How Much Saline is Placed in Expander at Time of Surgery?

A tissue expander is a temporary implant, which has a "port" where saline can be injected into it at regular inervals to expand skin. With breast reconstruction, the initial volume of saline placed depends on several factors. It is imprtant to avoid putting any tension on the overlying skin, so judgment is used on a case by case basis.

This all depends on the skin left after the mastectomy.   If there is a lot of skin, I have expanded as high as 500cc, more average for me is about 300-350 cc, and I have put in as little as 100 cc. 

If too much is put in, it stretches the skin closure.  This can lead towards wound separation and exposure of the implant.  I try to put in as much as I can, but not so much that I am concerned about the skin closure.

It all depends upon the individual patient. In my own practice I will place enough volume in the expander to fill the available skin envelope, but not enough to place any significant tension on it.

The volume we can safely fill your tissue expander depends on a few things.   Is there a skin sparing mastectomy being performed?  If there is enough viable  skin to provide a safe envelope for the tissue expander?   What technique is being utilized to place the tissue expander? total muscle coverage vs. partial muscle coverage with acellular dermal matrix (Alloderm or Strattice).   Generally the use of a dermal matrix product aides in on table expansion.   Talk to your plastic surgeon to see what he/she thinks they can achieve.  And don't worry, if you do not achieve your desired volume during the mastectomy, the expanders can be filled up after surgery in the office.   Best of luck.

There is no clear rule. It depends on how good the blood supply to the remaining breast skin envelope is, and what your preop breast shape is. Patients with very saggy, dependent breasts often have extra skin in the wrong place that has to be tailored to allow for an aesthetic closure, and that may influence how much fluid the surgeon puts in the device at the initial procedure. Many manufacturers of acellular dermal matrix materials suggest filling the expander enough so that the muscle and dermal matrix are comfortably right under the skin without a lot of space, to allow the matrix to get blood supply from the skin contact and reduce the potential for accumulation of fluid (seroma). This must be balanced against the risk of causing blood supply compromise to the skin flaps from the compression of a device that is inflated significantly.