Breast Reconstruction Using Expander (with Subsequent Expander-to-Implant Exchange) 

Breast Reconstruction Using a Tissue Expander Followed by Implant Placement

Two-stage breast reconstruction with a tissue expander is one of the most commonly used methods of breast restoration after mastectomy. It allows gradual creation of a soft tissue pocket for a permanent implant without excessive tension on the skin and with less surgical trauma compared with reconstruction using autologous tissue.

First Stage – Tissue Expander Placement

A tissue expander is placed beneath the pectoralis major muscle or beneath an acellular dermal matrix (ADM). The expander is a silicone device equipped with an integrated port through which it can be gradually filled.

The procedure is performed under general anaesthesia, and hospitalization typically lasts three to five days.

After discharge, the patient attends outpatient appointments every two to four weeks. During these visits, saline solution is injected through the skin into the expander port, progressively increasing its volume and stretching the overlying tissues.

Each filling session takes only a few minutes and is usually associated with little or no discomfort.

The expansion phase generally lasts between three and six months.

Second Stage – Replacement With a Permanent Implant

Once adequate expansion has been achieved, a planned second operation is performed.

Through the existing incision, the surgeon removes the tissue expander and inserts a permanent silicone implant.

The procedure usually takes one to one and a half hours, and hospitalization is typically limited to one or two days.

If necessary, additional contour adjustments can be performed during the same operation to optimize breast shape and symmetry.

Indications

This technique is most suitable for patients who have:

• Adequate skin quantity and quality after mastectomy
• No history of radiotherapy to the chest wall, or radiotherapy planned after reconstruction
• A preference for a less extensive surgical procedure
• No desire or possibility to undergo reconstruction with their own tissues

Situations Where This Method May Be Less Suitable

The procedure may be less favourable in the following circumstances:

• Previous radiotherapy to the chest wall, as irradiated tissues tolerate implants less predictably
• Insufficient soft tissue coverage, such as very thin skin with minimal subcutaneous tissue
• A strong preference to avoid implants altogether

Recovery

After expander placement, hospitalization generally lasts three to five days.

Heavy use of the shoulder girdle should be avoided for four to six weeks.

The expansion process itself takes approximately three to six months.

Recovery after the second-stage implant exchange is usually easier, and most patients return to their normal routine within two to three weeks.

The final aesthetic result is typically assessed about six months after completion of reconstruction.

Contraindications

Contraindications include:

• Previous radiotherapy to the chest wall (relative contraindication)
• Active infections
• Severe systemic diseases
• Uncontrolled diabetes mellitus

Smoking significantly increases the risk of complications and is strongly discouraged.

Frequently Asked Questions

Is Tissue Expansion Painful?

Expansion sessions are generally painless or associated only with a mild sensation of pressure.

During the first one or two days after each filling session, patients may notice temporary tightness or tension in the chest.

Most women tolerate this phase well.

Can I Live Normally With an Expander?

Yes.

Limitations are relatively minor and mainly involve avoiding heavy lifting and strenuous upper-body exercise.

Most daily activities and work can usually be resumed within three to four weeks.

Will the Permanent Implant Need to Be Replaced in the Future?

Modern breast implants do not have a mandatory replacement schedule.

Replacement is considered only if complications occur or if the patient wishes to change the size or shape of the reconstructed breast.

Book a Consultation

Book a consultation. The surgeon will assess the condition of your tissues and explain whether two-stage reconstruction with a tissue expander is an appropriate option for your situation.