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What is it?
The surgeon puts an empty balloon called a tissue expander inside your breast area. The expander is slowly filled with fluid to grow the skin. Several months later, the surgeon replaces the expander with a breast implant.Read more:
During the first step, the surgeon puts a pouch called a tissue expander inside your breast. This step is often done at the same time as your mastectomy, but can also be done later. After a few months, you will have a second operation and the surgeon replaces the tissue expander with an artificial breast mound, known as an implant.
Most patients need two steps for implant breast reconstruction. The first step is usually done at the same time as the mastectomy.
Tissue Expander
- An empty balloon made of silicone plastic with a small valve in its front wall
- The surgeon fills the expander with saline (salt water) through the valve
Implant
- Have round or teardrop shapes and covers made of silicone plastic
- Are filled with silicone gel or saline
- Silicone: a semi-solid gel
- Saline (Salt water)
Learn more about silicone versus saline implants:
Silicone implants
- Usually filled with thick, compressible silicone gel
- Usually feel softer and feel more natural than saline filled implants
- Less likely to show visible wrinkling or rippling on the skin surface, compared with saline implants
- If you had an implant leak, you might not be able to see or feel it, and you would probably need breast imaging (an MRI scan) to find the leak
Saline Implants
- Filled with saline (salt water)
- More likely to show visible wrinkling or rippling on the skin surface than silicone implants
- May have a firmer feel, compared with silicone implants
- If you had an implant leak, the implant will deflate and look flatter, so you would not need breast imaging to find the leak
How is it done?
Tissue expander breast implants involve a multiple step process over the course of about 4 to 5 months:
Learn more about the steps
Start
Tissue Expander Placement
- Done at the same time as your mastectomy or later
- Surgeon puts tissue expander under your chest skin and (sometimes) muscle
- Takes about 1 to 2 hours
- At first, the tissue expander will have little or no fluid inside, so both sides of your chest will still be mostly flat
2 - 3 weeks
Tissue Expansion Process
- Multiple visits to your surgeon (about 4 to 8 visits)
- Visits are 1 to 2 weeks apart
- At each visit, the surgeon injects saline (salt water) into the tissue expander
- As the tissue expander gets bigger, it makes the skin grow, creating the shape of the new breast
- Office visits for expansion usually take about 20 to 30 minutes
- No hospital stay
1 - 3 months
Rest Period
- No more expansion visits
- Gives your skin time to relax and finish growing
1 - 3 months
Replacement of Expander for Implant
- Surgeon removes expander and puts in the implant
- Takes about 1 to 2 hours
- Surgery does not usually require a hospital stay (outpatient)
3 Months
Nipple Reconstruction or other optional procedures
By the numbers
- Number of surgeries2
- First surgery: to get the tissue expander *
- Second surgery: to remove the expander and get the silicone or saline implant
* The first operation (tissue expander) can often be combined with the mastectomy (immediate reconstruction).
- Nights in the hospital0 or 1
These surgeries may require at most 1 night in the hospital, especially if the tissue expander is placed at the same time as your mastectomy. The surgery that exchanges the expander for the implant usually does not require an overnight stay in the hospital.
- Length of recovery2 to 4 weeks
For each of the two surgeries, patients can usually resume normal activities after 2 to 4 weeks. You should not drive for 2 to 3 weeks after your operation, and should not do physical work or heavy lifting (including gym time) for 3 to 4 weeks.
Even after the initial recovery time has passed, you still may not feel like yourself. You may still feel tired and sore for a few months after your surgeries.
What are the pros?
- Shorter surgery I Little or no hospital stay
The surgery that places the tissue expander and the implant surgery are shorter (1 to 2 hours) when compared to other reconstruction options.
If you choose to have immediate reconstruction (during your mastectomy), you will likely stay in the hospital overnight after the combined mastectomy and tissue expander surgery.
If you choose to have delayed reconstruction, the operation to place the tissue expander will likely be outpatient (not require a hospital stay). The second surgery that replaces the tissue expander with the implant, will also likely be outpatient.
- Faster recovery
Because implants require less extensive surgery than other reconstruction options, usually less recovery time is necessary.
