Saggy skin with tissue expanders after nipple-sparing mastectomy? (Photo)

You have a lot of excess skin that should have been adjusted at the time of the mastectomy. The expanded width and projection is not enough to stretch out the skin. Over filling the expander will not help as the device will become narrower.At the second stage a wider more projecting implant can be used along with a mastopexy to remove any lose skin. This should be only around the areolae which are too wide. This is readily fixable!

Depending on the location of the pectoralis muscle (most commonly) over the implant loose skin can be adjusted or contoured during the process of breast reconstruction- physical therapy probably didn't cause the loose skin but would check with your plastic surgeon..

Be sure to keep your surgeon in the loop with this issue.  It appears that you have a fluid collection around the implant.  If that is the case, an aspiration or seroma catheter placement may be indicated.

Dear LAF,
When I see the photo, I agree that there is deformity to your breasts. However, this is in some ways intentional. The point of a tissue expander is to act as an internal placeholder while the overlying skin adjusts to its new environment. Too much tension on the skin could cause it to break down. Sometimes the implant settles out nicely once it gets its first fill. Otherwise, you might need a little revision work during the expander exchange. Bring it up to your plastic surgeon and you can always feel free to seek a second opinion. But for now, your job is to heal! Skin loss is permanent but an imperfect appearance can always be refined by a skilled board-certified plastic surgeon.
Sincerely,

No, I don't think you should worry.  The nice thing about expanders is they can be filled out to fill in the skin, and so I don't think you should worry. It won't affect the long term results.

Its difficult to see from the picture the lateral aspect of the tissue expander.  The TE may be slightly higher on the right side, however it needs to be expanded fully to recruit as much skin as possible.  During the switch out surgery to permanent implants the pocket can be adjusted to try to achieve symmetry.  Having said all of this, plastic surgery is an art and make sure the artist understands your needs and your breast anatomy.  Good luck and I hope you found this be uselful.
Ali Sadeghi MD
Breast Reconstruction Speciaist 

Difficult to see the placement of the expander on the right but I understand your concern.  The expander should inflate and expand the lower portion of the breast reconstruction so that the excess skin is filled out properly.