Expander size is too small, what are my options?

Question

What can be done if the expanders placed are too small? My Dr placed 300cc expanders & overfilled to 400cc. I already had 275cc implants prior to my mastectomy & was very specific I wanted to be at least a full C (size prior to) or small D. I am very unhappy with my size B & Dr said he cannot fill more due to expander size. Is it possible to have a larger implant placed at the exchange? Do I need bigger expanders placed to increase the pocket size? I am 5'5, 130 pounds with a slender build.

Jennifer Lauren Crawford, MD · Answer

It is frequently possible to place a slightly larger implant than the expanded volume at the time of the second stage procedure. Having said that, the size you can go to is limited by the chest width and scar capsule work you can do to expand that pocket at the second stage. I have gone as large as 75-100 cc beyond the expanded volume before but more typically I am staying within 50cc of the expanded volume at the second stage. So, there is a bit of volume enhancement that can be done at the end, but it may not get you into that next cup size. There are definitely some limitations to breast reconstruction surgery, but I hope you end up satisfied with your outcome. Thank you for the question.

Andrew P. Trussler, MD · Answer

Tissue expander size does not directly correlate to permanent breast implant size. Depending on tissue quality and skin tone, as well as radiation exposure, the breast implant choice can be predicated on chest size and desired cup size. Typically, if a 275 cc implant was in place, the breast skin was pre-expanded and then after the expander was placed despite the unusual size selection, a volume appropriate breast implant could likely be placed.

M. Scott Haydon, MD · Answer

Thanks for your question. I can appreciate the frustration. Unfortunately trying to reconstruct someone who already has implants is more difficult because they begin at a "supranormal" position. The expander width is decided based upon the base diameter of your chest. If the expander is too wide it will be too far  out in your armpit. Once the expander is stretched the quality of the skin dictates the amount. Sometimes I will get to the last fill and then reevaluate in a month to see if the pocket has accommodated. In my opinion you can go up about 50CC in a lot people but is dependent on the pocket. The volume is really limited by the ability to stretch. It sounds like you are at a maximum. Best of Luck!

Damian Marucci, MBBS, PhD, FRACS · Answer

I am sorry to hear of the disappointing result you have had from tissue expansion.Tissue expanders can in various sizes. Expanders are all anatomical/tear drop so have varying width, height and projection. The expander width is determined by the base width of your breast - any wider and the expander (and ultimately the implant) will extend into your armpit - which is both awkward for arm movement and a bad look. The height of the expander is determined by how high the implant needs to be reconstruct the upper pole of the breast. If you are short, an overly tall implant would look unusual. Finally, the projection/profile of the implant can be low, moderate, full or extra full.Check with your plastic surgeon that the maximum volume expander has been used given the parameters I've outlines above. You may need to exchange to a larger tissue expander and have further expansion prior to having a definitive implant placed.I hope this helps.

Mark D. Wigod, MD · Answer

Expanders are usually selected based on chest wall diameter.  Expansion is then limited by overlying tissue thickness and elasticity.  Expanders may be overfilled with little risk of rupture.  Once a pocket is expanded, it makes little sense to change and expander.  If there is more room on the chest laterally and superiorly, a larger implant may be placed at the time of exchange.  Also, remember that the device itself usually adds about 50 cc of volume.  If a form stable shaped implant is being used, there will be some volume limitations on what is available as well.  While patients have expectations of their breast reconstruction, they may or may not be anatomically possible to meet.  These limitations should be covered by the surgeon during the consent phase and understood and accepted by the patient before proceeding.

Edward J. Domanskis, MD (in memoriam) · Answer

My specialty is XL breast implants. You may not want or need that but someone who is large and wishes to go past the normal sizes, I place a XL tissue expoander and then when reach size they wish, can change it to a custom silicone implant which I have available to me. I would visit my site below for more info on these.

Expander size is too small, what are my options?

Answers (6)

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