How Long Should Tissue Expanders Be in Place?

I had bi-lateral mastectomy and am in reconstruction now with tissue expanders. I heard the muscle contracts down and makes them smaller in the end. I had ductal carcinoma in situ in the right breast, and needed another lumpectomy to get clearer margins, and then have radiation. I chose mastectomy of both breasts and no radiation. Ductal carcinoma was found in Left breast tissue after surgery. I started expansion December 2008.

I have 450 cc in each breast and really want a nice full 36-38 C final look. I was a 34 C prior. I am 51 and want to make sure I expand long enough and large enough to complete process with good results. My daughter had implants done 2 years ago and her size went down about a year after surgery from a 32-34 D to large C. Was it muscle contraction? How long should the expanders be in place to insure that implants stay the same size?

Doctor Answers 17

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.  

Toronto Plastic Surgeon
4.9 out of 5 stars 67 reviews

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!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

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!

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.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Expanders can stay in indefinitely

Tissue expanders stretch the skin to increase the surface area. The soft tissue should be as pliable as possible when the expanders are exchanged for implants. It also depends on what size and dimension implants are used after the expanders are removed. Usually, the implants are at, or slightly smaller than, the expander volume.

Your surgeon will determine when he thinks the tissues are ready to accept the implants you and he have chosen. The longer you want, the more pliable the tissues.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

How long should Tissue Expanders stay in place?

The amount of time that tissue expanders stay in place is dependent on how much tissue was removed  during the mastectomy, and what size the reconstructed breast is desired to be as compared to the size before the mastectomy. Once the desired size expansion is reached, occasionally we over expand to prevent the skin from retracting after the tissue expander is removed, due to skin elasticity. After that, we then usually wait about six to eight weeks prior to proceeding with the permanent implant placement. 

Aldona J. Spiegel, MD
Houston Plastic Surgeon
4.6 out of 5 stars 7 reviews

Tissue expanders and implants size

The length of time that tissue expanders are in place does not really correlate with making sure that implants stay the same size. Depending on the type of implant-based breast reconstruction (sub pectoral vs prepectoral), some surgeons will want to overexpand the tissue expander to make sure that there is sufficient elasticity in the skin before placing the permanent implant. The reality is that the skin may want to contract when there is a smaller implant in place, particularly when the skin is radiated. If your daughter's implants went down in size, this could either be due to rupture/leaking (if silicone implant) or capsular contracture. The key making sure that the implants retain their size is to expand the skin sufficiently with the tissue expander, and then avoiding capsular contracture and rupture after the implant is placed.

Duration of tissue expansion

Great question.

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.

Damian Marucci, MBBS, PhD, FRACS
Sydney Plastic Surgeon
5.0 out of 5 stars 11 reviews

Tissue Expander Timing

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.

Mark Gaon, MD (account suspended)
Newport Beach Plastic Surgeon
4.9 out of 5 stars 10 reviews


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!

Ricardo A. Meade, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 120 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.