Expanders are Expanding Out to the Sides But Not Forward, Is This Correctable?

I wanted more cleavage than was provided in addition to wanting a larger size. It seemed that the expanders initially expanded away from my chest wall, then after a while started expanding from side to side but not front to back, so I still look fairly flat with huge roundness and no cleavage. The other issue is that one sits noticeably higher than the other. Are these issues correctable and would insurance normally cover such a procedure in IL? Seems like too much on sides, not enough in front.

Doctor Answers 6

Expanders are used to stretch the skin and muscle in preparation for placement of a permanent

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implant, and the issue you are facing is not uncommon.  The tissue will tend to stretch along the path of least resistance, and that is often out to the sides.  After you have been expanded, your surgeon can go back and use allograft (basically, an acellular matrix of the undersurface of skin) to hold the implant in the desired position.  Alternatively, the allograft could have been placed in position at the time the expander was placed (my preference) and used to direct the expansion along the desired path.  In the end, a skilled surgeon should be able to deal with the problem you are facing.  Good luck!

Mount Kisco Plastic Surgeon

Tissue expanders in breast reconstruction

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The tissue expanders in breast reconstruction will often follow a path of least resistance and fill upward and to the side where the skin will more easily give. Even if spot on the expander will feel round and firm, and while they will help expand a hold a space for a permanent implant, significant adjustments are made in position and size when the permanent implants are placed.

Best of luck,


How to get the right shape with expander breast reconstruction

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I would need more information in order to fully answer your question but here are a few general guidelines. If the tissue expanders are placed with total muscle coverage, as was the standard for many years, the forward expansion is very limited and the lower portion tends to be flat. That is one reason why the use of an acellular matrix such as Alloderm is popular now, because it makes a sort of internal bra that helps define the shape of the breast and allow for more forward expansion. The position of the expander can be adjusted when it is removed and replaced with an implant.

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Concerns about breast configuration during tissue expansion

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Without photos, a precise answer to your question can't be provided. However, just like for implants, tissue expanders need to be selected base on size and configuation to help you obtain the desired reconstructive appearance. It may be possible that not an ideal choice was made though there are several other possibilties as well. A major fact often affecting this projection during tissue expansion is having had previous radiation treatment.

Differences in height and someother issues can be addressed later on. However, if you have had radiation, the results will be tempered regardless of what is transpiring right now.

Expanders will stretch your tissue

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I am assuming you are having a breast reconstruction because I am not aware of using expanders in primary augmentations.  That being said, breast reconstruction with expanders will always leave a somewhat flattened breast mound compared to what a natural breast looks like.  There is nothing that can be done about this and I suggest to my patients that they use a crescent shaped breast enhancer to fill out the tips of their bras if it was important to them.

As for position of your expanders, that is a correctable problem when you have your expanders replaced by implants.  If the problem is extreme, it is sometimes better to have it repositioned before the expansion is complete and this is something you should talk to your doctor about. 

As for insurance coverage, if this is for reconstruction, it should be a covered procedure under your insurance.  Your doctor's staff should be able to clarity this for you.

Expanders are Expanding Out to the Sides But Not Forward, Is This Correctable?

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Sorry for your expansion issues. These are concepts and results than you need to address with your chosen reconstructive surgeon. In most cases revisions are the norm in reconstruction. And expansion is put a course you have chosen to follow. Yes, expansion follows the course of least resistance in the tissue, so if the anterior scar is less stretchable than the lateral tissue has more give. Again over the internet very hard to advise. seek in person discussions. Good Luck 

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.