Leaving tissue expanders in after double mastectomy. Is this normal?

Question

Hi, my plastic surgeon (in Australia) said it's now safe to leave tissue expanders in instead of having the second operation to replace them with implants. Apparently the new design makes them more a permanent option? I have them in now. Just waiting on my skin to heal as my nipples were removed and the skin is damaged/burned before I can have them filled.

Ned Snyder, IV, MD · Answer

Great question and thank you. I think we all wish breast reconstruction could always be done in a single phase. In the United States, we do not have permanent option for a tissue expander. Meaning that all of the devices we have access to are not approved by our government as a permanent device. In the past we had something called a post-operative adjustable implant. This was a device that was more like a saline implant that we could adjust the final volume much like a tissue expander would get filled. To my knowledge, these are no longer available in the US, but I am not certain that they aren't still available in Australia. Without more information I am not sure I can fully answer your question.

Lewis Albert Andres, MD · Answer

Hello!  Thank you for your question!  Implant-based breast reconstruction is a very common method for recreating breast mounds following mastectomy. Tissue expanders are used to gradually stretch the breast for later placement of an implant. Here in the U.S., it is typical to perform a second stage for the exchange if the tissue expander for the implant, either silicone or saline.  We use these as temporary devices. Hope that this helps. Best wishes!

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Breast construction in the United States seems to proceed much differently. Tissue expanders are not meant to be permanent devices. There used to expand skin to allow for a second surgery for definitive placement of a breast implant.

Roxanne Sylora, MD · Answer

It is not uncommon to have tissue expanders placed after a mastectomy. However, leaving those in as a permanent method of breast reconstruction is not considered standard at this time for the expanders currently utilized in the United States.  It is possible that different expander/implants are available in Australia, however.There have been different expandable implants which have been on the market by different manufacturers.  These are expandable after implantation and are meant to be the long term prosthesis.

John J. Edney, MD · Answer

Typically in the United States breast reconstruction with tissue expanders and implants is a two staged procedure.  Tissue expander is usually placed first and subsequent injections into the tissue expander cause it to enlarge and create the space that will accommodate the future implant.  After the pocket has expanded the expander is removed and the permanent implant is placed.  The tissue expanders however can be left in indefinitely if there is a reason not to proceed with the placement of the permanent implant.

Jeffrey Zwiren, MD · Answer

Most tissue expanders are temporary devices indented to expand the pocket and eventually be replaced with a permanent implant.  It is possible that implants are available that could serve both functions.  Your plastic surgeon is in the best position to answer your question.

Robert Whitfield, MD · Answer

Tissue expanders are exchanged at a later date for permanent devices.Three
basic forms of breast reconstruction exist. You can use your own tissue,
implants or a combination of the previous two techniques. Your own tissue can
be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting.
Implants can be done in one stage or two stage. Two stage reconstructions are
started by placing expanders at the time of mastectomy. Once they expanders are
placed they are able to be inflated as determined by wound healing. The final
time consists of combining any of the above techniques.

If
you are interested in being seen in Austin please give us a call.  I know
this is a difficult time for you.  The majority of my practice is devoted
to reconstruction for women with breast cancer or who are BRCA+

Leaving tissue expanders in after double mastectomy. Is this normal?

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