I currently wear a 34B bra. I am having bilateral nipple/skin sparing mastectomy due to phyllodes tumors. My Dr. is suggesting expanders before implants. Do you agree/disagree?
Is the Use of an Expander Recommended for Nipple/skin Sparing Mastectomy?
Doctor Answers 8
Expander Implant for First Stage of Reconstruction
With respect to implant reconstruction, there are one-stage and two-stage approaches for reconstruction. Whether you are a candidate for one-stage implant reconstruction depends on the amount and quality of skin remaining at your mastectomy site. I generally feel that two stage implant reconstruction with a tissue expander device placed at the time of mastectomy yields much better cosmetic results.
Another alternative to breast reconstruction after skin sparing mastectomy is using your own tissue. If you have enough excess tissue in your belly (if you've ever considered having a tummy tuck), you may be a candidate for tissue only reconstruction with a TRAM or DIEP free flap. Please visit with a board certified plastic surgeon to learn more about your options.
Expanders before implants for reconstruction of the breasts
If you are committed to a reconstruction using breast implants (rather than your own tissue in some form), I would usually recommend placing an expander first, in order to achieve the best skin envelope prior to placing the permanent implant.
Use of expander in breast reconstruction
That would be the typical scenario. There are instances where you can have direct permanent breast prosthesis placment but I could not make any formal recommendations without seeing you in cosultation and knowing full well the Breast Surgeon and their level of comfort with such a plan.
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A tissue expander, autologus reconstruction, or an immediate implant all can be placed but it really depends upon the expected post-op course of treatment that you would require. It can also be influenced on the final pathology of the specimen removed.
Tissue expanders are a good option.
Based you your tumor, the approach to be used and your current bra size I think that you are a good candidate for tissue expanders. This gives the surgeon some flexibility to adjust the size and shape of your final implants. It gives you flexibility during the expansion process to determine an approximate size of your final implants.
Expanders recommended for nipple/skin sparing mastectomy
I agree even though you did not post photos of the type of breasts you have. The expender type reconstruction has been in use since 1982. so it has withstood the test of time and there are great results.
From Miami Dr. B
Expanders in Breast Reconstruction
Whether one uses expanders or just inserts the final implant after a skin sparing (subcutaneous) mastectomy depends on many factors including your skin, the tumor nearness to the skin, your medical history, and who is doing the mastectomy among others. Although this procedure can be done inserting the final implants primarily, using expanders is certainly the most cautious and safest way to proceed.
Post-mastectomy breast reconstruction
Certainly using implants rather than a flap to achieve a bilateral reconstruction is simpler and preferable. Whether or not you need to use expanders is dependent on the individual situation and the surgeon. The expanders allow a degree of flexibility since it can be place unexpanded so that there is no undue tension on the skin. However, in select situations, the use of serial implants may be simpler than the expanders. Here, an implant can be placed as a space if the end breast size is not too large. After 3-6 months, the implant can be exchanged for a larger implant after the soft tissues have stretched and relaxed