Breast Reconstruction with Implants, Tissue Expanders & Alloderm

The most common method of breast reconstruction currently performed in the US uses tissue expanders and breast implants, usually with Alloderm. This is usually performed as a multiple-step procedure starting with tissue expanders. In certain select cases, implant breast reconstruction can be performed in a single-stage ("one-step").

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Tissue Expanders

Stage One:

The first stage involves placement of tissue expanders. This can either be done at the time of the mastectomy (for immediate reconstruction patients) or after the mastectomy has healed (for delayed reconstruction patients). Expanders are essentially temporary implants that act as spacers.

Stage Two:

The expanders are filled as much as possible at the time of the initial surgery. Further expansion is performed in the office as required once the incisions have healed. This expansion process can require several weeks, depending on the amount of expansion required to reach the optimal breast size.

Stage Three:

Once the tissue expanders are adequately filled they are exchanged for permanent breast implants. Two types of breast implants are available to patients: Saline and Silicone. It is advised that you speak with your plastic surgeon as to which implant would be best for you. Patients who undergo breast reconstruction with implants should be aware that their implants may need to be replaced at a future date. Fat grafting is also performed at this stage if required.

Alloderm One-Step

Some patients are candidates for "Alloderm one-step" (also known as "single stage" or "direct to implant") reconstruction whereby a permanent implant is inserted at the same time as the mastectomy. The patient avoids the use of an expander and the whole expansion process. In the one-step Alloderm reconstruction the breast implant is completely covered by the pectoralis muscle and Alloderm (a cadaveric acellular dermal graft). The PRMA surgeons prefer to offer this single-stage procedure to patients undergoing prophylactic, nipple-sparing mastectomy only.

Key Information: 
  • Tissue expanders can be placed at the time of the mastectomy or after the mastectomy has healed
  • The expanders are partially filled during the initial surgery
  • Further expansion is performed in the office as required and can take several weeks to complete
  • Tissue expanders are eventually replaced with permanent breast implants (saline or silicone)
  • Patients should be aware that their implants may need to be replaced in the future
  • Some patients are candidates for Alloderm one-step
  • PRMA surgeons prefer to offer single stage procedures to patients undergoing prophylactic, nipple-sparing mastectomy only
  • View breast implant before and after photos
  • To learn if you are a tissue expander or one-step candidate or to schedule a consultation, please contact us here or call us on (800) 692-5565.
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