WTF Are Expanders?

I started writing a regular post, but I realized that I was making a lot of reference to expanders and implants, and that I’ve never actually explained breast construction on this blog. I’ve had enough questions from friends to realize that a full explanation might be in order. So I’ve decided to save the update for tomorrow, and instead tell readers everything they never really wanted to know about breast reconstruction. If nothing else, it will make my posts over the next few weeks make a little more sense.

There are two basic types of breast reconstruction: implants, a concept with which most people are familiar and “flap” reconstruction, which uses fat and skin from other parts of the patient’s body to form a new breast. I don’t know a ton about the flap reconstruction option, because it was never really even pitched to me as something that I should consider. I believe it is mostly employed by patients whose original breast skin can’t handle implants due to removal or radiation. Although it can yield more natural-looking results and has a better potential for some sensation returning, it requires additional surgery on other parts of the body to get the donor tissue and that did not sound like something I wanted to deal with.

I am having the most common type of implant reconstruction, which is a two-step process. During my original surgery, the surgical oncologist took out the breast tissue, a few lymph nodes from the side where the cancer was, and biopsies from behind the nipples, leaving all of my breast skin in place. This was done through 3-4 inch incisions in the fold under each breast which should fade and become unnoticeable in a year or so. Before I was closed up, the plastic surgeon came and created the “pocket”, which would become the infrastructure for my reconstructed breasts. This included inserting temporary implants called expanders, which are filled with saline over time.

In my case, they were placed under the pectoral muscles, which is why my arms are in such bad shape now. In some cases, over the muscle placements are done, and the recovery time is a lot faster, but my surgeon said that he prefers the results of under the muscle placements.

Because of the trauma to my skin, the expanders were left completely deflated for the first six days after surgery to make sure that I had good blood flow to my skin and nipples before the expansion began. This is why the two-step process is more common than complete reconstruction during the mastectomy. Unless the patient is wanting their reconstructed breast size to be smaller than the original, it is unlikely that their skin can handle a full-size, permanent implant being placed at the same time as the mastectomy surgery.

For patients using the two-step process, saline is added to the expanders in the weeks after the surgery until the desired size is reached. How quickly this is done depends on how healthy the skin is and the size to be reached. I have now had my expanders filled twice, and now they are somewhere between 10 and 30% bigger than my original breasts, depending on how one counts. I still have a lot of swelling in weird places and the expanders are a lot stiffer than the implants will be, so it’s hard to imagine what the final result will look like. I’m planning on discussing this with my plastic surgeon on Monday, and I may or may not get a smidge more saline added, depending on what he says.

After Monday’s appointment, I’m expecting to have permanent implants placed in about 4-6 weeks. Once again, the length of time between the final fill and the second surgery varies from person to person, depending on things like the health of their skin, if they are trying to get significantly bigger than before, or if they require other treatments like radiation or chemotherapy. Everything is looking good so far for my having a relatively short wait time, although we still not close enough for my doctor to commit to actual surgery date yet.

The second surgery should be a lot easier than the first, because as my doctor said, “The pocket is already there.” It’s just a matter of reopening the incisions, pulling the expanders out, and putting the permanent implants back in.

I’m looking forward to having the second surgery, because then it will finally feel like this is really, really over. There is a chance that the surgeon might want to do some minor tweaks six months after placing the implants, but that really just comes down to how everything looks at that time. If another surgery is required, it should also be pretty minor and it will be in November or December, which is the least bad time to be sidelined from riding for a couple of weeks. However, I’m really hoping everything looks good, and I don’t need any revisions in the future.