Tissue Expander to Implant

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The most common method of breast reconstruction currently performed in the US uses tissue expanders and breast implants, usually with an ADM (acellular dermal matrix) such as 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 ("direct to implant" or "one-step").

Stage One:

The first stage involves placement of tissue expanders either below or above the pectoralis muscle. 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.

The expanders are usually partially filled 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 Two:

Once the tissue expanders are adequately filled they are exchanged for the permanent breast implants. Two types of breast implants are available to patients: Saline or 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 frequently included in the second stage to improve the soft tissue "padding" over the final implant. It is extremely helpful in filling in contour defects created by the mastectomy, as well as thickening the fatty layer beneath the skin. A thicker tissue layer over the implant decreases the risk of being able to see the waves in the implant shell, known as "rippling", and greatly improves the final cosmetic results. 

Tissue Expanders Used at PRMA:

Saline Expanders

Saline expanders are by far the most common type of expander currently used. They can be placed at the same time as the mastectomy or any time later. When placed at the same time as the mastectomy, they are usually partially filled at the time of surgery. Further expansion is performed by the surgeon during several office visits once the patient has healed from surgery. The saline is injected into the expander fill-port through the skin using a syringe.

AirXpander

The AeroForm Tissue Expander uses carbon dioxide which is released in controlled, small amounts from a cartridge inside the expander. The expansion process is controlled by a hand held remote and can be performed at home by the patient by pressing a single-touch button. This expander has just been approved for use in the US by the FDA.

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 Direct to Implant surgery
  • To learn if you are a tissue expander candidate or to schedule a consultation, please contact us here or call us at (800) 692-5565.
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Once the tissue expanders are adequately filled they are exchanged for permanent breast implants.

PRMA Plastic Surgery