Breast Reconstruction Expanders Removal and Replacement?

The traditional teaching was that a minimum of 3 months was needed to achieve optimal tissue expansion on breast reconstruction. Recent experience has caused many surgeons to rethink this guideline. In addition to what has already been discussed, another variable that determines how long to leave the tissue expander is if an acellular dermal matrix (Alloderm or similar product) was used as part of the reconstruction. Recent studies have shown that there is a shorter expansion period with the use of these products since the expander can be filled to a higher volume at the time of surgery. So depending on your skin, breast size and details of the reconstruction, a shorter expansion time may be appropriate.

The time for the second stage of the tissue expander/implant breast reconstruction does vary with each individual patient.  Basically, after the last tissue expansion, your plastic surgeon is awaiting an ample time for your body to take advantage of the expansion performed by allowing the pocket to be created/matured via the construction of collagen and elastin.  3 months is a typical time for the body to adequately create this pocket.  Today, with the use of acellular dermal matrix (e.g., AlloMax, AlloDerm, etc.), the time frame has been shortened since they act as a scaffold for tissue ingrowth.  6 weeks is the least amount of time that I would await prior to the exchange, but I have also waited 4-6 months prior to performing the 2nd stage.  On average 6-12 weeks is a typical time in my practice.

In general, the time period for exchanging a tissue expander to implant just depends.  For my patients, I generally ask them to sit for a month at whatever maximum fill we have settled on.  Once they have been stretched out for a month at that size, I go ahead and exchange to the implants.  How long it takes to get to that maximal fill can really vary.  For some women it is 6 weeks after their mastectomy while others it may be 6 months.