What is the difference between a breast filler/spacer and a breast implant at the time of double mastectomy?

Hi, thank you for sharing your question. 
The "breast spacer" or tissue expander is a temporary device used to optimize the overlying breast skin envelope while the breast is healing from the mastectomy and/or undergoing adjuvant therapies like radiation.  Direct-to-implant reconstruction is also possible, but will depend on the plan from your breast oncologic surgeon and your native breast size/shape.
Consult with a board certified plastic surgeon to review all your options. I hope this helps. Best of luck!

I’m sorry you are starting a scary journey. Good news is that there are lots of support groups, survivors and healthcare professionals to fight with you!
Breast surgeon will dictate what needs to be done. Your baseline anatomy and breast size will be a big factor. The plastic surgeon serves the role of restructuring your native anatomy depending on the defect that needs to be created. If you need skin an option is a tissue expander to stretch existing skin and an implant as a second surgery one the skin envelope is sufficient. Another reason for this spacer is if your skin is thin after a mastectomy. The pressure of an implant can cause death of that thin skin. This will compromise your cancer treatment and reconstruction. If your goal is implants you have to work with your team to first determine the appropriate surgery for your needs to fight the cancer (or make an assessment for cancer). This is your number 1, 2, and 3 goals. A good plastic surgeon who has a full armamentarium to reconstruct your breast can then guide you as to whether you can be a candidate for single vs two stage breast reconstruction. Often times this is an intra operative decision. The goal should be to keep you safe and get you back to your friends and family!

Dear Motleyminerva,Thank you for your question.  Immediate breast reconstruction is where reconstruction of the breasts takes place at the time of mastectomy.  It may be performed in a staged fashion (more than one surgery) versus being performed in a single stage.  A staged approach may consist of placing a breast spacer or tissue expander, which is a temporary prosthesis placed in the breast envelope at the time of a mastectomy.  This may help to preserve precious native skin to be used for future reconstruction and may help to buy time while still gathering information regarding possible cancer treatment needs, such as chemotherapy and/or radiation, if at all needed.  In order to allow the skin incisions to heal, the expander may not initially be inflated or may only be partially inflated, so as not to place tension on the skin incisions.  The expander may be inflated or deflated over time during an office visit, as needed, and eventually removed in a separate surgery, and replaced with a permanent implant or potentially, your own tissue.  In contrast, a direct-to-implant breast reconstruction, is where a permanent breast implant is placed at the time of the mastectomy.  Each approach may hold its own set of risks and benefits, and these may vary from patient to patient.  It is important to evaluate each individual patient to determine specific needs and best treatment options.  I suggest that at this current time, you seek a virtual consultation with a board-certified plastic surgeon to be evaluated and to determine your options.  Best wishes and stay safe!

I assume that you mean a tissue expander.  there are several factors determining whether you could be reconstructed in one stage vs 2 stages.  some are size related and some  are tissue and disease related.  make sure you speak to your plastic surgeon and ask him/her why they don't think it can be done

Dear Motleyminerva,
generally speaking, breast spacers are used after mastectomy in order to stretch the tissues and create implant pocket in order for implant to settle later. Spacers are temporary solution while implants are more permanent solution. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Direct-to-implant (DTI) reconstruction is a single-stage reconstruction that directly inserts the implant at the time of the mastectomy. Women who are ideal candidates for this option do not require tissue expansion because the size of the soft pocket at the time of mastectomy is healthy and safe enough to fit the final implant. While a tissue expander is not required with this technique, the use of acellular dermal matrix (ADM) is often required to help hold the implant in place.

A breast tissue expander is sometimes referred to as a "spacer or filler". A tissue expander is a temporary implant that has a port built into the expander. This allows the plastic surgeon to place the expander at the time of your mastectomy partially filled and then add additional saline (salt water) to the expander in the office to achieve your desired breast size. A second ambulatory (go home the same day) operation is needed (typically 2-3 months later) to remove the expander and place the final implant. A direct to implant procedure places the final implant on the day of the mastectomy. Although a direct to implant is often described as a "1 and done" procedure, most patients will undergo a revision to improve improve the reconstruction. Revisions often include, adjustment of implant position or size and fat grafting. The revision procedure is built into the tissue expander procedure because device adjustments, fat grafting, etc. are all done at the second planned procedure when the final implant is placed. Whether to have a direct to implant or tissue expander/implant reconstruction depends on a number of factors including...surgeon preference, health of the mastectomy skin and size of your breasts. Without examining you, it sounds like you may be a good candidate for a direct to implant if you are athletic with a B to C cup breast size. All of these options should be discussed with you at the time of your consultation. I hope this helps.

Hello Dr.Chao here,Thank you for your questions, Basically breast tissue expander require 2 operations to complete your breast recon.  Direct to implant at time of mastectomy only requires a single operation.Whether you get a 2 stage tissue expander and implant candidate vs a 1 stage direct to implant candidate depends on1) your current size and shape of your breasts2) whether you like your size and shape of your breast3) the quality of skin flaps after your mastectomy4) will you have a nipple sparing mastectomy5) what kind of breast cancer do you have

Thank you for your question!
Let me explain a bit more about what a tissue expander (breast filler/spacer) is vs. a breast implant, and then I can talk more about why you might prefer one over another.  
A tissue expander is a temporary implant that is usually placed at the time of mastectomy.  It may be partially filled with saline (or salt water) at the time of the mastectomy.  The expander is then usually filled over the course of a few weeks-months in the office by placing a needle directly through the skin and into a port that allows the saline to fill the expander.  This doesn't usually hurt very much or at all. Then, a second surgery (much shorter, outpatient procedure) is needed to exchange the tissue expander for the breast implant. 
A breast implant is a device with a silicone shell that can be rough or smooth that surrounds a core made of either liquid silicone or saline.  There is a kind of cancer that can be associated with breast implants called BIA-ALCL.  Although this is a relatively rare problem, it is more commonly associated with breast implants with a rough or textured surface.  For this reason, I typically use implants with a smooth surface.  Please keep in mind that although this is called a "permanent" implant, breast implants are similar to the tires on your car - just the way the tires on your car need to be changed every few years, it is recommended that you have your breast implants replaced every 10-15 years or if they are causing a problem for any reason.  
Why is a tissue expander useful or necessary?  The analogy I use often with my patients is that the tissue expander "expands" the skin from the mastectomy flap (the remaining skin and underlying fat minus the breast tissue) that remains after the mastectomy similarly to how your stomach skin expands during pregnancy.  
Some reasons to use a tissue expander rather than put the breast implant in directly at the time of surgery include: significant change in size between your original breast and the planned implant and concerned over the blood supply to the tissue of the mastectomy flap.  In general, direct to implant procedures work best in relatively small-breast patients whose nipples are well-centered on their breast mound (their breasts are not too droopy) and who have a healthy mastectomy flap with good blood supply.  It is important to note as well that either the tissue expander or the breast implant can be placed either above (pre-pectoral position) or below (sub-pectoral position) the pectoralis chest muscle.
I know this is a long answer but I wanted you to have some background for understanding.  I am sure you will also have an in-depth discussion with your plastic surgery about all your options, including the possibility to using your body's own tissue (autologous reconstruction) instead of an implant.  
Good luck and take care! Dr. Schneider