What is a tissue expander, and what is it like to live with them?

24 Aug 2021

When I woke from my mastectomy, the first question I asked the nurse in recovery was, “did I get an implant or an expander?”

As a young woman, there was no way that I was going to go through the process of a double mastectomy and end up unhappy with my end result – I wanted wonderfully big breasts (call me vain!) at the end of this – but I wasn’t sure I wanted to go through with another procedure if I ended up with an expander because from what I’d been told, they were uncomfortable and ugly.

The nurse looked down at her notes, “you’ve got expanders.” And whilst I know in my heart it was for the best long-term outcome, I couldn’t bear to think of what it was going to be like having to live with these boxy ‘things’ for the next few months as my body adjusted to the changes, in preparation for the implants.

And you’re probably thinking, why didn’t I know what I was going to end up with? Well, my surgeon wanted to set expectations that she would do her best to pop an implant in following the mastectomy, however, she was well aware of my desired outcome, and was not willing to compromise on this, so we had to wait until she was “in there” (her words) to see what she could do.

So, what is a tissue expander, and why do doctors use them?
During implant reconstruction, if you’re having implants inserted at the same time as a mastectomy (immediate reconstruction) and there is enough tissue available to cover your implant, your surgeon will place the breast implant either under the chest muscle or over it, once the breast tissue has been removed.

If however a large amount of skin is removed during mastectomy, or you’re having a staged approach to implant reconstruction (delayed-immediate reconstruction), your surgeon may place a tissue expander between the skin and chest muscle once the breast tissue has been removed. A tissue expander is an implant that’s more like a balloon, stretching the skin over time to make room for the final implant.

Tissue expanders have a port, which is either a metal or plastic plug, that allows your surgeon to add incremental amounts of saline over a period of time (usually two to six months) until the skin has gradually stretched enough to accommodate an implant.

After each injection into the port, you may feel some slight pain or pressure for a few hours, and this tends to go away by the next day. Once the skin stretching is complete, you’ll have surgery to replace the expander with a permanent implant. Tissue expanders are also a great option for women who are unsure of whether they would like to undergo reconstruction or instead remain flat, and they can stay in place for up to 18 months, giving you plenty of time to decide which avenue is right for you.

What’s it like living with a tissue expander?
When I first awoke from my surgery, the tissue expanders were deflated and unshaped, resembling more of a deflated balloon than a breast. However, over the next months, as they began to fill with saline, they took a better shape, albeit a little square.

The important thing to remember when living with a tissue expander is that they are a lot firmer, and less round than an implant, and therefore not a completely accurate representation of what your end result will likely look or feel like.

Given their firmness, it can make tummy sleeping tricky, however, I did manage to navigate this relatively easily with the right cushioning and sleep position.

Want to know more about breast reconstruction options? Check out our resources by clicking here!