Breast Reconstruction Methods: Tissue Expander vs. Direct-to-Implant
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Breast Reconstruction Methods: Tissue Expander vs. Direct-to-Implant

The discovery of a breast lump, a cancer diagnosis, the recommendation of a mastectomy —breast cancer feels like one piece of bad news after another. Relief can come when your oncologists tells you that you have the option of breast reconstruction. The possibility of getting back to “normal” becomes the light at the end of the tunnel. You just want to feel at home in your body again, and having your breasts and your health back seems almost too good to be true.

But as you dive into the wealth of information about breast reconstruction, it is important to be patient. Taking your time to evaluate your options will help you make an informed decision for your health and long-term outcomes. One area you may explore can include the different methods of reconstruction using implants. This is a common reconstructive procedure that comes with a relatively quick recovery time, reliable and predictable results and a high level of customizability. One of the key decisions is whether you will have immediate reconstruction, where your final implants are placed during your mastectomy; or reconstruction using a tissue expander, which means placement of the expander at the time of your mastectomy to create a natural-looking breast shape before placing the final implant in a second surgery.

It can be easy to gravitate toward immediate implant reconstruction — why draw the process out further? — but there are pros and cons to both types that warrant consideration. Dr. Christine Fisher, board-certified plastic surgeon and breast reconstruction expert, has weighed in and created this guide about the differences between the two. Learn more below or contact us today at (512) 815-0123 to schedule an in-person consultation with Dr. Fisher in Austin, Texas.

Immediate Implant Reconstruction

True to its name, immediate implant reconstruction offers results right away; patients who choose this option will have their breast implants placed during the same procedure as their mastectomy. There is typically a recovery period of six weeks following mastectomy and implant placement, and then patients are free to resume all normal activities, including exercise.

There are several limitations of immediate reconstruction, though. It is only suitable for women who:

  • Want smaller breasts
  • Have enough skin after their mastectomy for the size of the implant they desire
  • Will not be undergoing radiation therapy

If there is not enough skin to safely cover an implant of your desired size, you will not be eligible for immediate reconstruction. In addition, radiation therapy can cause complications with breast implant surgery such as hardened implants (known as capsular contracture) and scarring, so women who require radiation treatment will not be able to have their implants inserted right away. And, even for women who meet the criteria for immediate reconstruction candidacy, this option may not offer the best or most natural aesthetic outcome. There may be a higher risk of “rippling” or visible edges of the implant showing through the skin, or a higher likelihood of breasts that sit unnaturally high on the chest wall.

You should be sure to carefully discuss this option with your plastic surgeon if you are eligible. They will be able to tell you whether your body type, cancer care plan and desired implant size appropriately allow for immediate reconstruction. Be sure to consult with a board-certified plastic surgeon who has expertise performing immediate implant and tissue expander reconstructions, so they can offer a perspective on the risks and benefits of both types of reconstruction in your particular case.

Tissue Expander Reconstruction

Dr. Fisher and many other plastic surgeons specializing in breast reconstruction prefer tissue expander placement at the time of mastectomy for most patients. This option, though it involves a two-step process, nearly always offers more natural and aesthetically beautiful results — and also offers more flexibility in implant shape and size. The tissue expander process begins with the placement of a specialized expander implant in the breast pocket during the mastectomy or after the patient has fully healed from the mastectomy (in the case of a delayed reconstruction). Over the course of about three months, the tissue expander is slowly enlarged with the addition of saline at weekly or bi-weekly appointments to create a natural pocket that will comfortably and safely accommodate the patient’s final implants.

This option is available for women who:

  • Want larger breast implants
  • Do not have enough skin after their mastectomy to insert implants right away
  • Need radiation therapy after their mastectomy

Implants of many different sizes can be potentially used and will sit in a natural position on the torso. Women who had larger breasts before their mastectomy can recreate a similar breast size, while those who want larger breasts for aesthetic reasons may choose a higher-volume implant. This also gives Dr. Fisher the ability to recommend a specific implant size that will best complement the patient’s body type. And, with the tissue expander method, your final result is less likely to have rippling or visible edges — the implants will take on a more natural shape as they fit within the space created for them.

Which Type of Breast Reconstruction is Best for Me?

If you want to find out more about breast reconstruction with implants in Austin, Texas, call us to schedule your one-on-one consultation with Dr. Christine Fisher. Dr. Fisher regularly performs the full spectrum of breast reconstruction options and has extensive experience creating beautiful results for patients of all backgrounds and body types. We are adept at coordinating with your healthcare team to ensure all of your providers are up-to-date on your reconstruction decisions. Dr. Fisher will evaluate you and your health history to recommend the reconstruction option that will be safest and most effective for your needs. Contact us today at (512) 815-0123 or reach out online to make your appointment.

Christine Fisher MD

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