Tissue expander disparity, is this okay?

Question

I underwent prophylactic bilateral mastectomies on Aug 20th with immediate tissue expanders placed. Thank God there were no complications. I noticed immediately after my surgery that my right expander is fuller/more muscle spasms and sits higher up in my chest. My left expander is flatter and placed lower and slightly more lateral. I am left handed. There is more muscle overlying the high positioned right one. I have had one fill of 30cc each -asymmetry remains. Is this OK?

Richard Baxter, MD · Answer

The simple answer to your question is that adjustments can be made when the expanders are switched out to permanent implants, and this is commonly done. A more detailed answer would require knowing more about the details of the surgery. Was Alloderm used? Was it a skin-sparing mastectomy? In many cases of prophylactic mastectomy (depending on the diagnosis) we do a one-stage direct to implant reconstruction with an Alloderm internal bra and skip the expansion phase. This works when the skin-sparing technique is used and the breasts are not enlarged beyong their pre-surgery size. If expansion is judged to be needed, I believe that the Alloderm technique also helps to get the expanders positioned well.

Steven H. Williams, MD · Answer

Thank you for your question.

	Tissue expanders are not designed to look or feel like natural breasts they are designed to stretch the skin so there is enough room to fit the full sized implant underneath. Often after bilateral mastectomies the tissue expanders look and feel different from each other, this is normal. The disparities between breasts are accounted for at the surgery to replace the expander with the permanent implants, giving the breasts a more symmetric appearance and natural feel.

	I hope this helps.

Steven Wallach, MD · Answer

Yes, some asymmetry may develop as the expanders are inflated. They can be adjusted during the second stage.  Be patient.

Robert Whitfield, MD · Answer

Yes this is ok. Expander placement can be variable from side to side. We of course like to have them as even as possible. The operation that is required to remove the expanders to exchange to permanent devices allows for modification of the position on the chest.

Tissue expander disparity, is this okay?

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