Breast Reconstruction Expanders Removal and Replacement?

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.

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.

For most patients I would wait three months after the last expansion before the second stage.  However, there are certain circumstances where I would do it early.  Particularly in a patient who has required very little expansion (small breasts with easily expansible skin). 

Usually it takes a few months maybe 3-6, but in some cases where it was more a skin sparing mastectomy, the expansion rate is quicker.

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.

In general, I leave expanders once fully inflated for 3 months. The removal/replacement process, however, can vary with repect to the size of the expander to the size of the implant. If you have a large expander and a small implant going in, you may not need as long as 3 months to the skin to stretch, relax, and make more collagen and elastin.

The time for expander removal and implnat replacement varies form surgeon to surgeon. There was a recent article that examined this and found no difference in the final outcome when waiting 1 month or 6 months after the last expansion.
I like to wait a minimum of 6 weeks but most of the time I switch them out at 3 months. I do examine my patients often to see if there are skin changes following the last expansion. I hope this helps.