Timing until 2nd stage of tissue expander breast reconstruction
What happened to your daughter is not a common one, and do not have an answer for this besides possibly difference in bras? You must take into account body habitus, height, weight, as well as the projection-type of implant used. A smaller woman will require much less volume (cc's) than a much larger and taller woman would. The chest girth in inches (36, 38, etc.) will not change as this is a measure of the chest circumference beneath the breasts. The cup size (B, C, D, etc.) is measured by the projection from the chest. Also, this is always variable, as not all bras are made standard and one brand may give a different cup size from another. Determining this value during your expansion process, if you are having tissue expanders placed initially, may be the easiest way, as you could see the size as it expands and determine for yourself when you are happy with the size in clothing. Your surgeon would then put in a similar volume upon the exchange of your expanders for the implants. I typically overexpand by 10% of the final volume, then wait at least 6 weeks until the 2nd stage for exchange of the expanders for implants. It certainly will take several months for swelling to go down and the implants to settle before seeing final results. Difference in size, or contour deformities, may be ameliorated with fat grafting to fix problems, such as that you stated above. Hope this helps...good luck!
Duration of tissue expansion
Tissue expansion is a process of stretching the skin and soft tissue of the chest so that an implant can later be placed. Some fluid is put into the expander at the time of initial surgery and then I usually commence tissue expansion in the office a few weeks later once the wounds have settled down.
I fill the expander slowly and ask the patient to tell me when things are feeling a little tight - then I stop. I tell all my patients, that if they still feel very uncomfortable when they get home, they can always come back and I can remove some fluid in the same way as I put it in. I don't want my patients to have any pain. I perform expansions fortnightly until the desired volume is reached - and then I like to over-expand by 10-20% so that there are no issued with wound closure when the definitive implant is placed.
I generally wait a few weeks after the completion of over-expansion prior to the exchange procedure.
I hope this helps.
In my practice, once I place tissue expanders, I keep them in place for an average of 4 months. This gives adequate time for gentle expansion from the time of mastectomy (starting between weeks 2 and 3 post-op), and time for the remaining breast skin to soften and become supple again. The expanders can be filled to capacity very early on during this timeframe especially when tissue grafts such as Alloderm are used during the initial reconstruction. I will leave the expanders fully filled (or commonly slightly overfilled) until the second stage of the reconstruction. Waiting those few weeks will allow for a more cosmetic final outcome since the tissues will have recovered from the initial surgery and the expander to implant exchange can be addressed in the exact same fashion as a cosmetic breast augmentation.
It would be interesting to hear with more clarity what happened to your daughter, often weight-loss can make the breast implants seem smaller.
It sounds to me like your tissue expander may be too small now and I would communicate with your board-certified plastic surgeon exactly what you think you want. It is one of the main reasons to have that spacer in there so that you can communicate accurately. Lateraling to the vernacular of ABC or D cups confuses things. Simply look at your chest and wear a few outfits, do they need to be bigger or smaller... Then go from there. Best wishes!
How long should expanders be in place
I typically place a tissue expander either at the time of mastectomy (immediate reconstruction) or at a later date (delayed reconstruction). After that I usually wait 3 weeks before starting expansion and then see the patient every 2 weeks for further expansion. When we get to the size they want we would then over inflate 60-100 cc depending on the volume of the implant. This allows more movement and a more natural feel when we switch to an implant 3 months later.
Everyone is different. Some people need more time to expand. This is most commonly seen in patients that had radiation.
How long can tissue expanders be in place!
Usually between 3 and 4 months. I feel this gives adequate time for the capsule around the implant to mature. This allows for a change in the pocket if necessary at the time of exchange.Please find an experienced Board Certified Plastic Surgeon
and member of the Aesthetic Society using the Smart Beauty Guide. These Plastic Surgeons can guide you on all
aspects of facial surgery, breast augmentation and body procedures including
tummy tucks or mommy makeovers!
How long do tissue expanders need to stay in place?
I do not think it is common for the muscle to contract and cause change to the implant. This may have been related to swelling and the implant settling.
I typically recommend overfilling the expander by 10% once the patient reaches their goal volume. I then wait 4-6 weeks prior to doing the expander to implant exchange. I have seen very little problem with changes in size using this method.
I wish you a safe recovery and wonderful result.
I usually leave expanders in place after my final expansion for 6 weeks. Then plan to go back to the operating room to do the definitive breast reconstruction.
At my Austin, Texas area plastic surgery practice I start expansion at about 2-3 weeks after placement of the expanders and continue with weekly or every other week expansion until you reach a size you are happy with. Sometimes I overfill, it depends on the patient. I make you wait a minimum of four weeks once we reach the right size and then we remove the expanders and place implants. There are lots of variations on this protocol but this is what works for me. Good luck! Dr Kerr
Expanders and reconstruction
The process of tissue expansion can take a several months to reach the desired volume. I usually discuss with my patients the range of final implant volume that they want. I ask them to tell me during the expansion process at what volume are they happy with. Then I over inflate them a bit and exchange to an implant that matches their chest wall diameter and the volume that they liked.