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

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!

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

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!