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Plastic and Reconstructive Surgery

Breast Reconstruction (Tissue Expansion)

Contact: (0191) 282 0194 - Plastic Surgery Breast Nurse RVI


IntroductionShow [+]Hide [-]

This information is intended to help you understand the operation and the aftercare that will be necessary to achieve the best possible result.  This should be read together with Understanding the Implications of Breast Implant Surgery

What is Tissue Expansion Breast Reconstruction?

This is one of a number of techniques that may be used to reconstruct a breast after mastectomy surgery (or to increase the size of one breast where there is a marked difference between the two breasts, or both breasts if development has been limited). The procedure involves placing a “tissue-expander” implant under the muscle of the chest wall. This expandable implant has a silicone shell and may contain some silicone gel but also has a chamber into which saline (salty water) can be injected to gradually fill the implant. The purpose of this is to stretch the skin gently over a period to accommodate the implant at its largest size.

Filling with saline is carried out via a small port attached to the implant, which is also positioned under the skin. It is usually carried out several times at an outpatients’ clinic at intervals of one to three weeks. It only takes a few minutes to perform these injections. Often, the implant is expanded up to slightly larger than the final intended size. It is left at that size for approximately three months to achieve maximum stretching of the skin. After this, some of the saline is removed and the stretched skin lying loosely over the implant gives the new breast a more natural appearance.

Depending on the type of tissue-expander implant used, it may remain in place permanently or it may be changed for a fixed-size silicone implant. If the expander implant is to remain in place, the filling port is usually removed during another minor operation.

Before your procedureShow [+]Hide [-]

For Breast Reconstruction procedures, general assessment and information giving usually begins in the Nurse-led outpatient clinic. For all procedures, assessment and information giving will take place in the outpatient clinic appointment with your consultant.

After this, if the operation involves a general anaesthetic, you will be requested to attend a "pre-assessment" clinic for a full check of your general health and home circumstances. Any further questions about the operation or the anaesthetic can be answered at this appointment. For urgent procedures, you may be given a date for surgery by your consultant. For non-urgent procedures, you will be informed of your date of surgery by the Waiting List office in due course.

During your procedureShow [+]Hide [-]

The operation is carried out under a general anaesthetic. A Trust information leaflet is available which will provide you with the details you require regarding your anaesthetic – “You and your anaesthetic.”

For patients who have undergone mastectomy, the implant is inserted through the same scar. For patients with small breasts, the implant is usually inserted through a scar underneath the breast. The operation takes approximately two hours to perform. It is likely that you will have a “drain” or plastic tube inserted into the breast wound. This acts to drain away any further oozing of blood and prevent large bruises or clots building up around the operation site. It will be removed on the ward once the amount of fluid being drained is minimal.
 

After your procedureShow [+]Hide [-]

For most patients the length of stay is for two to four days after the operation when the drains are removed and you are able to go home.

An appointment will be made for you to have the stitches trimmed or removed, approximately 10 days after surgery, in a plastic surgery dressing clinic. You may also need to attend this clinic for further dressings. Your wounds should be kept covered by dressings until the stitches are trimmed or removed. Another appointment will be made for you to see the doctor in the outpatient clinic, at two to three weeks after surgery, to start the expansion process.

You will be offered painkillers both in hospital and to take home.

Advice on bras or other garments to be worn will be given after surgery. You may need to use a soft prosthesis or padding in a bra until the expansion process is complete.  Underwired bras should be avoided until your wounds are healed.

After three to four weeks, you may start light exercise.  Return to work will depend on occupation. Light duties can usually restart within three to four weeks.

You will need to attend the outpatients’ department every one to three weeks initially for expansion procedures.

Heavy lifting and strenuous exercise should be avoided for at least six weeks. Vigorous arm exercises should be avoided for 12 weeks.

Driving should be avoided until your wounds have healed and you can comfortably wear a safety belt. This may take several weeks.

Any specific instructions for you will be explained before your discharge from hospital.
 

Consequences and risksShow [+]Hide [-]

Most patients will experience few, if any, complications but it is important to be aware of possible problems.

Bleeding:  Bleeding may occur after surgery (usually within 12 hours of the operation). A very small amount of bleeding is not uncommon but anything more than this may mean that you need another short operation to stop the bleeding.

See your leaflet “Understanding the Implications of Breast Implant Surgery” for all implant related issues.

Infection: You will be given antibiotics during the operation to reduce the risk of infection. If the wound becomes infected after surgery, you may require a course of antibiotics. Any infections that occur in the tissue around the implant can usually be treated with antibiotics. Sometimes, it is necessary to remove the implant until the infection has been treated. It would then be replaced with a new implant.

Asymmetry (unequal size and shape):  In the short term, there will be a marked difference between the breasts until the tissue expansion process is complete.

After breast reconstruction, the size and shape of the new breast will adjust with time and weight changes. It will feel different to natural breast tissue with silicone implants giving a more natural appearance than saline-filled implants.

Most women have some degree of asymmetry (unequal size/shape) between the breasts and this is more likely after this surgery.  If necessary, further surgery can be carried out to reposition or replace the implant. Alternatively, adjustment surgery could be carried out to the opposite breast, if your surgeon recommends this.

Scars:  You are left with a scar on the front of the chest either in the same location as the mastectomy scar or underneath the breast. All scars are red and raised initially and begin to settle over a 12-month period. Occasionally, the scars can become red and raised permanently and can itch. These are known as
hypertrophic, or keloid, scars and are difficult to treat. The scars may also stretch. Once the wound has healed, massage of the scar, using a nonperfumed
moisturising cream, for 10 minutes, four times a day, will help the scar to fade.

If you require any further information or advice, please contact any of the following:

Plastic Surgery Breast Nurse RVI
(Monday – Friday 8am – 5pm)
Telephone:  (0191) 282 0194

Sister or Nurse in Charge – Plastic Surgery Outpatient Department RVI
(Monday – Friday 8am – 5pm)
Telephone:  (0191) 282 4228

Sister or Nurse in Charge – Ward 47 RVI
(at any time)
Telephone:  (0191) 282 5647

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