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Breast Reconstruction Surgery - Part I - Tissue Expanders, Breast Implants and Alloderm

Posted Jan 22 2009 6:53pm 6 Comments

This posting is the first of a 3-part series on breast reconstructive surgery  discussing the reconstructive options available to women facing mastectomy for breast cancer.

Every woman has a right to breast reconstruction. This has now actually become a federal mandate and insurance companies are required to pay for all types of breast reconstruction by law. Having said that it is also important to remember that it’s not up to the health insuranc carrier to decide which reconstruction a patient receives. That’s determined by the patient and her surgeons.

Breast reconstruction is not a form of cosmetic surgery – it restores something that nature has provided but cancer has taken away. There is also no age limit – as long as there are no medical conditions that render the surgery unsafe and the breast cancer is diagnosed at an early enough stage, most women are candidates.

Breast reconstruction can be performed as an “immediate” or “delayed” procedure. As the term implies, immediatereconstruction is performed immediately after the mastectomy while the patient is still under anesthesia. Once the general surgeon has completed the mastectomy the plastic surgeon begins creating the new breast. Advantages of this approach include the option of preserving most of the breast skin (“skin-sparing mastectomy”) and a shorter scar. The patient also wakes up “complete” and avoids the experience of a flat chest. Immediate reconstruction generally provides far superior cosmetic results.

Delayed reconstruction generally takes place several months following mastectomy. Patients required to undergo radiation after mastectomy may be advised to delay reconstruction in order to achieve the best results. This delay may last several months in order to allow the tissues to recover as much as possible from the radiotherapy.

There are several reconstructive options for women to choose from, ranging from breast implants to “autologous” techniques using the patient's own tissue to recreate a more “natural”, warm, soft breast. The nipple and areola can also be recreated.

Tissue Expanders and Breast Implant Reconstruction

This is the most common method of reconstructive breast surgery currently being used in the United States. Most surgeons perform this is a two-stage procedure. The tissue expander is essentially a temporary breast implant which can be placed either at the same time as the mastectomy or after the mastectomy has healed. The expander is used to stretch the skin envelope and recreate the size of breast the patient wants. The expander is ultimately replaced by a permanent implant (saline or silicone) at a separate procedure several months later.

Some patients undergoing immediate breast reconstruction are candidates for one-step breast implant reconstruction whereby a permanent implant is inserted at the time of the mastectomy and the patient avoids going through the whole expansion process. In the one-step implant reconstruction the implant is completely covered by the pectoralis muscle and Alloderm (a cadaveric acellular dermal graft). This is specially treated skin from a cadaver that is used to provide a sling and coverage of the lower part of the implant.

Two types of implants are available to patients: saline and silicone. There are many opinions regarding both types of implants and it is advised that you speak with your surgeon as to which implant would be best for you. Patients who undergo implant reconstruction should be aware that their breast implants may need to be replaced at a future date.

Implant reconstruction can be the best option for some patients. However, tissue expanders and implants can be fraught with complications long-term, particularly if the patient has had or is going to have radiation therapy as part of her cancer treatments. For these reasons, many surgeons and patients prefer autologous reconstruction, i.e. reconstruction using the patient's own tissue taken from another part of the body. These will be discussed in upcoming posts.


Dr Chrysopoulo is a board certified plastic surgeon specializing in  reconstructive breast surgery after mastectomy.  Techniques offered include Alloderm one-step reconstruction and DIEP flap reconstruction.   PRMA Plastic Surgery, San Antonio, Texas.  Toll Free: (800) 692-5565. Keep up to date with the latest news in breast reconstruction at  The Breast Cancer Reconstruction Blog. Also follow us on  Facebook  and  Twitter!


reconstructive breast surgery, breast reconstruction surgery blog, breast cancer reconstruction,  Tissue Expanders, Breast Implants and Alloderm, chrysopoulo, PRMA plastic surgery 

Comments (6)
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i had expanders placed in both breast on Nov 18 2009 with a doctor in houston, problem is two fold my right side feels it has fallen into place although still sore at the center "v" area.  my left side is up near my collar bone still draining alot and has tissue filled with fluid under the expander which is causing a lot of pain in my chest and arm   my follow up with the plastic surgeon didnt go well He call me a whimp and told me that most of his clients get up and pole dance when this is done to make a women feel better but when it is a choice to deal with cancer we make it as though it is more diffcult than it is and for me to "man up" 

I am now coughing up lime green stuff from my chest and my lungs are clear and i do not have a cold 

What effects does this have on my surgery and is the lime green liquid do to a leak?  I am to see the plactic surgeon tomorrow and would like to have some good question to ask relating to these issues. 

Thank you for your assistance


Sorry GMA, just noticed your post! How did it go with your PS?

Thank you for listening and offering your time to me

I have had one fill and the drains were removed, one drain was still red blood emptying 47 cc within 8 hours before he removed it.  I now have a large buldge under my arm with pain going into my left arm,  my blood pressure is high then low seems to get high when i use my left arm in just everyday use.  I have been rush to the ER twice for blood pressure being high 223/167 my pain control doctor and pc feels the rise in BP is due to pain coming from under my arm.  Then I had pnenuia (sorry for the spelling) and spend 6 days running every test related to my heart and my heart is fine the doctors at St Lukes feels it is the pressure under my arm due to fluid build up causing my issues I can not take deep breaths due to pain so I breath shallow.  My plastic surgeon just refuses to commuicate with these doctor No doctor or myself thinks he did anything wrong with his procedure with the except of the left implant being to high on my chest.  This doctor has insulted me in many ways mostly by telling the doctors that this is all in my head, that i just want meds, and attention.  He does not know me well enough to make those comments and i am very hurt and upset that he says the thing to professional who have assured me that my pain is real and that the placement of the expander is high and could be causing my shallow breathing.  I still have to have surgery not to mention seeing this doctor again.  I truly dont trust him and I dont think he likes me much  as he says i am a problem patiant for him.  What do I do now I am in the middle of this thing and on medicare who has paid him for completing the second surgery and I dont think i want him operating on me again.  

If you could advise me of what I should do I would like your advice

Thank you for being here for us all who have to deal with this difficult time


Carol Newell

sorry was not sure how to use this so i put my comment below I hope you receive it thank you Carol

The feeling in the new breast won't be as good as what Mother Nature provided but it's certainly a lot better than the alternative. A nice bonus at the very least.


The feeling in the new breast won't be as good as what Mother Nature provided but it's certainly a lot better than the alternative. A nice bonus at the very least.


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