Tissue Expanders for Breast Augmentation?

I had radiation to my chest because i had cancer from the ages of 5-7. I have no breast tissue and want to be a "B" cup. My Ps suggests I get tissue expanders. How much would they cost?

He also said that I should get saline but I am a thin person! Wouldn't that be a bad choice? The first PS I went to said nothing about the expanders and said to get a B size I would need from 225-250ccs. What do you think?

Doctor Answers 6

Ask about expander-implants

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Another option is what is called an expander-implant (Mentor Spectrum). This is a saline implant with a "fill port" that is attached to the implant and it sits under the skin below the bottom of the breast. The idea is to gradually fill it over a couple of months to the desired size, like a tissue expander, but then the port is removed under local anesthesia as a simple procedure. It is of course a saline implant but the Spectrums seem to do very well in terms of rippling and so forth.

With your history of radiation, using expansion seems like good advice to me, whether with a Spectrum or in two stages.

Radiation damage stunting breast growth.

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This is a very complex problem and requires a physical exam. Clearly your own bodies tissues with a healthy vascular supply would be a preferable choice and a have a lower chance of capsular contracture due to your history of radiation.However,this would require more surgery. Fat grafting has emerged as a new option with the potential to reverse some of the radiation changes.  

Would need to see you

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As you probably know the radiation you had as a toung woman effected your tissues making them tighter and less stretchable. This is unfortunately something that does not go away. A tissue expander often does not work well in irradiated tissues but may allow enouch stretch for a small implant. Being a thin woman I would think a silicone gel implant would be your best choice.

Dr Edwards

Gel filled implant may be appropriate

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Your history of radiation to the chest is the wild card when making a decision about using implants and which type of implant would be best in your situation. Radiation can definitely effect your soft tissue response the the implant. Radiated tissue, in general, can have increased problems when it comes to tissue expansion. In order to give you a good answer I would need to review your anatomy. If your skin is not overly tight then a simple breast augmentation using an implant in the range you indicated may be all that is needed. If your skin is thin then you may be a better candidate for a gel filled implant. A 250 cc implant should get you into a B cup size.

Many different roads...

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There are many different roads to the same destination. In general, implants do not do as well in irradiated tissue as in non-irradiated tissue. From what you describe, you had a lack of development due to radiation as a child. Depending on the pliability of your tissues, a surgeon might suggest tissue expanders to gradually stretch the soft tissues. This will require two operations, the second being to exchange the expander with the permanent implants. Alternatively, a surgeon can try to get you the size you desire from the get-go. If he can't , or the implants gets tight. he could then do a second operation to put in a larger on. This is called serial implants. Most of the time an expander is required after mastectomy to recreate breast in irradiated tiisue but your situation is a little different since you do not have a post-mastectomy defect. Saline implants have a less of a risk of capsular contracture but also has less of a chance of feeling natural in your situation. I suspect that both advise going under the muscle.

I think you need to have a flexible expectation and game plan. First you need to accept the risk of imperfection or even failure, say if the implants get persistent hardness due to the irradiation. You also have to acept the responsiblity of multiple operations due to complications or dissatisfaction. Finally, your game pan should involve some flexibility. For example, you could go in expecting to do a submuscular augmentation with a silicone implant to give you the size you want. But if the surgeon finds that the tissues are too tight, he could be prepared to put in expanders instead.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Breast augmentation after childhood radiation to the chest

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Childhood radiation for treatment of a variety of illnesses can interfere with breast development.

Since your current state is the consequence of a medical illness, correction of this condition should be classifed as breast "reconstruction".

Your insurance plan should cover at least some of the associated cost(s) for reconstruction of your breast(s).

There are many options available to you - the very same options as for breast cancer reconstruction. These include either a breast IMPLANT or a tissue FLAP.

Since you do not have a large amount of breast tissue and the skin is likely tight, stretching of the area will be required, using a type of expander.

All tissue expanders involve placement of a prosthesis (some are temporary, others are permanent) that are filled with SALINE. The reason for this is to enable the implant to be filled gradually and for the volume to be modified to suit your aesthetic goals (i.e. A cup, B cup, C cup, etc.).

Once the breast has been expanded to the desired size, the implant or expander is often removed and a permanent implant is placed. This can be either saline or SILICONE. Silicone is a fixed volume and is not usually placed at the intial procedure, as gradual stretchng is safest.

The other option for flap reconstruction can involve transplanting tissue from the tummy area (DIEP flap, SIEA flap, TRAM flap), the inner thighs (TUG flap), back, or buttocks. Many women choose this option if they have areas of excess skin and fat (such as after pregnancy).

The nipple and areola may also require reconstruction - this is often done as a secondary outpatient (day surgery) procedure.

Be sure to see a Board-Certified Plastic Surgeon who has a great deal of experience in breast reconstruction for their expert opinion. Your procedure may indeed be more complicated than most, given the previous radiation.

As insurance may cover this procedure, select a doctor who takes your insurance to decrease the overall costs to you.

Best of luck!

Karen M. Horton, MD
San Francisco Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.