Women who have had breast reconstruction may be instructed to limit their range of motion when beginning these exercises. We obtain your history and discuss reconstructive options. The tissue from your back is removed and moved to the front of your chest, with the arteries and veins still attached. Denk points out that, in general, any woman who is a candidate for tissue expander reconstruction, whether immediate or delayed, is a candidate for the aeroform tissue expander. Breast reconstruction timeline prma plastic surgery.
Breast cancer reconstruction and expander infection. Mar 10, 2011 a presentation in our plastic surgery society indicates this puts patients who undergo breast reconstruction at a higher risk for infection, reoperation, and consequently, reconstructive failure. After mastectomy and tissue expander reconstruction, you may wake up feeling groggy as you awaken from the anesthesia. The timeline for completing breast reconstruction varies, depending on how many surgeries are done and the need for other cancer treatments. Scope these guidelines specifically address the risk factors, treatment, anticipated outcomes, and followup of patients undergoing breast reconstruction with expandersimplants for the treatment of cancerous defects. Breast reconstruction faqs md anderson cancer center.
Shareef jandali is a board certified plastic surgeon in connecticut. If you need transportation, lodging, child care or elder care, there may be programs that can help. Breast reconstruction with implants and expanders what you. Tissue expansion procedure steps american society of. This is a preliminary series of 2stage breast reconstructions by means of tissue expander placed subcutaneously with the support of a titaniumcoated polypropylene mesh. B port c catheter d syringe e ribs f pectoralis major muscle. When i was originally shown the expander it looked like a small, almost.
Typically requires a 3 day inpatient hospital stay. During surgery, a small incision is made in the breast muscle to house the expander device. With delayed breast reconstruction, the surgery is done at. Weekly visits for percutaneous expansion in the office68 weeks 3.
In a clinical trial, tissue expansion with the aeroform for all sizes took an average of 21 days as compared to 46 days for saline expanders. This is usually performed as a multiplestep procedure starting with tissue expanders. It does, however, involve another surgery to have the permanent implant placed. This procedure is called a latissimus dorsi ld flap. A comparison of dermal autograft and acellular dermal matrix in tissue expander breast reconstruction. Expanderimplant delayed breast reconstruction medscape. You will have compression sleeves on your legs that help with circulation. Feb 03, 2020 breast reconstruction is surgery to rebuild one or both breasts with implants. Before the procedure, temporary tissue expandersimplantable, expandable, balloonlike devices used to stretch breast skin and chest wall muscles over several monthsare used so that the breast implants can be adequately accommodated.
How tissue expanders are used in breast reconstruction. Tissue expansion is a process that stretches your remaining chest skin and soft tissues to make room for the breast implant. When back tissue is used for breast reconstruction, it involves the latissimus dorsi muscle, along with the skin and fat that covers the muscle. Some women dont need tissue expansion and can have an implant saline. Implant based reconstruction should be performed immediately at the time of mastectomy. We discuss your surgical plan and start the scheduling process. Feb 04, 2020 a metaanalysis of human acellular dermis and submuscular tissue expander breast reconstruction. A tissue expander is an empty breast implant that your surgeon will fill with normal saline over 6 to 8 weeks until it reaches the breast size that you and. The most common method of breast reconstruction currently performed in the us uses tissue expanders and breast implants, usually with an adm acellular dermal matrix such as alloderm. All patients undergoing breast reconstruction using tissue expanders at the authors institution in the 5 years before the protocol, and in the 2 years after, were analyzed. The expansion timeline depends on the condition of your breast skin and how often you trigger a release of carbon dioxide. Breast reconstruction with a tissue expander and implant usually involves at least three stages.
Expanders are slowly filled with saline over 2 to 3 months. Drain instructions timeline for breast reconstruction how to. A breast tissue expander is an inflatable breast implant designed to stretch the skin and muscle to make room for a future, more permanent implant. Alternative treatments would consist of the use of external breast prostheses or padding, breast reconstruction without tissue expansion, or the transfer of other body tissues for breast reconstruction. At the same time your mastectomy is done by our breast surgical oncologist, the breast plastic and reconstructive surgeon will insert a tissue expander beneath your skin and chest muscle. Before the procedure, temporary tissue expanders implantable, expandable, balloonlike devices used to stretch breast skin and chest wall muscles over several monthsare used so that the breast implants can be adequately accommodated. Research is looking at implant reconstruction with a tissue expander using a dermal matrix product to cover the implant compared to using skin and muscle to cover the implant. See the exercises to do after breast reconstruction surgery using a simple implant or a tissue expander implant. Used in breast reconstruction, mentor cpx4 breast tissue expander. There is no absolutely correct answer to your question.
