Exchange Surgery? Concaves After Expanders? (photo)

Have had expanded in now for 5 and1/2 months. Had a prophylactic bilateral mastectomy (BRACA 2 positive) w/o complications. My left expander healed with scarring down in the lower left medial infra mammary area and also I am more concave in the upper left area overlying the implant - my Plastic Surgeon has assured me that he can fix the concavity with grafted fat from my abdomen and that he would break up the scar/ adhesions during the permanent exchange. What happened?

Doctor Answers 6

Exchange Surgery? Concaves After Expanders?

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Nothing happened! The healing biologic process is unpredictable so if bilateral reconstruction is being done there can be differences in appearance and results. These differences than can be addressed in further surgical revisions. Hope this helps you understand. 

Concavity can be corrected with fat grafting

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Placing expanders can be challenging during mastectomy surgery.  The expansion process hopefully can be done partially at the time of surgery depending on the quality of the mastectomy.  There is a great deal of stress put on the sin that remains after mastectomy.  Once expanded typically there is an interval where you can wait and take a brake provided there is no need for radiation treatment.  At the second stage or exchange stage the opportunity to correct fold and other pocket related issues is performed and the devices are replace with permanent, usually silicone gel implants.  After that has had an opportunity to heal I re-evaluate the result with my patients for fine tuning with fat grafting.  The other way to do this procedure is as a single stage direct to implant reconstruction.  It is a little more challenging but I prefer this method.

Breast Reconstruction

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When your general surgeon performed the mastectomy the tissue that was removed from each breast was asymmetric which will ultimately create a deficit. When the expanders are placed, as you know they are only temporary. Fat grafting can be done at a later stage (either when you transition to breast implants or when the nipple reconstruction is done) to add volume in any area that a deficit is present.


Fat grafting is done using your own fat cells which are harvested utilizing liposuction techniques. With micro catheters they are then placed in a three dimensional fashion in contact with healthy tissues. These cells ultimately create their own blood supply and live locally in the area that they are placed. Most often you will have two small incisions on the lateral chest wall where they inject the fat (this will help to add volume to any deficits that exist). Recovery time for this is minimal and the patient may require serial sessions to fully restore the volume deficit. From the pictures you provided I do believe that you would benefit from fat grafting.


I hope this helps you and good luck


Fadi Chahin MD, FACS

Plastic and Reconstructive Surgery

Diplomat, American Board of Surgery

Diplomat, American Board of Plastic Surgery

Fadi Chahin, MD, FACS
Beverly Hills Plastic Surgeon

Breast reconstruction

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In Bilateral mastectomy and reconstruction, there would be difference between  two breasts mainly because the mastectomy was not 100% the same in both breasts. depending on the general surgeon and how much subcutaneous tissue is removed there would be a difference,

The concavity is most probably due to removing more fat. It can be repaired with fat grafts. your plastic surgeon is dealing with whatever defect was created by the mastectomy and  each problem needs to be addressed seperately and may require more procedures.

On the avarage for reconstruction one need atleast 3 surgeries.

Samir Shureih, MD
Baltimore Plastic Surgeon

Breast reconstruction

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The tissue expanders are placed to expand the skin. They may not expand the same on both sides. Revisions or adjusting of this takes place with implant surgery and may require additional procedures after this as well.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Plastic surgery and scar tissues

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The bane of all plastic surgery is that despite your surgeon's best efforts and even in the absence of complications, it is still possible for your body to ruin the result with the excess scar tissue it makes.  This is not the surgeon's fault, nor yours.  It just can happen.  Your doctor sounds like he/she has a plan for this but realize that if you make bad scars there is only just so much they can do.

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.