Expander implants

Most reconstructions using implants require expanders at first. The expansion is a process that involves dilating the skin and subcutaneous tissue -the chest area- using a refillable implant that gradually fills in during visits -without entering the hospital- to get the space needed to accommodate a final prosthesis.

It is an experience similar to the abdomen of women during pregnancy process.

How do we do it?

The first step of this procedure consists of creating a space under the pectoralis major muscle so as to place the expander, which acts as a kind of a temporary implant. It is a simple procedure, although you must correctly calculate the size of the space that is generated under the thorax: Neither too big for the implant nor too small.

The expander is inserted and is entired with the appropriate amount of saline to create a first volume. That temporary implant incorporates a valve through a small painful prick that allows us to manage the saline filling the prosthesis through the skin.

After that, surgeon puts a drain and closes the incision with absorbable stitches, which will not be removed later. To complete this process, the patient is hospitalized during a couple of days and, after removing the drain, she can come back home.

The purpose of the expander is to create a soft pocket to contain the permanent implant.

The expander takes shape

When patient recovered, the expander is gradually enlarged with saline over several weeks (4 to 6 months, although the exact period depends on the elasticity of the skin and tolerance to process) to create a space or bag below the muscle to hold the implant in the most natural way possible and thus, recreating the shape of the other breast size.

Although this method lasts a short period of time and usually is not painful, it has some drawbacks: besides having to visit the surgeon's office on a regular basis (every 2 or 3 weeks), until the expander has enlarged at all, the patient may feel tightness and discomfort after each filling and difficulty for dressing.

However, most patients do not have significant discomfort or pain after expansion.

Good hydration

  • Due to these changes, maintaining good hydration of the thorax skin during the expansion process is recommended.
  • In fact, the patient can see a significant change after each of the gel-filled with saline, although the chest does not seem to be as how the process is complete.
  • During the expansion of provisional implant, the patient will notice that the implant could become unnatural or balanced forms, but she must avoid discouraging.
  • If surgery and follow-up are performed correctly, the chances of complications, such as the puncturation of the expander and the deflation or infection of the implant are almost nonexistent.

The second operation

Once the expansion process is over, few weeks must be left for the implant and the skin before replacing one of the definitive prosthesis.

A second surgery is performed so as to replace the expander implant and get a final volume. In comparison to the first operation, this second surgery is faster -two or three-hours- and less painful because we only have to place the final implant. After the second surgery, where general anesthesia is required, a surgical drain with the new chest and a bandage is placed around the chest to reduce inflammation or swelling.

After 24 hours, the surgeon will remove the bandage and the patient will be able to see, for the first time, the new breast. Then she will appreciate an improvement in the appearance of the breast in comparison with the first stage of expansion.

However, there is still some time to reach the final appearance of the reconstructed breast. In fact, a few weeks will be required in order to get rid of the swelling and the implant to be placed more naturally and more or less final.

In some cases during this second surgery, surgical techniques to get both breasts symmetrical may be required.

Drawbacks

Expanders with implants can only be performed in women with enough healthy chest so as to allow expansion area. In fact, most surgeons agree that implants are not the best solution for women who have received radiotherapy.

Radiation reduces blood flow and the elasticity of the skin and subcutaneous tissue, so that the skin may not expand enough and the implant could squeeze or deform. This type of intervention is not recommended in:

  • Cases of poor healing after mastectomy.
  • Cases of insufficient blood supply to the skin.
  • Obese patients.
  • Smokers.
  • Hypertensive women.
  • Women with diabetes.
  • Patients with impaired healing or blood clotting.

Deadlines

  • Surgery: 1-2 hours
  • Hospitalization: 2 days
  • Usual daily activity: 1 week
  • Sports and vigorous activity: 1 month
  • Creating the nipple and areola: 2-4 months

Drawbacks

In spite of the most common used techniques such as the expander technique, the reconstructive procedure requires a much longer period of time because several visits and several months are needed. You will have to visit de doctor so as to settle on a second surgery in which the final reconstruction is performed.

Compared to autologous tissues, implants are foreign objects inside the human body and, simultaneously, artificial elements that are subject to wear out. That means your replacement may be necessary in the future.

The patient will need a few months to get used to the implant and feelings that generates when performing certain movements. They are no painful sensations, but some tightness or slight discomfort.

Even if many women may feel satisfied with the result achieved, the breast does not have the same shape, fall, movement and evolution compared with the natural breast: In fact, over the years, the implant ends up creating asymmetry between both breasts that often requires additional plastic surgery.

The implant is a static element, that does not change or evolve in conjunction with changes and developments in the rest of the female body.

In some women it can cause complications such as capsular contracture or implant intolerance.

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