Tissue Expander to Implant Procedures

Expander-implant reconstruction is considered a two-stage or delayed immediate reconstruction. Although the reconstruction process begins at the time of mastectomy with the placement of tissue expanders, the final implant placement takes place during a second, separate surgery.

After the placement of the tissue expanders, a small amount of saline will be filled into the expander during the initial surgery. Over a period of several months, your surgeon will add increasing amounts of saline to the tissue expander through the port, allowing for the skin and muscle to stretch and expand gradually over time. The time of expansion varies depending on desired volume and breast size, but it can take a few weeks to a few months to achieve. You can expect that process typically takes 2 to 3 months to be fully expanded at 1-2 week intervals, starting approximately 7-14 days after the initial surgery. The “fills” are done in the office setting and takes no more than a few minutes to perform.

When the skin and muscle have stretched enough to accommodate the implant, the expander is removed and the permanent implant is inserted. The Stage Two surgery, often referred to as the “exchange surgery,” typically takes 2-3 hours to perform and patients leave the hospital the same day. Having chemotherapy or radiation therapy can affect when the permanent implant is inserted, so you’ll need to discuss timing with your doctor.

Stage Three reconstruction, in which the nipple and areola are reconstructed, generally happens 2-4 months after placement of the permanent implant. Fat grafting is also sometimes performed as an additional procedure to help fill and contour the breast and achieve optimal results.