In certain select cases, implant breast reconstruction can be performed in. If performed concurrently with a mastectomy, as the procedure will take considerably longer and will be more complex. During the first stage of reconstruction, when the tissue expander is placed, most patients take a minimum of several weeks off of work. First stage placement of expander can be at time of mastectomy or afterwards 2. Tissue expander breast reconstruction study on breast volume.
Cpx4 breast tissue expanders maintain key features fundamental to the. The purpose of a tissue expander is to stretch your skin to prepare it for an actual breast implant. Halvorson, md, for unc in chapel hill reports the use of one dose of perioperative prophylactic antibiotics was associated with a 4fold. Breast reconstruction can help restore the look and feel of the breast after. After the breast surgeon removes the breast tissue called a mastectomy, the breast surgeon or plastic surgeon performing the reconstruction will often put a tissue expander underneath the pectoral muscle. Preoperative appointment for first stage reconstruction surgery. This may be done immediately following the mastectomy, or as a delayed procedure. Post mastectomy reconstruction with a tissue expander and implant involves a staged approach. During my decisionmaking process of whether or not to have a preventive double mastectomy based on my family history of breast. Tissue expander surgery involves decreased time in the operating room, decreased length of hospitalization, and decreased recovery.
The first stage is inserting the tissue expander either above or under the pectoral muscle chest muscle. Subcutaneous tissue expander placement with synthetic. Another recent advancement in tissue expander breast reconstruction is the use of. This appointment will be scheduled for the same day as your first appointment with the doctor. Longterm aesthetic outcomes and capsular contracture. Your surgeon will increase this limit after your first followup visit. Breast reconstruction with tissue expanders and implants. Surgeons work off the timeline they feel most comfortable. You will be on pain medication, and usually have two drains for each breast that are under your skin and exit from your underarms. My mastectomy permanently changed my ability to work out. Most agree that the expanders do need to be in place for somewhere between 36 months before being removed for the second stage procedure to place permanent implants. The most common method of breast reconstruction currently performed in the us uses tissue expander and breast implants. Implant based reconstruction is a popular choice for breast reconstruction when a woman does not want to use her own tissue. The tissue expander will be expanded in multiple sessions to allow a gradual stretching of the patients muscle and skin.
Breast implants implants are placed in a womans chest under the skin, fat, and muscle. Tissue expander to implant breast reconstruction prma. Implant based surgery tissue expanders, directtoimplant with alloderm typically requires a 1 day stay in the hospital. Timeline for breast reconstruction with tissue expanders.
The purpose of the expander is to create a soft pocket to contain the permanent implant. Breast reconstruction using a tissue expander memorial. Health system customer programs healthy workforce hip fracture care program. Tissue expansion is very much like pregnancy in that after pregnancy, most women find that they have new skin of their lower abdomen that they did not have before. You may need to have a tissue expander, or balloon like sac, placed in each breast before an implant is placed. After implantation, the aeroform tissue expander uses controlled carbon dioxide inflation operated by patients in preparation for a permanent implant and breast reconstruction. Prior to having breast cancer, i naively thought a bilateral mastectomy consisted of removing old boobs and putting in new permanent implants. Apr 08, 2014 this video describes tissue expander reconstruction in detail. Once in place, the expander is gradually filled over time. During the different stages of your breast reconstruction, your bra can be padded to help balance your appearance. Expanderimplant breast reconstruction guideline work group of the american society of plastic surgeons. Cordeiro p g, pusic a l, disa j j, mccormick b, vanzee k j.
Achieving new dimensions of customization in breast reconstruction. A silicone balloon expander is inserted beneath the skin. This essentially involves expansion of the breast skin and muscle using a temporary tissue expander. In breast reconstruction, a permanent implant is then inserted. Breast reconstruction with tissue expanderprosthesis. Novel tissue expander for breast reconstruction clears fda. Overfill of tissue expanders is a commonly used modality to achieve customized dimen. The patient was seen for followup 6 months later, after completing a staged right breast reconstruction with tissue expander to implant, nac reconstruction, and a left breast symmetry procedure. Breast reconstruction may be done at the same time as a mastectomy or in a separate surgery. Breast reconstruction or prosthesis after mastectomy. Tissue expansion is a common technique used for breast reconstruction. Exercises after breast surgery with reconstruction using a. Tissue expander reconstruction surgeries are usually performed in a hospital and require an overnight stay. Implants may require removal or replacement at some time in the future.
