Breast reconstruction after mastectomy

Question

My surgeon put in teardrop expanders. Can I get round implants at my exchange? Also one expander is alot higher than the other and is going into my armpit. I look like i have two different breast sizes because of how there sitting. Does this need to be fixed now or can it wait until my exchange surgery?

Michael A. Fallucco, MD, FACS · Answer

Yes, you can absolutely get round implants at your exchange surgery even if your surgeon placed teardrop (anatomical) expanders initially. The expanders are just temporary devices designed to stretch the skin and muscle; the final implant shape can be different based on your aesthetic goals. Many patients start with teardrop expanders because they mimic a more natural breast shape during expansion but then choose round implants later for fuller upper pole volume or a different look.

Regarding the issue with one expander sitting higher and migrating toward your armpit, it’s important to address this with your surgeon. Asymmetry in expander position can cause visible differences in breast shape and size, which you’re already noticing. In many cases, some degree of adjustment can be made during the exchange surgery itself, especially if the pocket needs revision to center the implant better. However, if the expander is significantly malpositioned or causing discomfort, your surgeon might recommend intervention sooner.

It’s best to discuss this concern promptly with your surgeon. Sometimes minor adjustments can wait until exchange, but if the position is causing problems or risks tissue issues, earlier correction may be necessary. Open communication will help ensure you get the best possible outcome at exchange.

Ryan Rebowe, MD · Answer

All expanders are teardrop shaped in order to appropriately shape the pocket and preferentially expand the lower pole of the breast. However, almost all permanent implants are round shaped. I would discuss this with your treating surgeon as any teardrop shaped implant comes in a textured form. Implant texturing is not necessarily bad but has been associated with BIA-ALCL, so I would make sure you are comfortable with any implant your surgeon may place. As far as the position of the expander, this is easily addressed at the exchange surgery.

Mats Hagstrom, MD (license on probation) · Answer

Breast reconstruction surgery is inherently complex and much more difficult than cosmetic surgical procedures.
The plastic surgeon has to follow what was left after the general surgeon did the mastectomy.
Sometimes the tissues left behind are not ideal for reconstructive purposes.
Without seeing pictures, we can’t begin to make an assessment.
If you have questions regarding where you are at this stage of your reconstruction process then you should talk to your plastic surgeon.
Sizers are not representative of the final outcome in our device to create space for the final implant. A lot of changes are made during the exchange of a tissue expander for an implant.
Follow up with your plastic surgeon and have him or her address your concerns. Most expanders are generally expanded gradually during the postoperative. Period that should give you a chance to meet with the plastic surgeon on a fairly regular basis at which time you should be able to discuss your concerns. If not, then simply schedule an appointment with them and have them addressed your concerns at that time.
It makes little sense to revise a tissue expander that’s doing its job.
 Best,
Mats hagstrom MD

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