Can uneven Breast tissue expanders be corrected? (photo)

Question

I had bil skin & nipple sparing mastectomies & reconstruction w/tissue expander & Alloderm on 9/23/15. Can the following be corrected? RIGHT breast: Expander extends too far into axilla; Nipple is not in center of expander pocket; Appears less full/less volume than Lt; Expander too high (higher than Lt); distance from nipple to inframammary shorter than Lt. LEFT Breast: lateral border w/area of skin tightness & adhered to expanders causing puckering fold; Lt breast pulled laterally. Thx!

Justin P. Martin, MD, FACS · Answer

All of your concerns can be corrected during your second surgery when the tissue expanders are exchanged for permanent implants.  It is not uncommon for there to be some asymmetries with respect to position of the expanders, and there are specific techniques that your plastic surgeon can use to ensure that the placement of the permanent implants is appropriate and symmetric.

Richard J. Brown, MD · Answer

The short answer is yes, but you have several things going
on. First of all I tell my patients the tissue expander phase is just a rough
draft. Lots of things can be done at the second stage to fine tune the pockets
and create symmetry. The expanders are simply to stretch skin. Being that said
I see some things on you pictures. Your left breast fold is lower than the
right and that can be elevated at your second stage to be more even. Next, the
fold on the left is because all the breast tissue that was once there is gone
and so the skin has not choice but to sink around the implant and your existing
chest wall. Sometimes after expansion and pocket modification at your second
stage we can get the implant to fill that region out, but not always. The last
thing I see about your anatomy is that you are one of those patients whose
pectoralis muscles insert widely on the sternum so you have a bit of a gap
there. That can not be changed and is your given anatomy. With expansion and
high profile implants you may be able to obtain some degree of cleavage, but
this is an anatomical characteristic of your body that the surgeon can not
change. The good news is you have nipple sparing mastectomies which makes a
world of difference with reconstruction from the cosmetic standpoint. I always
warn patients however that you must make the mental leap from what you had
before to what is possible to create now. Both may be great but very different
in the way they feel and look. Managing expectations is the hardest part of
this process so that you will not be unhappy when it is all done. I hear
patients say all the time they are so happy and know that the reconstruction
looks great, but it is not what they expected. So really spend time, even now, talking with your surgeon about what you think you will have for a result and
what is actually possible. Good luck on your journey and congratulations on
getting through the fight against breast cancer.

Samir Shureih, MD · Answer

All the issues with the position of the tissue expander and the position of the inframammary line and the lateral displacement and position of the nipple can be corrected during the second stage. Preoperative measurements and addressing these issues and how to correct point by point should be discussed in writing with you. You need to choose your surgeon carefully.

Can uneven Breast tissue expanders be corrected? (photo)

Answers (3)

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