Breast Reconstruction Topic: Tissue Expander Exchange Surgery
What Is Tissue Expander Exchange Surgery?
A tissue expander exchange surgery is a breast reconstruction procedure commonly performed after a mastectomy. The goal of this procedure is to recreate a woman’s breast by creating a soft pocket in the remaining breast tissue that will contain a permanent implant. The procedure can be performed immediately after a mastectomy or as a delayed procedure. Breast tissue expanders are available in many different shapes and sizes, so the patient will be able to find an expander and implant that matches their natural breasts.
Placing the Tissue Expander
The first step of a tissue expander exchange surgery is to place the tissue expander itself. This can be done as part of the mastectomy, or it can be performed as a separate procedure months later. When the expander is first placed within the chest wall, it is partially filled with saline. The recovery period for this initial procedure is a few weeks.
Once the patient has healed from having the tissue expander placed, the tissue expansion can begin. This step is completed as a series of outpatient procedures that are spread out over a period of several months. The expansion procedures are scheduled at one-to-three week intervals, and can be coordinated with chemotherapy treatments. The amount of saline that is placed within the tissue expander will determine how many expansions will be required. Modern tissue expander exchange surgery typically uses a dermal matrix to place a higher volume of saline into the expander. This will reduce the number of expansions that are required to achieve the ideal breast size and shape.
Most tissue expanders are designed with a fill port in the front that can be accessed with a needle placed into the skin. The actual expansion takes about a minute, and the amount of saline that can be added is limited by the tightness of the patient’s skin. Approximately 50 cc’s of saline are added to an expander during a typical procedure. This is the equivalent of 10 teaspoons. Patients usually don’t feel significant discomfort during the expansion. In most cases, discomfort and pain can be managed with Tylenol or a similar over-the-counter pain medication. Patients will feel some tightness in their skin that usually subsides within 24 hours.
Placing the Implant
Once the tissue expansion is complete and the patient is deemed healthy enough for an additional procedure, the next stage of the breast reconstruction can be performed. This is an outpatient procedure in which the tissue expander is removed and replaced with a permanent implant. The procedure typically takes about one hour, roughly the same amount of time it takes to place the tissue expander.
Traditionally, saline implants have been used in implants for breast reconstruction surgery, but silicone gel implants may also be used. Silicone implants were used before 1992 and were well-received by patients, but they were taken off the market due to concerns of microscopic silicone leakage. They do have a softer and more natural feel than saline implants, so further research was performed until a safe and effective implants could be produced. Today’s silicone implants look and feel more like natural breast tissue than saline implants, but it is ultimately up to the doctor and the patient to determine whether silicone or saline is the best option.
Once the permanent implant is in place, the patient will almost immediately feel more comfortable than they did when they had the tissue expander in place. The tightness and soreness that the patient initially feels immediately after the surgery should decrease as the patient heals.
After two to three months, the nipple areola can be reconstructed. If the patient desires, the breast shape can be adjusted through fat injections and other contouring procedures during this time. This is common in patients who undergo a unilateral breast reconstruction and may have asymmetrical breasts as a result. Symmetry is easier to achieve through implants with bilateral reconstruction.
If you have recently undergone a mastectomy or will undergo a mastectomy in the near future, you may be a good candidate for breast reconstruction surgery. Call today to schedule a consultation.