What Are the Benefits of a Two Stage Breast Reconstruction?

Why a two-surgery process would be better?

Doctor Answers 3

Two stage breast reconstruction

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Two stage breast reconstruction usually refers to a tissue expander followed by implant reconstruction. In the first surgery, a tissue expander is placed underneath the pectoralis muscle with a dermal matrix (such as Alloderm) used as a sling of the lower portion of the expander. The expander is slowly increased in size over time allowing the pocket that is forming to progressively fill out the skin from the mastectomy. This essentially allows for a controlled expansion process to create space for an implant. By using an expander, there are several benefits:

  • Controlled stretching of the overlying pectoralis muscle
  • Ability to choose an appropriate size of the final implant with greater accuracy
  • Allows for reduction in expander size should overlying skin healing become an issue
  • Greater expansion of the lower pole of the breast compared with the upper pole (create a tear-drop shaped pocket)

The second stage is an outpatient procedure which removes the expander, reconfigures the pocket (if necessary), places the final implant, and may even allow for nipple reconstruction. Essentially, two stages allows for greater control and predictability of a complex reconstruction by simplifying the operation into 2 phases, rather than trying to control all these variables in 1 operation.

Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

One or two stage breast reconstruction

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Hi Anne. I am assuming you are asking about one versus two stage implant reconstruction. Please resend question to clarify this. Or are you talking about implant versus autologous tissue (your own tissue) reconstruction? In the case of one versus two stage implant reconstruction, this decision is made between you, your breast surgeon and your plastic surgeon. Not everyone is a candidate for one stage implant reconstruction and the reasons why are very complicated to explain. Please have a consultation with a board certified plastic surgeon who has experience in one stage implant reconstruction. It is relatively new and not everyone is experienced with it. The best way to perform reconstruction is to use the method that is right for the patient. There are so many methods because different approaches are better depending on the specifics of the situation. Hope this helps.

Tracy M.Pfeifer, MD, MS

Tracy Pfeifer, MD
Manhattan Plastic Surgeon
4.8 out of 5 stars 29 reviews

Breast reconstruction

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A one stage versus a two stage procedure does not make one better than the other. It really depends on what type of reconstruction is performed.  Autologous( your own) tissue versus a non-autologous reconstruction( tissue expander and then implant). 

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

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.