Asymmetrical tissue expander insertion post bilateral mastectomy. Should this be corrected? Advice? (Photo)

Question

R IDC with neoadjuvant chemo and bilateral skin/ nipple preserving mastectomy, SNB and immediate tissue expanders insertion. No rads. I’ve had 3 fills and I think that the TE on the L side is misaligned. It is lower and much wider on the pec and appears to be rotated outward relative to the other breast, causing the breast to stretch asymmetrically and the nipple to point off to the side. I’m concerned about making this asymmetry permanent and more pronounced if it isn’t addressed now. Advice?

Keith T. Paige, MD · Answer

Dear aliasa,
Thank you for your question and the accompanying photographs.  I agree that there are some asymmetries between the two breast mounds.  In my practice if I have a situation in which a tissue expander has shifted or is demonstrating asymmetric expansion, I will consider a revisional procedure to reposition the expander prior to replacing with the final implant.  In general, the closer the two sides can be prior to the final step of implant placement the better the overall result.  I would certainly raise your concerns with your plastic surgeon who may be comfortable with addressing the concerns after expansion at the time of implant placement or may want to revise sooner.

Peter A. Felice, MD · Answer

Thank you for sharing your question and photographs with our panel. 
It is not at all uncommon to perceive a difference in the position of the expanders relative to your remaining breast skin and soft tissue. I agree with the other respondents that finishing expansion and proceeding with implant exchange is an appropriate way to proceed, as opposed to revising the expander placement at this point. When the expanders are exchanged for implants, your Plastic Surgeon will be able to address many of the asymmetry issues. Keep in mind, too, that it will take several months to see the final position/results of your reconstructed breasts, so be sure to communicate your questions directly with your Plastic Surgeon and have patience with your body during the recovery process. 
I hope this was helpful, breast of luck to you! 
Peter A. Felice, MD

Mark Deutsch, MD, FACS · Answer

Thank you for sending your pictures and question. Tissue expanders have suture tabs that can be sewn down to prevent rotation but that is no guarantee that they will not rotate. Often your surgeon can determine rotation based on where the port is in relation to the opposite breast. I would discuss this with your surgeon and you may want to finish expansion before considering any revision. Best of luck!

Earl E. Ferguson III, MD, FACS · Answer

It is not uncommon to have asymmetry of your expanders used for breast reconstruction.  As the expansion continues, it may exacerbate the asymmetry to a degree.  All of those issues can be addressed at the time of exchange for permanent implants.  It looks like you will have a nice result based on your photos.

Asymmetrical tissue expander insertion post bilateral mastectomy. Should this be corrected? Advice? (Photo)

Answers (4)

Answer: Expander asymmetry

Answer: Expander asymmetry

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Everything you need to know about Breast Reconstruction

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Asymmetrical tissue expander insertion post bilateral mastectomy. Should this be corrected? Advice? (Photo)

Answers (4)

Answer: Expander asymmetry

Answer: Expander asymmetry

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Recommended reading

Everything you need to know about Breast Reconstruction

Our mission is to create a world where every investment in modern beauty is Worth It.