Tissue Expanders

The majority of women who elect to have post-mastectomy reconstruction with beast implants have a staged approach using tissue expanders. A tissue expander is a temporary device that is placed on the chest wall deep to the pectoralis major muscle. This may be done immediately following the mastectomy - as it was in my case - or as a delayed procedure. The purpose of the expander is to gradually create a soft pocket to contain the permanent implant, allowing the body to adjust over time. Tissue expanders are available in a variety of shapes and sizes to suit different body types and sizes.

At the time of the initial post-mastectomy reconstruction operation, when it is first positioned on the chest wall, the tissue expander is partially filled with saline - for me, 200 cc's on each side. (As a side note - tissue expanders and implants are always measured in cc's, which is totally unfamiliar to most of us, who are used to talking about breasts in cup sizes. 200 cc's is a little more than 6 oz., which makes it slightly easier to imagine, but not much. There is no direct translation to cup sizes because cup sizes are not strictly correlated with volume, and they actually vary with band size. I would estimate that my 200 cc's were roughly equivalent to a small B cup.)

Within a few weeks after this surgery, once the patient has healed, expansion can be started as an office procedure. The process of expansion takes place at one to three week intervals over several months, coordinated with chemotherapy treatments as needed. The amount of fluid that is placed into the expander at the time of the initial surgery and the overall size of the expander determine how many expansions are later required. In addition, the patient can decide when the size looks and feels right, and choose to stop expanding, or even have some saline removed if she thinks she's expanded too much.

Most expanders have a fill port that is built into the front of the device and accessed with a needle through the skin. Expansion takes about one minute. The amount of fluid that is placed at one time is limited by the tightness of the patient’s skin, but a typical volume for each expansion procedure is 50 cc's of saline (an equivalent of 10 teaspoons). Most patients do not have significant discomfort or pain after expansion, but a sensation of tightness is common for the first day or so. I've now had two fills and I think I'm done - I'm happy with how my clothes are fitting now, and I definitely don't want to make the mistake of going too big.

Once expansion is completed and the patient is medically cleared for another operation, the second stage of reconstruction is performed. This is an outpatient procedure that involves exchanging the expander for an implant, and creating a more refined breast shape. The exchange procedure takes about one hour per breast in the operating room, and patients are typically back to work the next day. I have not scheduled my exchange yet, but I think it will probably be at the end of April. 

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Almost every woman I've talked to who has gone through this process has expressed relief after their exchanges, but I actually don't mind my expanders. They feel nothing like natural breasts - the closest analogy I can think of is a tire: they have a little give but are quite hard and heavy-feeling. But I don't find them to be uncomfortable, and I do like not having to wear a bra.

Although I have never even for a moment considered not having reconstruction, it has struck me at several times throughout this process that it's odd how much trouble we go through to recreate a body part that will have no function. I will never again be able to produce milk, even if I were allowed to get pregnant, which at this point I'm not. Most of the sensation is gone as well, so they are no longer an erogenous zone. They no longer even provide insulation - I've noticed that my chest feels colder since my surgery, without all that nice breast fat to keep me warm. 

My breasts now are entirely aesthetic, and I am pleased at how normal they look in clothes - the forgery is virtually undetectable, I think. When I get my permanent implants, they should look even better. And they'll never get saggy, so that's a plus! But they aren't breasts, and they never will be. It's a bittersweet thing that all of us face as we get older - but I'm especially aware of it in the context of this disease - the realization that something that once was, will never be again.