My tissue expanders are uneven and not filling to the shape or size that I expected at this stage. Any suggestions? (photo)

I appreciate your question.The best way to assess and give true advice would be an in-person exam.Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.best of luck!Dr Schwartz

Thank you for the questionFrom the limited information that you have provided it seems the challenges in your case most likely are the result of having mastectomy at different times and trying to match a delayed and immediate reconstruction. From the picture the mastectomy scars appear to be uneven which could be the result of either uneven skin envelope, asymmetry of the pocket or rotation of the expander. An in person consultation with a plastic surgeon will provide more information and guide you towards a better treatment plan to address your specific concerns.

It is always difficult to match a delayed and an immediate tissue expander reconstruction.  If the shape and projection are completely off then you need to have a discussion about that with your plastic surgeon.  

Thank you for your question.   Depending on how asymmetric your breast were prior to surgery and how much tissue was removed with each mastectomy side, it is not uncommon to see some asymmetry at the tissue expander stage.   The nice thing about staging breast reconstruction is that many of these concerns can be drastically improved at the second stage when the final implants are placed.   All the best.Dr. Gill

Thank you for including photos. In your photo, it does look like you are lacking some projection (outward expansion) of the breast as compared to your example photo. There are several ways to address this, but I should mention that this warrants a discussion with your reconstructive surgeon. There are different shapes/projections of expanders, and you may simply just need a larger one to help the expand the skin outward for a more round shape. Additionally, expanders do not always look like an implant will look. Implants can be a lot more round with better projection, but you need to have enough skin there to begin with. 

Your expanders look like they need more fill. Yes, during thw second stage, the folds should be adjusted so that they are even and implants can then be placed.

Once the decision for breast reconstruction with implant is made, one needs to assess the skin, the amount of soft tissue coverage and choose the right tissue expander. Placement of the expander is under the muscle and acellular matrix. This would allow the expansion.If we need much more skin than what realistically can be achieved, then a Latismmus Dorsi flap would provide for the soft tissue coverage and the excess skin.

Best t have in person discussions with your PS to understand the plans and future surgeries you will need......

I do not use Becker implant/expanders for breast reconstruction so cannot comment directly about your exact situation.  However, the pictures you show as your hoped-for result do indeed show a great result.  We just don't know the details of that woman's cancer, and there-in lies a big part of the story.  We tend to think of breast cancer and breast cancer reconstruction as pretty much the same in all women.  However, each woman develops a specific type of cancer (invasive ductal? DCIS? invasive lobular?), a specific size of the tumor (< 1 cm? 2 cm? larger?), in a specific area of her breast (upper outer? lower outer?), or maybe in two or three areas of her breast, and maybe even with tumor spreading to the lymph nodes.  Each surgeon involved in your care has designed an operation to help maximize removal of the involved cancer as well as optimize the reconstructive result.  The amount of breast tissue removed from one breast, and the location from which it was removed, was likely slightly different between your breasts.  I use more traditional tissue expanders quite often. Sometimes the expansion goes a little unevenly.  When the expanders are replaced with implants, specific areas can be addressed.  For instance, if the lower part of one breast did not expand quite the same as the lower part of the other breast, I can often make some changes in the lower part of the less-expanded breast when the more permanent implant is placed.  Have several conversations with your reconstructive surgeon as you go in for your expander/implant fills.  Let your surgeon know of your concerns.  I have confidence that your surgeon wants to achieve a great outcome with you.  Good communication helps lead to the very best outcome.

I am sorry your expectations aren't being met at this point. The goal photo unfortunately is as perfect as implant reconstruction can ever be and 99.9% of patients fall short of this. Perhaps reveiwing this with your doctor will help to set a more achievable goal so you will be happier.