Breast Reconstruction Topic: Tissue Expander Exchange Surgery
What Is Tissue Expander Exchange Surgery?
The tissue expander exchange surgery is the process of removing the existing tissue expander and replacing it with a permanent implant. Typically, this procedure is done through the same incision as for the initial surgery and the reshaping of the breast may be performed at the same time as well. The patient has multiple options when considering permanent implants and in most situations, this is an outpatient procedure.
The goal of this procedure is to recreate a woman’s breast by creating a soft pocket in the remaining breast tissue that will contain a permanent implant. Breast tissue expanders are available in many different shapes and sizes so the patient will be able to find an expander that matches their natural breasts.
How It Works
Placement of the tissue expander can be done as part of the mastectomy or it can be performed as a separate procedure later on. During this tissue expander exchange surgery, the expander is placed within the chest wall and partially filled with saline. The recovery period for this initial procedure is typically a few weeks.
Once healed, expansion can begin. Expansion is completed over a series of outpatient procedures spread out over several months. Often the expansion procedures are scheduled every 1-3 weeks and can be coordinated with chemotherapy treatments if desired. Depending on the amount of saline desired determines how many expansion appointments will be required.
To reduce the number of expansions required to achieve the ideal breast size and shape, modern tissue expander exchange surgery will utilize a dermal matrix to place a higher volume of saline into the expander.
Tissue expanders are designed with a fill port in the front that can easily be accessed with a needle placed into the skin. Expansion of the expander takes only about a minute and the amount of saline per appointment is limited by the tightness of the patient’s skin.
Typically, approximately 50 cc’s of saline are added to an expander (about 10 teaspoons). Patients don’t often feel significant discomfort during this process, however, if experiencing pain or discomfort, it can easily be managed with Tylenol or similar over-the-counter medication. It’s common for patients to feel some mild tightness in their skin that can subside in as little as 24 hours.
PLACING THE PERMANENT IMPLANT
Once the expansion is complete and the patient is healed, the next stage can be accomplished. This next phase of a patient’s journey is placing the permanent implant, which typically only takes an hour, similar to placing the tissue expander.
Traditionally in tissue expander exchange surgery, saline implants have been the most popular for breast reconstruction surgery, however, the silicone gel may also be used. Silicone implants have a history of being well-received by patients but quickly became less popular (even taken off the market) due to microscopic silicone leakage. Silicone implants have since been significantly improved and continue to be very popular because of their ability to look and feel more like natural breast tissue. Your trusted surgeon will ultimately determine whether silicone or saline is the best option for you and your body.
Once in place, the patient will almost immediately feel more comfortable than when the tissue expander was in place. Tightness and soreness should decrease as the patient heals.
The final step for some includes the reconstruction of the nipple-areola. If the patient desires, the breast shape can be adjusted through fat injections and other contouring procedures during this time to achieve a symmetrical look to the breasts. Nipple reconstruction techniques include
- Skin Flap
- Skin Graft
- Autologous Graft
- Medical Tattooing
To learn more about nipple reconstruction, click here.
Tissue Expander Exchange Surgery
If you have recently undergone a mastectomy or will undergo a mastectomy in the near future, you may be a good candidate for breast reconstruction surgery. Call Dr. Rimma Finkel MD today to schedule your initial consultation.
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