Expansion is also used to repair skin on the head and neck, hands, arms and legs. Irradiation after immediate tissue expanderimplant breast reconstruction. When a patient has a mastectomy and desires reconstruction, the breast reconstruction is often done in stages. Dec 20, 2017 because fewer than 20% of the women elect to undergo immediate reconstruction after mastectomy, many survivors are candidates for delayed breast reconstruction. Aug 29, 2019 during implant reconstruction, if youre having the implant inserted at the same time as mastectomy immediate reconstruction and enough tissue is available to cover the implant, your plastic surgeon will place the breast implant either under the chest muscle or over the chest muscle after your breast surgeon has removed the breast tissue. Breast reconstruction and the pain in the ass known as. Both stages of teimplantbased reconstruction can be performed as a oneday surgery procedure. Three hundred five patients underwent 456 tissue expander reconstructions in the 5 years before the protocol, and 198 patients underwent 3 reconstructions in. Expander the expander is basically and implant with nothing in it. The dermal matrix essentially forms a sling that helps form a pocket and support the lower portion of the implant, holding it in position. Tissue expanderbreast reconstruction surgery timeline for breast reconstruction implant expander 1. A tissue expander is a temporary, waterfilled implant that acts as a spacer to prevent contraction of the skin and maintain the shape of the breast. Living with breast tissue expanders after reconstruction.
First surgery after the mastectomy has been completed, the reconstructive surgeon and his assistant prepare for immediate tissue expander placement. When the tissue has grown to the desired amount, the expander is removed. Take team approach to breast cancer treatment duration. Table 1 presents the study variables stratified by tissue expander type per woman, breast, and procedure.
Immediate breast reconstruction with tissue expander. The tissue expander will be replaced with a permanent prosthesis in 36 months. This information will help you learn how to care for yourself after your breast reconstruction surgery using a tissue expander and will help you. Continuing these exercises after you regain full range of motion will help to prevent scar tissue from forming in your armpit and shoulder. Tissue expander reconstruction is a good procedure for most people.
Tissue expanders recovery patients who undergo tissue expander surgery normally have several surgeries to complete their reconstruction. What is a typical timeframe to keep in tissue expanders after. Breast reconstruction with tissue expander is an elective surgical operation. A novel tissue expander system offers new options in breast. Jan 07, 2016 a subcutaneous, prepectoral, musclesparing approach has been recently described for implantbased breast reconstruction. During the second stage, the tissue expander is exchanged for permanent prosthesis with fat grafting to reconstruct the breast. Breast reconstruction using a tissue expander memorial sloan. The first phase of breast reconstruction using tissue expanders is this stretching of the skin expansion. Breast reconstruction with implants and tissue expanders.
The reconstruction process takes 6 months to one year, no matter what procedures are chosen, and if no further cancer treatment is necessary. It is important to remember every breast reconstruction journey is different and depending on your individual experience, this timeline may vary. The anatomic tissue expander group had a higher proportion of women who underwent chemotherapy and radiation before 491 tissue expander implantation and a higher proportion of women who had both breasts reconstructed. The premature removal of tissue expanders in breast reconstruction. Women who choose to have their breast or breasts reconstructed after a mastectomy have several options, including breast implant surgery. The breast is usually reshaped in two stages, or surgeries. Tissue expanders are breast implants that can be inflated while they are in your chest. The first stage involves the temporary placement of a tissue. Breast reconstruction with expanders andor implants breast. After your breast surgeon performs the mastectomy, your plastic surgeon from the institute of reconstructive surgery begins your. What is a typical timeframe to keep in tissue expanders.
In certain select cases, implant breast reconstruction. The tissue expansion actually creates new skin for us to work with if necessary. Right now i have tissue expanders first step in breast reconstruction that were placed inside my empty breast cavities. About breast reconstruction using a tissue expander and implant after your mastectomy surgery to remove your breast, you will have a breast reconstruction surgery using a tissue expander. Many plastic surgeons differ somewhat on their tissue expander timeline for breast reconstruction. Nipple reconstruction will take place 23 months later. Tissue expander reconstruction mastectomy breast repair.
953 637 778 1263 75 695 463 811 1258 1067 360 1188 877 693 1073 515 1585 320 12 1394 276 80 232 310 587 697 1122 838 422 49 783 492 995 1149 427 473 1272 684 528 876 284