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Tissue Expanders for Dummies

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Before my first breast reconstruction surgery, I stuffed socks into my bra so my flat chest matched the size of my other breast. Since I’m not big on carrying a purse, it wasn’t long before I started filling the empty bra cup with practical things like cell phone, money, driver’s license and keys. James compared me to a magician who retrieved rabbits and flowers out of a hat. While I did use rocks and raisins as nipple substitutes, I drew the line at lining my bra with living things.

Today I talked with a woman who’s had phase one of her reconstruction surgery: insertion of a tissue expander. So far, she’s not happy with the results. Compared to her other breast, she says the new one’s too high and too perky, but she knows when all is said and done, the new breast will look more like her natural breast. As we talked I remembered how involved the whole reconstruction process was, so for those of you who don’t understand how it works, here’s “Tissue Expanders and Breast Reconstruction for Dummies.”

Immediately following a mastectomy, or at some future time after the mastectomy incisions have healed, a tissue expander or temporary implant is surgically inserted under the pectoral muscle. Gradually over a period of weeks or months the surgeon, in the office, numbs your skin and inserts a needle into a port on the expander, then adds small increments of saline solution. This gradual increase in size allows the pectoral muscle to stretch over time until it reaches the desired breast size. Some women complain of tightness while the muscle is being stretched, a few say it’s painful, but for me it was more of an annoyance. You may be thinking, “Women get ‘boob jobs’ all the time, and they don’t need tissue expanders. Why do they need them with breast reconstruction surgery?”

With a regular boob job, or breast augmentation, the implant is placed between the existing breast tissue and the pectoral muscle so the implant is not as noticeable. However, because the breast tissue is removed during a mastectomy, an implant that’s placed on top of the pectoral has no place to hide. It would look like a grapefruit with skin draped over it. Actually, some bad breast augmentations look like that anyway.

Once the expander has been filled to the desired size, it’s then surgically exchanged for either a saline or a Silicone Gel implant. In 1992, the FDA halted the sale of Silicone implants due to safety concerns. In those older implants, the Silicone was in liquid form, which meant if the implant ruptured, the Silicone could potentially travel to other parts of your body, plus it was linked to a variety of autoimmune problems. Today the Silicone is in gel form so if the implant ruptures the Silicone supposedly remains intact. Silicone gel implants result in a more natural looking and feeling breast, as opposed to saline implants, which can often look and feel like a coconut shell. By the way, saline implants are Silicone shells that are filled with saline, which is sterile salt water. Saline implants have a greater likelihood of rippling along the edges where the silicone shell wrinkles and folds and may be noticeable in spots not covered by the pectoral muscle. Regardless of whether you choose saline or Silicone, both implants are subject to rupturing and may need to be replaced in the future. That’s just the nature of the beast. Also, some women are good candidates for a procedure that allows a permanent implant to be inserted immediately after their mastectomy without the need for a tissue expander, so ask your doctor. So that’s the basic one, two, three of tissue expanders. Revisions, nipple reconstruction and tattooing of the areola are optional.

When I tell people I’ve had 10 breast cancer surgeries they find it hard to believe, but after a lumpectomy, mastectomy, tissue expander, permanent implant and nipple reconstruction on just one breast, that’s five surgeries right there. For me, the worst part of any of my surgeries was mentally getting geared up for it. The hardest part of reconstruction is the fear and anxiety of the unknown: How will I react to the anesthesia; what could go wrong; is the surgeon and his team really top notch; will I be in any pain; what will my new breast look like and what if I don’t like it? I sometimes wonder if the reason many women elect not to have reconstruction is because of their fears. Except for the post surgery corset I wore for months and months that made my ribs hurt, the procedure itself wasn’t painful. However, as with any surgical procedure, there are always risks so ask questions and weigh your decisions carefully. You should also know that Silicone and saline implants can interfere with mammography screening and both are subject to breakage during the procedure.

Back to the woman who feared her reconstructed breast might be too high or too perky… After a certain age, can breasts ever be too perky? Oh, and in case you’re wondering, don’t even think about stashing Reese’s Peanut Butter Cups in your bra. Don’t ask… It was chemo brain, I tell you, and that’s my story, and I’m sticking to it.