant will overexpand the top and not round out the bottom enough. Shaped expanders focus on the lower part without... more

Richard Baxter, MD
Seattle Plastic Surgeon

Radical mastectomy?

Issaquah, Having had a radical mastectomy, if you are doing implant reconstruction, you do need muscle to cover your implant/expander. Question #1 would be, do you need tissue expansion at all or can you have a permanent implant placed at the time of latissimus flap? The answer to this question and ultimately your question about what type of expander to use depends on what you are trying to match on the other side. If your remaining breast has a lot of sagging, then... more

Kenneth R. Francis, MD
Manhattan Plastic Surgeon

Tissue Expander shape in Breast Reconstruction

When doing an implant only breast reconstruction, the shape of the expander is very important. However, with a latissimus flap reconstruction, it probably matters little. The real question is, why the expander at all. Most frequently, when bringing in tissue, an expander is not necessary. Only an examination of your specific needs could decide exactly what will work best. Your particular situation may also be why a TRAM flap was not recommended. If possible, I prefer this (as one of its... more

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Shaped tissue expander for breast reconstruction

If you were going to get a reconstruction with a tissue expander followed by implant I would recommend using a shaped anatomical expander to stretch the lower part of the breast however if the reconstruction is with a flap then it does not make a difference if the expander is shaped or not because the flap position will help define the shape of the reconstructed breast. Good luck

Dana Khuthaila, MD
New York Plastic Surgeon

www.drkhuthaila.com

Shape ot tissue expander in Lat. Dorsi Breast Reconstruction

This is a difficult question to answer in the absence of a photos and a physical exam. In general, the tissue expander and subsequent permanent implant usually serves to provide additional volume with the Lat. Dorsi flap. The use of a shaped or round tissue expander is probably of less importance.

Stephen Delia, M.D.
Boston Plastic Surgeon

Tear Drop Expander Best for Breast Reconstruction

I feel that a tear-drop shaped expander in conjuction with AlloDerm works best for Implant breast reconstruction. These encourage greater expansion inferiorly which corresponds to the normal shape of a breast. I do, however, prefer to use round implants to place at the time of expander removal. Feel that without usung both products, it is difficult to achieve a normal breast shape and without them a simple mound is likely to result.

John Whitt, MD
Louisville Plastic Surgeon

Does Risk of Necrosis Go Up if I Have a Tummy Tuck After Smartlipo?

I feel the appearance of your breast dictate if a shaped expender is needed. But you did not post photos. So go see 3 boarded surgeons in your area. Regards Dr. Darryl j. Blinski

Darryl J. Blinski, MD
Miami Plastic Surgeon

Mastectomy, reconstruction, and expander

Your question is not an easy one to answer because there are too many variables, philosophies, and I do not have the opportunity to exam you. The amount of tissue remaining after the mastectomy and the final goal of the reconstruction will also play a role. Many times the use of the latissimus flap obviates the need for an expander since the flap can either recruit the skin necessary to place an implant near the final volume required and/or the soft tissue brought in by the flap... more