Patient Questions

QUESTION

Whats the Longest a Expansion Can Take?

I am considering reconstruction implants seven years delayed. Is the skin and muscle going to stretch enough or will it be for nothing? I met with PS on Tuesday and feel very nervous. I asked t be a C cup. No way I wanted the tram flap. How long does it take from the fill to the replaced permanent implant? When I went in they took measurements and photos too, would the measurements be able to tell what I can handle? I have so many questions. Why cant they use a permanent expander?

ANSWER

Tissue Expander/Implant Staged Breast Reconstruction Timing

First and foremost it sounds like you haven't really gotten the answers you need before surgery and should take some time to discuss these issues with your surgeon. Breast reconstruction can begin at any point after mastectomy (as long as the oncologic diagnosis is favorable), including during the same surgery once the breast, or breast tissue has been removed. If a patient is planned for radiation therapy many plastic surgeons will wait for this stage to be complete prior to beginning a reconstruction. Because so much skin is removed during the mastectomy a tissue expander, or temporary implant, is used to expand the skin and muscle over time so there is enough to cover the permanent implant. Expansion generally begins around 4 weeks after surgery and occurs every two weeks until the implant is your desired size, which requires roughly 4 to 13 expansions. There is, however, a large variation in time that it takes each individual patient because the tissue can be more difficult to adequately expand in some patients. In addition, there are also limits to the size that some patients can be safely expanded to. After your last expansion the tissue expander can be replaced 4 weeks later. The tissue expanders themselves are not designed to be permanent and are much firmer and not as natural looking as the permanent implants. There are implants from manufacturers like Mentor that allow for expansion and are designed to not need to be replaced but they are typically viewed as a compromise and not normally as soft or pliable as traditional implants. These are all questions you should discuss completely with your plastic surgeon prior to your reconstruction.

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