How Can Lopsided Breast Tissue Expanders Be Corrected?

Question

During my bilateral mastectomy, breast tissue expanders were inserted. My right breast tissue expander later became infected and was removed. Recently, it was reinserted and is now about 1 to 2 inches higher than the left breast expander. They are very lopsided, unlike when they were initially inserted at time of mastectomy. Saline injection process has not yet begun. How can height difference be fixed before DIEP-Flap reconstruction, if possible? If not, will surgery correct it? Thanks!

Robert Brueck, MD · Answer

This is simple to correct the position of the inframammary fold and can be done later during your final stage.

Jill Tomlinson, MBBS, FRACS · Answer

Good questions!

	Tissue expanders are temporary and DIEP surgery can correct the height difference. At the time of DIEP reconstruction your surgeon will position the flaps taking into account the ideal breast position on your torso.

	Given that all surgery has risks (such as repeat infection of your tissue expanders necessitating removal), I would advise you not to have surgery to adjust the height of the expanders. Based on the information available, I recommend that you go through the expansion process and then have the height difference corrected at the time of DIEP flap surgery.

	Your plastic surgeon is the best person to advise you on what to do and is best placed to discuss your concerns with you, so please be sure to raise your concerns with him or her at your next appointment. Good luck!

David Bogue, MD · Answer

Many women have tissue expanders which are not in perfect harmony. However, manipulation of the pockets created by the tissue expanders can be performed in the second stage to improve the symmetry. If you are exchanging for DIEP flaps, this pocket manipulation can still be performed. The goal of tissue expanders prior to DIEP flaps is simply to preserve the skin envelope and eliminate the necessity of a skin "patch" from the flaps. Also, keep in mind that after expander removal for infection, the breast skin on that side can give the appearance of an elevated expander, although the discrepancy in reality may be minimal. Time, patience, and trust in your physician are key at this point of your reconstruction.

C. Bob Basu, MD, MPH, FACS · Answer

Without photos or a physical exam, it is difficult to make any recommendations.  Generally speaking, reconstruction is a process.  You have tissue expanders.  So you are in the "under construction" phase of your reconstruction.  The skin needs to be stretched out to recreate your reconstructed breast envelope.   Asymmetries can be improved/corrected during the second stage of your procedure.   Please talk to your PS to get your concerns addressed.  Good luck.

	Dr. Basu

	Houston, TX

How Can Lopsided Breast Tissue Expanders Be Corrected?

Answers (4)