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Home > Cosmetic & Plastic Surgery Procedures > Breast Reconstruction > Part 2

Breast reconstruction plastic surgery

To get answers to the most frequent questions about breast reconstruction plastic surgery and tissue expansion, please select one of the links below:

What is tissue expansion?

In the early 1980's it was discovered that skin (and other tissues) when subjected to a gradual stretching force will not only stretch but will actually grow.

A good analogy is the way in which a woman's abdomen accommodates to pregnancy — not only does the skin stretch but there is actually more skin present as the delivery date nears. Moreover, some increase in skin is permanent.

This discovery has led to a minor revolution in plastic surgery, and consequently, various expansion devices are now available to take advantage of the ability to stretch and manufacture tissues.


What is a tissue-expander?

A tissue-expander is a device, similar to a water balloon, that is placed in the body so that tissue expansion may be performed. Tissue expanders are made from a silicone compound similar to that used in saline breast implants.

The exact size and shape of the expander is determined by the size, shape and nature of the defect requiring reconstruction.

The most popular expanders used today for breast reconstruction are the so-called "anatomical" tissue expanders. These expanders are shaped as a tear-drop which simulates the natural drape of the breast. They are designed to inflate more toward their bottom thus providing greater "inferior pole expansion" or greater amounts of tissue where needed toward the bottom of the reconstructed breast.

Tissue-expander photo
A modern anatomical
tissue-expander with
integral filling port


How is tissue expansion performed?

The tissue-expander (or expander) is placed during a surgical procedure in a deflated or largely deflated state.

After the surgical incision has adequately healed (ordinarily about two to three weeks) the expander is gradually inflated in your surgeon's office through weekly injections of saline solution by way of a small needle placed through the skin. The injections are usually performed on a weekly basis although this can be liberally modified to fit the patient's schedule.

As the expander gradually inflates, the process of tissue expansion occurs and the shortage of skin is compensated. (Tissue expanders and tissue expansion are used throughout the body in plastic surgical reconstruction of other defects and are not limited to breast reconstruction.)

Early tissue expanders had what was known as a "remote filling port", a small button-like device which was placed beneath the skin adjacent to the expander and which was connected to the expander by a small, soft tube. The saline solution was injected into the remote filling port in the surgeon's office. Removal of this remote filling port at the time of implant placement was difficult and required an additional small incision.

Most expanders in use today for breast reconstruction utilize an integral filling port that consists of a metal lined pocket within the expander itself. One manufacturer utilizes a rare-earth magnet within the filling port. The surgeon precisely locates the filling port prior to each injection so that damage to the expander does not occur.

Removal of these expanders is greatly simplified and no additional incisions are needed to remove the filling port.


When is the expander placed?

Placement of the tissue expander is the most common first step in breast reconstruction. The expander can be placed at the time of mastectomy ("immediate breast reconstruction") or can be placed at any time in the future.

Many plastic surgeons prefer to place the expander at the time of mastectomy because it saves the patient a second anesthetic, a second recovery period and a second trip to the hospital. Moreover, because scar tissue has not yet formed, the procedure is easier to execute.

In addition, we prefer to close the mastectomy incision using plastic surgical techniques in an attempt to optimize the appearance of the scar and to determine the quality of the overlying skin flaps. (This attention results in a more cosmetically acceptable scar.)

If an immediate reconstruction has not been performed the existing mastectomy scar can be utilized for access during subsequent ("delayed") placement of the expander. Many surgeons prefer this approach because an additional scar is avoided and because the mastectomy scar is revised during expander placement.


Will immediate reconstruction with a tissue expander prolong my hospital stay?

Usually not. Expanders can even be placed on an outpatient basis when reconstruction is delayed.


How long does tissue-expansion take?

In most breast reconstructions, depending upon the patient's breast and chest wall size, a tissue expander in the range of 400 to 700 cc is used and usually can be filled at the time of placement with about 120 to 300 cc.

If one begins expansion about two weeks following surgery and inflates weekly with 100 cc, then seven weeks are required for the expansion.

We feel it's important to expand slightly more than the anticipated goal and to leave the expander fully expanded for a few weeks to insure that adequate tissue is available for implant placement as well as to achieve a softening of the tissues, which will give the new breast a more natural look and feel. We also adjust the expansion routine to accommodate our patient's work and social schedules.

Some patients also wish to proceed more slowly than 100 cc per week, particularly toward the end of the expansion period. These factors can all modify the length of time required for tissue expansion, but the important point is that tissue expansion should proceed at a rate and over a period of time that's comfortable for the patient with minimal disruption to her daily schedule.


Is tissue-expansion painful?

There is some minor discomfort associated with the process, however this is mostly during the 48 hours immediately following an injection as the skin stretches. This is why smaller amounts of saline are injected as the process nears completion. The discomfort is usually well controlled with oral pain relievers.


How will I look when expansion is completed?

As the expander is filled a mound develops in the location of the breast. The expander is usually filled to a volume that is slightly larger than the implant used to replace it. The expander usually feels significantly firmer than the subsequent implant and many patients report some discomfort during the expansion process.

The final implant is usually quite comfortable and well tolerated.

Remember, the expander is really a "rough draft" of your future breast. Sometimes the expander can extend farther upward in the direction of the clavicle than desired, or an asymmetry of the inframammary fold can occur. These imperfections can be corrected at the time of implant placement.

Fully inflated tissue-expander photo 1 Fully inflated tissue-expander photo 2
Appearance of a fully inflated tissue-expander


To contact Connecticut plastic surgeon Dr. Joseph B. O'Connell about any cosmetic surgery procedures, please fill out our contact form or call us at (203) 454-0044.

Plastic Surgery of Southern Connecticut
208 Post Road West • Westport, CT 06680
Phone: 203-454-0044 • Email:

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