I am small breasted 36A, and am due to have surgery tomorrow, without an expander put in. Can I have an expander fitted prior to my reconstruction in 9-12 months time? As I might have to have further treatment (Chemotherapy), I do not want this delayed if I have a problem with the expander (by way of infection)
Can I Have a Breast Expander Fitted After Total Right Breast Tissue Removal (I Am Keeping my Breast Skin) and Radiotherapy?
Doctor Answers 3
Breast reconstruction - immediate versus delayed with skin sparing mastectomy
Skin sparing mastectomies, such as the one you are having, usually gives your plastic surgeon more soft tissue to work with and more options for your reconstruction. Depending on the desired size of your reconstruction, a tissue expander may or may nor be necessary. Some patients have implants placed immediately. Others have a tissue expander placed and inflated, then have the tissue expander exchanged out for silicone implants after radiation.
When choosing an implant reconstruction +/- alloderm, immediate reconstructions give the best result for three reasons. 1. Your plastic surgeon and your breast surgeon can work together and design a better looking scar that is much less noticeable. Usually the plastic surgeon marks out the incision line and the breast surgeon performs the mastectomy through these incisions. 2. More of your skin envelope is saved for your breast reconstruction. Normally, if you have a delayed breast reconstruction, the skin envelope that is saved contracts and gets tight with time. Thus you loose the advantage of a skin sparing mastectomy. If a spacer is placed right away, such as an implant or expander, it keeps the skin envelope from contracting, becoming flat and sticking to the chest wall. Thus when you are ready for the reconstruction a year later, you're essentially starting from zero and your plastic surgeon has to stretch you skin out to regain what was lost. 3. If you are going to receive radiation, it is easier and more predictable to stretch out your skin with a tissue expander before you get radiated.
Regarding tissue expanders, they do not need to be customized. The come in a variety of sizes and shapes. Your plastics surgeon would measure your Chest dimensions and breast footprint and pick the most suitable one for you.
Implants/expanders with mastectomy
There are many options for breast reconstruction. A tissue expander can very commonly be used at the time of mastectomy and filled in between chemo session if necessary. AS for patietns getting RT it may be better to delay it.
Ask your plastic surgeon about expander timing after mastectomy
There are different thoughts about timing of the expansion of the tissue expander and when to replace it with a permanent implant when radiation therapy is planned. Some feel that complete expansion prior to radiation is best, particularly with skin-sparing mastectomy, others the opposite.This is something to coordinate with your plastic surgeon and oncology team. Hopefully they will be planning to use Alloderm with your reconstruction since this can help avoid some of the problems that radiation can cause with implants. Wish all the best.