How long can a tissue expander stay in?

Question

I've had a tissue expander in for the last 10mths I'm almost at the end of Radiation and was told I'd have to wait 3 to 6mths after radiation to do the reconstruction my health insurance will end on Dec 31st I'm wondering how long I can wear the expander as the only insurance I'll have now is Medicade so that means I'll have to find another surgeon as the one I have doesn't except medicade and I want it out soon as I can as its uncomfortable and hurts.

Dean Trotter, MBBS, FRACS · Answer

There are many types of tissue expanders used in breast reconstruction.  Most however are best changed to a definitive implant within about 3 years of insertion as the rupture rate starts to increase around then.  If you're implant ruptures it is not an emergency (given the expanders are filled with saline, air or carbon dioxide) but it is best that the definitive implant is inserted or else the stretched tissue may contract and then need to be re-expanded to allow completion of the reconstruction.  In addition, as you've discovered most people find the expander quite uncomfortable since it is much stiffer than the definitive implant.Usually it is better to wait at least 3 after completing radiotherapy to change the expander over.  Waiting longer is often better as it tends to increased predictability when it comes to the change-over procedure.Your situation with insurance sounds difficult and something I think would be best you discuss your options with your surgeon.All the best with the next phase of your reconstruction.Kind regards,Dean

Rodger Shortt, FRCSC · Answer

A tissue expander can stay in a long time.  It is not likely to cause problems.  However, it is not designed to be a permanent prosthesis so it is firmer (to accommodate the port) and may rupture.  Even if that happens, release of saline into the pocket is not generally a concern.  It is always better to change to a permanent implant for a number of reasons but not something that patients need to fret about getting done instantly.

Natasha Van Zyl, MBChB, FRACS · Answer

A tissue expander can stay in as long as you need to to. Tissue expanders are often uncomfortable and even painful especially when you have had radiation treatment. Once the final reconstruction is done this should improve substantially. Remember you can use simple analgesia to help with the discomfort. Discuss this with you local doctor as you will need to wait the 3-6 months before you final reconstruction is done.

Mitchell Brown, MD · Answer

Tissue expanders that are used in North America are excellent devices. There is no " shelflife" on these devices and they can be left in indefinitely. My experience is that the second procedure to exchange the expanders may become a little more involved with longer duration, as the capsule or scar tissue around the expanders tends to thicken or mature. Not a major issue but something to be aware of

Mark Deutsch, MD, FACS · Answer

A tissue expander can be left in your breast indefinitely although it can be uncomfortable.  I agree with your surgeon in that you need to wait several months after radiation has been completed before removal of the expander with reconstruction. Having surgery sooner puts you at risk for poor wound healing and/or infection.

Chris Porter, MD · Answer

The expander potentially can stay in for several years. Your breast will feel uncomfortable during the radiotherapy phase but should settle after a couple of months, over this time you should take simple pain relief medication for any discomfort. It is wise to wait 6 months after completion of the radiation to allow the breast expansion to mature and minimise any complications.

Darryl J. Blinski, MD · Answer

I have had expanders in place for years without any issue. But you need to see or find a PS whom would follow you on a every 6 month basis.

John Dean, MD · Answer

If necessary, a tissue expander can stay in for years. Typically you have to let your tissues recover from radiation therapy for at least 6 weeks before returning to surgery to replace the implant with a permanent implant.

Jules Walters, MD · Answer

A tissue expander can stay in as long as it doesn't get infected.  The most important issue here is to find a surgeon who will resume your care and take your insurance.  Best wishes.

Edward J. Domanskis, MD (in memoriam) · Answer

The manufacturer usually does not guaranttee a tissue expander past about three months for deflation and replacement costs but I have had many of my patients keep them in for much longer.

How long can a tissue expander stay in?

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