Following mastectomy, your reconstructive surgeon will insert a tissue expander (a silicone balloon filled with saline) in a pocket formed under the muscle and remaining skin on your chest wall. More saline solution is gradually added to the tissue expander during outpatient clinic visits, stretching the muscle and skin to the desired size. Often the skin is stretched slightly more than needed because it has a natural tendency to shrink when the tissue expander is removed.
The amount of saline needed for each expansion may vary depending on the tightness of the skin. This process usually takes 2-3 months, but may take longer if you need other cancer treatments, such as chemotherapy.
Once the "pocket" has reached the desired size, the expander is left in place, stretching your skin for approximately 1-3 months more. Surgery is then scheduled to remove the tissue expander and replace it with a permanent implant, which is an outpatient surgical procedure. The permanent implant will either be filled with saline or silicone and will be much softer than the tissue expander. Your reconstructive surgeon can discuss the various types of available breast implants.
The advantages include:
- Decreased surgery and recovery time
- Fewer scars
- Satisfactory shape in clothing
The disadvantages include:
- Need frequent office visits for the tissue expansion process
- Two-stage procedure: tissue expander followed by exchange for permanent implant
- Hard to achieve nipple projection with nipple reconstruction, due to thinner skin
- Difficult to achieve symmetrical shape with the natural breast
- Need to replace implants periodically, meaning more surgery
Breasts reconstructed with an implant alone will not create a natural droopy appearing breast and may appear fuller in the upper half compared with a natural breast.