- Less invasive | Fewer scars
Since no tissue needs to be taken from other areas on your body with this approach, implant surgery leaves fewer scars. In most cases, the mastectomy scar (or incision) is used to place the tissue expander and the implant, so you will have no extra scars after the reconstruction.
- Good cosmetic results for most women
Implant reconstruction on both breasts generally has good cosmetic results.
What are the cons?
- Usually takes more than one surgery
With two step implant reconstruction, you need a tissue expander first. The expander will be exchanged for the implant during a second surgery several months later. In total, it will take 3 to 6 months for the reconstruction to be completed.
- Time consuming and inconvenient
This type of implant reconstruction requires frequent doctor visits (every 1 to 2 weeks) to have the expander filled with saline. Since it also requires two surgeries, there will be two recovery periods.
- Tissue expander will feel tight and may be uncomfortable at times
The expansion process can cause soreness in some patients. Other patients simply have a feeling of tightness for several days following each expansion.
- Implants wont change in size with body weight gain or loss
Implants do not change in size or shape to match changes in body weight. This means that the size and shape of your implant-reconstructed breasts will also remain the same, regardless of changes that may occur elsewhere in your body. If you lose or gain weight, your breasts may seem the wrong size compared to your new body shape.
What are the risks?
- Infection
- About 5% of patients (5 out of 100) will get an infection after the tissue expander surgery and another 3 to 4% will get an infection after the implant surgery. This can require a hospital visit or another surgery. Sometimes the doctor has to remove the implant because of infection.
- Bleeding or fluid collection
- 2% of patients (2 out of 100) may have bleeding (hematoma) or fluid collection (seroma) under the breast skin after these surgeries. Although not life threatening, this may mean a hospital visit or another surgery.
Possible long term problems
- Leakage of the implant
- The most common complication of implant reconstruction is leakage. This happens in about 10% of patients (1 out of 10) over the first 10 years for either saline or gel-filled implants. At this time, there are no reliable data that track an implant after the first 10 years.
When leakage occurs, the implant must be removed or replaced. This procedure usually takes about an hour and does not require a hospital stay. For silicone gel implants, more extensive surgery is sometimes needed to remove loose silicone from the breast area. However, this tends to be less of a problem for the newer solid or semi-solid silicone gel implants.
- Pain from scar tissue
- Scar tissue forms on the outside of all artificial devices (like implants) when placed in the body. Usually, this does not pose a problem. However, in about 5 to 10% of patients (5 to 10 women out of 100), too much scar tissue forms. This may happen more frequently with silicone implants than with saline implants. The scar tissue may cause pain and discomfort and make the implant feel hard to the touch.
If this happens, you may need surgery to break up or remove the scar tissue. It may also be necessary to remove or replace the implant. Scar tissue can form at any time from a few weeks to many years after the implants are inserted.
- Implant shifting or wrinkling
- In about 7% of patients (7 out of 100), the implant shifts or settles after the surgery, causing a "wrinkle", "dent" or change of position in the breast implant ("contour irregularity" or malposition). These may require more surgery.
Wrinkling is much more common in saline implants, compared with silicone gel-filled implants.
Possible major complications
- Re-operation | Re-hospitalization | Reconstruction failure
- In general, there is a 20% chance of having a major complication after tissue expander implant reconstruction. That means 20 women out of 100 will need one of the following:
- Re-operation (needing to have another, unexpected surgery)
- Re-hospitalization (needing to be admitted back into the hospital after surgery)
- Reconstruction failure (the reconstruction doesn't work)
Learn more about your risk of complications:
Your personalized risk*
Implant reconstruction
- If you have implant-based reconstruction, your risk of a major complication would be 52%.
This means 52 out of 100 women like you have a major complication after implant-based reconstruction.
* This information is only an estimate. Everyone is different, and your risk might be different from what's shown here. Talk with your doctor for more information.
How do other women feel about it?
We asked women who had breast reconstruction how they felt before surgery and two years after their procedure. We asked about these topics. Here’s what they said:
Satisfaction with breasts How happy are you with the look and feel of your breasts?
Sexual well-being How do you feel about your body as it relates to your sexuality?
Psychosocial well-being How do you feel about your body image, and how confident are you in social settings?
Physical well-being: Chest How does your chest feel, physically?
Physical well-being: Abdomen How does your abdomen (stomach area) feel, physically?
