Tissue Expansion Process

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3/16/2016

Today we are going to talk specifically about the tissue expander process. Many patients ask me about the expansion process at their first postoperative visit after the mastectomy surgery. Some questions patients ask: When does the expansion process begin? How is the expansion process done? How many expansions will I need? How many expansions is a “C” cup? Or any cup size? Does the expansion hurt? What is an overexpansion? How long does the expansion process take? How long before my surgery do I have to do the last expansion?

The expansion process will begin around 2-3 weeks after your initial surgery once the drains have been removed and the skin appears healed. The expansions are done in the office and can be done weekly until we achieve your desired size. If you require additional therapies, the expansions can be done throughout chemotherapy, but not during radiation therapy. Future surgeries take place after chemo and radiation therapies are complete.

Once you begin expansions, you can continue weekly until you reach your desired size. Many times there is fluid placed into the expanders at the time of surgery. Depending on this amount and how large you desire to be, will determine the number of expansions necessary. At each expansion, 50-60ml of fluid is placed into the expander. The fluid is placed into the expander through the port located on the upper middle portion of the expander. This port is located using a magnet and is accessed through the skin. Most commonly, the area is numb and you will not feel the needle stick. You may feel a pulling or pressure sensation during and even after the expansion is complete. This typically only lasts a few days. If you have continued discomfort from the expansion, over the counter medication such as Ibuprofen or Tylenol can be used. Generally, expansions take 10-15 minutes a session and around 2 months to complete. In some cases, limitations due to skin may dictate your ability to continue with expansion, and we will discuss that as the process proceeds.

The most common question I am asked, during the expansion process, is about bra cup size. Patients want to know how many expansions they will need to achieve a certain cup size. I, in return, ask what cup size they were before reconstruction. Most patients usually tell me a couple of different sizes depending on where they are shopping. I then reply to them, “Exactly!” What I mean by this is that we don’t measure in bra cup sizes, but rather in milliliters of volume. The reason we don’t go by bra cup sizes is because that is really dependent on the manufacturer. There isn’t a universal bra cup mold that exists that all manufacturers have to adhere to. What doesn’t change anywhere you go is: volume. We keep a record of how much fluid is being placed in the expander at each visit and will order your permanent implant based on that volume. My advice to patients is to choose a bra they like in a cup size that they desire to be. As we fill the expanders each week, I have them go home and try the bra on to see the progress we have made. With each fill, you will fill in the bra better until you achieve the look you want. This is the best way to determine when you have achieved your desired bra cup size.

Once you have achieved your desired size, we will do an additional expansion that is called the overexpansion. This additional expansion gives the surgeon a little extra skin to work with at your exchange surgery, to make any adjustments necessary, to create the best result possible. We like for that overexpansion to be done about 3 weeks prior to your exchange surgery. At the exchange surgery, the expanders are removed and a permanent implant of equal volume is placed. This permanent implant can be either silicone or saline. The exchange surgery is an outpatient surgery that is done under sedation and doesn’t require the use of drains. The initial mastectomy incision is used for the exchange surgery unless you have been radiated. On the radiated breast, a new incision at the bottom of the breast will be used. Most patients would only need around 2-3 days for recovery with your first postoperative visit in the office occurring within the first two weeks.

If you have an adjustable saline implant instead of an expander, exchange surgery may not be necessary. If you are content with the initial cosmetic result; instead of exchange, the port can simply be removed either in the office or the operating room. Once the exchange surgery is complete, many patients will proceed to the next stage in the reconstruction process: nipple reconstruction. Stay tuned for future blogs discussing the nipple reconstruction process.

When my daughter broke her nose in a high school sports accident, she was referred to a local ENT for surgery immediately. I wanted to make sure a plastic surgeon performed the surgery and spent hours trying to find a surgeon who would treat her. I knew that this was a very time sensitive injury that needed to be treated ASAP. Barb on Dr. Moradian’s team scheduled a consult with him very quickly and patiently answered all of the (many) questions I had. I was absolutely amazed that Dr. Moradian was able to schedule surgery the day following our consult. My daughter’s prom was one week after her surgery and Dr. Moradian was determined that she would be able to go and look like herself. No one could tell, one week later, than she had surgery, and she had a wonderful time!Dr. Moradian and everyone on his team were friendly, caring and empathic. They made us feel confident and comfortable with the procedure. I was also impressed with the follow-up check-ins and responsiveness when we’ve had questions after the procedure. He’s been very responsive and helpful. I feel like we hit the jackpot and couldn’t have found a better surgeon! Thank you, Dr. Moradian, for everything!

K.J. Google

Dr. Fine, his team, and all the staff at NSPS are just the best! Having to go thru a crap situation (mastectomy) I trust his process and feel at ease at every appointment/procedure. I am so thankful to be going through this with them and highly recommend. I will actually miss going to NSPS when the reconstruction process is fully complete.

M.H. Google

I went to Dr. Schierle to address my gynecomastia - which had been a lifelong issue that suddenly gone from being a purely cosmetic flaw to a much bigger overall health issue for me over the course of a year or so. The first green flag for me was this office was the first plastic surgery practice that was willing to listen to my concerns and try billing my insurance for the surgery (coverage for the procedure was approved).Dr. Schierle himself made the entire process as positive as possible. I felt that he truly listened to me, asked thoughtful questions about my goals for the surgery, was frank and open about every aspect of my procedure and what I could realistically expect, and never once made me feel judged or uncomfortable.The team and office staff have been incredible to work with. I’ve always been able to reach someone if I had a question or concern during recovery. I never have a problem getting into the office when I’ve needed to.I knew that I had made the best decision in choosing a surgeon during my second post-surgery checkup, when Dr. Schierle recommended I hold off on any scar revision treatments for at least a year. To me, this just demonstrated further that he is actually invested in his patients’ success and not just out to milk people for as much money as he can.I’m really grateful to Dr. Schierle and his team for making what was an incredibly stressful and scary ordeal into a much more manageable process. Can’t recommend them enough.

N.H. Google

Dr Fine was realistic when discussing cosmetic results. He was straightforward and provided several options. He also was honest with what he thought was the best way to proceed and very clear on what not to expect.

J.M. Google

I will continually recommend and refer my friends and family to Northwestern Plastics. I underwent a breast augmentation yesterday and feel great! My pre-operative experience was nothing but detailed, understood, and all my concerns and questions were answered by Dr. Moradian and his amazing PA, Monika. I will speak highly of the faculty because you are always warmly greeted by the front desk and Kendall makes your logistical arrangements seamless!During the day of my procedure, I felt ZERO anxiety and the experience was very pleasant and passionate from all the nurses and the anesthesiologist. Prior to going into the OR, Dr. Moradian came into the room to greet me and mark me up - this was indicative of how passionate he was because he asked me if I had any last minute questions and concerns. Another small but impactful statement he said was “I’ve studied your aesthetic wants/inspirational pictures of what you would want and know exactly what to do”. This shows me compassion, the drive to make me feel heard, to how much thought and detail he has put into this artistry.Overall, I am extremely happy and when I am healed - I will update my pictures! I am excited for my recovery journey. They are perfect already.

S.T. Google

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