Implant-based breast reconstruction is the most commonly performed method of reconstruction in the US. For most patients, it’s a multiple-step procedure that starts with tissue expanders.

These medical devices are placed beneath the skin and chest muscle to gradually create space for a future breast implant. While they may seem simple on the surface, understanding how expanders work—and why they need to be filled over time—can help patients feel more prepared, informed, and in control.

Are Tissue Expanders Temporary Breast Implants?

A tissue expander is a temporary, implant-like device used most commonly in implant-based reconstruction. Shaped like a deflated balloon, the expander is placed beneath the chest muscle and skin after a mastectomy to gradually stretch the tissue and create space for a permanent breast implant later on.

Generally, tissue expanders are used when:

• A patient chooses implant-based reconstruction and doesn’t have enough natural tissue to support a direct-to-implant approach.
• Delayed reconstruction is necessary after mastectomy or radiation therapy.
• The skin needs time to heal or adjust before a permanent implant is placed.

On the other hand, they may not be needed when:

• The patient is a candidate for direct-to-implant reconstruction (where a permanent implant is placed immediately).
• A patient opts for natural tissue (flap) reconstruction, such as the DIEP flap, where no implant or expander is required.
• There’s sufficient skin preservation during mastectomy to allow for immediate reconstruction without expansion.

Understanding the different scenarios in which tissue expanders may or may not be needed can help patients navigate their choices with greater clarity and confidence.

What’s the Tissue Expander Process After a Mastectomy?

Tissue expanders are most commonly placed immediately after a mastectomy, during the same surgery. This approach—called immediate reconstruction—allows the reconstruction process to begin right away, which can be emotionally and physically reassuring for many patients.

However, not every patient is a candidate for immediate expander placement. In some cases, the procedure may be delayed to prioritize cancer treatment or allow the body more time to heal. This is known as delayed reconstruction.

Several factors influence the timing of expander placement, including:

• Cancer Treatment Timeline: For patients needing chemotherapy or other ongoing treatments, reconstruction may be staged around their oncologic care to avoid delays or complications.
• Radiation Therapy: If post-mastectomy radiation is required, surgeons may delay expander placement or opt for a temporary expander that can later be revised. Radiation can affect skin elasticity and healing, so planning carefully around it is crucial.
• Skin Quality and Healing Capacity: Poor skin condition—whether due to previous surgeries, scarring, or compromised blood flow—may necessitate delaying reconstruction until the area is healthier and better able to tolerate expansion.

Ultimately, the timing of tissue expander placement is a personalized decision made between the patient and surgical team. 

How Are Tissue Expanders Filled? 

Fill appointments are quick, in-office visits that typically take no more than 15 minutes. During the appointment, your surgeon or nurse will locate the expander’s built-in port—often with the help of a small magnet—clean the area, and gently inject a precise amount of sterile saline using a fine needle. 

You may feel a bit of stretching or soreness for a day or two afterward, but over-the-counter pain relief is usually sufficient. These appointments continue until your tissue expander reaches the volume needed to match your desired breast size.

Once the expansion phase is complete, the next step is a second surgery: the expander-to-implant exchange. This outpatient procedure, which takes place usually 2-3 months after the final fill, replaces the temporary expander with a permanent silicone or saline implant. 

Recovery after the expander-to-implant exchange is typically much easier than the initial reconstruction. Most patients experience mild soreness and swelling for a few days, but are back to normal activities within one to two weeks.

Talk to PRMA About Breast Cancer Reconstruction Surgery

Tissue expanders play an important role in many implant-based breast reconstruction journeys—gradually creating the space needed for a permanent implant in a controlled, comfortable way. 

The experienced microsurgical team at PRMA specializes in both implant-based and advanced natural tissue (flap) reconstruction, including DIEP, PAP, and GAP flaps. Whether you’re just beginning to explore your options or considering an implant-to-flap conversion, we’re here to guide you with compassion, clarity, and over 30 years of expertise.

Have questions about tissue expanders—or want to know which reconstructive path is right for you? Contact PRMA today to schedule a virtual consultation and take the first step toward reclaiming your confidence, comfort, and sense of self.

Author: Dr. Minas Chrysopoulo and Courtney Floyd