My plastic surgeon says my skin is too tight/thin around tissue expanders to expand anymore. Can a bigger implant be inserted?

Question

I had prophylactic mastectomy with expanders. I am at 350ccs and doc says my skin is too tight to expand more. I am disappointed as I wanted to be a bit larger. Is there any way around this or is this it for me?

Edward S. Gronka, MD · Answer

I have never personally seen that happen. The premise of tissue expansion is to stretch tight skin.  It may be very thin but that is a different problem

John J. Edney, MD · Answer

Unfortunately it is unlikely that your surgeon can place an implant in you that has a volume greater than your current tissue expander.  When using tissue expansion/implant reconstruction one of the factors limiting your outcome is the capacity for your skin and underlying muscle layer to expand.  If you are unhappy with the expected size you could undergo a procedure whereby additional tissue is transferred to the reconstructed breasts.  A latissimus dorsi myocutaneous flap is often a good option in this situation.  In this procedure additional skin and underlying muscle is transferred from your back to your front.  Additional tissue expansion can then be achieved allowing for reconstruction of a larger breast.

Nirav Savalia, MD · Answer

If
the skin and tissue over the implant are stretched too thin, then you won’t see
the level of coverage that’s likely to give you the best results. I suspect
this is your surgeon’s reasoning behind stopping expansion and using smaller
implants than you would prefer. I would revisit this discussion with your
surgeon for a better understanding of the reasons behind this recommendation.
 Remember that the skin,  a thin layer of fat and the pectoral muscle
are all that cover your implant -  you want as thick a padding as you can
get and overstretched the skin to allow a larger implant may compromise this
padding and increase the visibility of the implant and result is rippling.

Justin West, MD · Answer

As has been previously mentioned in the answers below, it's a tough question to answer without examining you. When we expand patients we have to use our best judgment as to how much the tissues will tolerate. If the skin flaps appear to be getting too thin we have to stop expanding because we want good coverage for your implant. Depending upon how your expander is situated on your chest it is possible to open some additional space during the surgery to allow for a large implant. For example, sometimes the expanders don't fill the upper part of the breast enough, so we can open up that space in the OR. That can frequently allow you to accommodate a larger implant. Again, this is best assessed by surgeon taking care of you. Good luck with your surgery.

Neal Handel, MD · Answer

Without examining you it is hard to
determine if you can be expanded further. However, for patients with thin tissue
there are alternatives, such as the use of fat grafting or products known as
ADM’s (acellular dermal matrix) that can allow safe additional expansion of the
skin so you could have larger implants. You need to confer with an experienced plastic
surgeon. Best wishes.

Ross Stutman, MD · Answer

Thank you for your question. The purpose of the expander is to expand the muscle and skin, so that you can obtain a breast size close to your pre mastectomy size.You may want to discuss fat grafting and autologous breast reconstruction to help gain more volume. Breast reconstruction can have several variables (e.g. post op size goals, history of radiation, skin laxity, medical issues, etc.) that will determine the best method of reconstruction for your particular case. I would discuss with your plastic surgeon all of the concerns you have. Best Regards,Dr. Stutman

Samir Shureih, MD · Answer

It is difficult to answer your question without examination and more information. What is the size of the expander? Where the expander is put? Under the muscle? above the muscle? Was any acellular matrix used and where it is anchored? How do you feel about fat transfer? If the skin is tight and thin with the tissue expander, then it will be tight and thin over the implant.need more information and more thought put in to get you the shape and size you desire.

My plastic surgeon says my skin is too tight/thin around tissue expanders to expand anymore. Can a bigger implant be inserted?

Answers (7)

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