How do I know when to stop saline injections into expanders?

Question

I am 3 months out from double mastectomy. I have expanders - how do I know when to stop saline injections? I was 36C before & would like to be that same size with implants. Are implants smaller than the completed fill of expanders? I appreciate your help with my concern.

Lewis Albert Andres, MD · Answer

Hello!  Thank you for your question. You should participate in the final volume as the decision of when to stop expansion should be when you are content with the size in clothing.  You can try your old bras and see how the cup size fits. Often times, your surgeon may slightly overfill the expander to give additional space for the implant.  Your surgeon will then exchange your tissue expander for an accordingly-sized implant.  As the implant is more compressible and natural than the corresponding tissue expander, the appearance may not be as projecting or full as your appearance with the expander. However, shaping of the pocket to create the most aesthetically-appearing breast will likely be performed at that stage.  Hope that this helps. Best wishes!

Donovan Rosas, MD · Answer

One of the benefits of having expanders in place is the flexibility they provide. Patients are encouraged to actively participate in the filling process and decisions that need to be made. There are some benchmarks which can be used as guidelines including the capacity of the expander, the weight of the mastectomy resection specimen. It is not uncommon for the surgeon to overfill slightly in order to accommodate the implant at the second stage of reconstruction.Ultimately, the patient should dictate when you are at your goal whether that is before, at, or above capacity.As always, discuss your concerns with your board certified plastic surgeon.

Erik Miles, MD, FACS · Answer

This is something that you should be discussing with your surgeon.  In general the permanent implants are more compressible and look smaller than tissue expanders of similar size. Most surgeons will slightly overfill the expanders and stretch the skin prior to implant placement so it is not so tight around the implant.  It is also helpful to give the stretched skin time to expand and relax for several months prior to implant placement.

Erik Hoy, MD · Answer

Hi Pendery,Good question-- unfortunately we probably can't give you a very good answer online.  This topic is slightly controversial among surgeons (some say underfill, others say overfill), and the answer may vary based on your tissue characterstics (how tight), whether you need or have had radiation treatments, and what final implant your surgeon will use.  Just as an example, if you were to choose an anatomically-shaped, cohesive gel implant like the "gummy bear" type, then the manufacturer actually discourages overfilling the expander.  This is because loose tissues could promote rotation of the device.  There are many factors your surgeon takes into account in terms of the final tissue expander fill volume.  Discuss your questions and concerns with him or her.  Congratulations on being 3 months out from your mastectomy and best wishes on your continued recovery!--Erik Hoy, M.D.

Jeffrey Zwiren, MD · Answer

Your plastic surgeon will be the judge about when to stop the expansion of tissue expanders.  If you have a question then ask him.

Erika Sato, MD, FACS · Answer

Implants tend to look smaller than the TE as their shape is more natural. You do want to overfill the TE to bigger than the goal size.

How do I know when to stop saline injections into expanders?

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