How is it possible for breast expanders to flip and why isn't there a way to stabilize them so they are not able to flip?

Thank you for your question.  Breast expanders do have a front (where they are expanded) & back (which rests against your chest) and can occasionally flip.  Some surgeons will try and secure the expander with suture through special tabs during the surgery when they are first inserted while some will not.  Its possible that your surgeon did secure them but the suture could have come loose.  My advice would be to continue to work with your plastic surgeon to ensure the expanders are oriented correctly, the tabs secured, and I wish you luck with your breast reconstruction! 
Hope this helps!

Sorry to hear that this has happened to you.  The majority of expanders have tabs that can be sutured to the chest wall tissue so that they do not flip.  Ask your surgeon about this.  Best wishes!Daniel Brown, MD, FACSBoard Certified, American Board of Plastic SurgeryMember, American Society of Aesthetic Plastic SurgeonsMember, American Society of  Plastic SurgeonsCastle Connolly Top DocReal Self Top 500

Most expanders are placed under the pectoralis muscle, but there is a tendency now to place expanders under the skin alone. So, two placements are possible. If yours were under muscle, it is possible that a seroma can occur, and the implants can literally "float" and turn with muscle contraction. This usually only occurs with  patients that did not have a drain placed. It also can occur with subcutaneous expanders where the ADM[acellular dermal matrix] has loosened and a seroma has enabled it to turn. If a stitch has been placed in a stabilization tab, it can also break and allow the implant to turn. the point is, that we are placing implants into an actively moving area with muscular activity and possible fluid accumulation. The "turning" of the implant will be a short procedure and should not cause increased  pain. This is a recognized complication.

Dear randtdiamond,Sorry to hear that your expanders have flipped.  I presume they have determined this based on how the magnetic port finder is behaving.  Yes these devices can flip even though there does not seem to be much space for that to happen.  With movement of the arm, changing positions in sleep the expanders are subjected to some stresses.  Expanders now almost uniformly have suture tabs that can be used to secure the expander to the chest wall in the correct orientation.  I used to use a short dissolving stitch to secure expanders but switched to a permanent suture after having a suture fail and a flipped device.  Even despite using the suture tabs and appropriate suture material, the suture can fail and lead to a flipping of the expander. Sorry to hear you are having these difficulties but maintain your follow up with your surgeon.Thank you for your question.Andre Levesque M.D.

Dear Randtdiamond,Hello and thank you for your excellent question. Unfortunately, tissue expanders can rotate and/or flip. Even if we use the suture tabs on the sides and back of the implants, they can still flip.  It does not happen frequently, but it can happen nonetheless.  My best recommendation is to work with your current surgeon, unless this becomes a recurring issue.  If you have any questions, call our office for assistance. Good luck!

Best,

Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Texas “Top Doc” 2017, 2018

RealSelf100

America’s Top Plastic Surgeons, Consumer’s Research Council, 2010 - 2018