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Breast Reconstruction Using a Tissue Expander

This information will help you learn how to care for yourself after your breast reconstruction surgery using a tissue expander and will help you prepare for the tissue expander process.
 
You will have a tissue expander placed during your breast reconstruction surgery. A tissue expander is an empty breast implant that will be filled with normal saline over 6 to 8 weeks. This process slowly stretches your skin and pectoralis muscle (large muscle in your chest). When your new breast mound reaches the right size, we will stop the expansion process.
 
About 6 to 8 weeks after the tissue expansion is finished, you will have a second surgery to remove the tissue expander and insert the permanent breast implant. If you will be having  chemotherapy or radiation therapy, your doctor will tell you when your implant will be placed.
 
This resource is meant to supplement, not replace, discussions with your doctors and nurses. Some of the information may not apply to you. Be sure to ask your plastic surgeon or nurse if you have any questions.
 

What to Expect After Your Surgery

Jackson-Pratt® drain(s)

One or 2 small plastic drains, called Jackson-Pratt® (JP) drains, may be placed near your incision. The drain(s) collects fluid that normally develops under the skin after surgery. The drain(s) usually remains in place for 1 to 2 weeks after surgery.
 
If you go home with a drain(s) in place, your nurses will teach you how to care for it. You can also watch a video that shows you how to care for your drains at:
www.mskcc.org/cancer-care/patient-education/resources/how-care-your-jackson-pratt-drainage-system
 

Pain and sensations

You will have some discomfort after your surgery. You may have a stinging sensation along your incision and your drain site(s) may itch. You may also notice some tenderness along your lower ribcage. These sensations will gradually decrease. You can take pain medication when you need it. Be sure to ask your doctor or nurse for it so you will be as comfortable and active as possible.
 
Other common sensations you may experience after your surgery include:
 
  • Numbness under your arm and over your chest on the affected side (side of your surgery).
  • Warmth in your arm on the affected side.
  • A feeling of water trickling down your arm on the affected side.
These sensations are caused by nerves being cut or moved during surgery. They will gradually get better over time, but some amount of numbness may be permanent.
 

Incision

After your surgery, you will have a gauze dressing over your mastectomy incision. The dressing will be held in place by either clear tape or a surgical bra.
 
The incision across your breast mound will be closed with stitches. These stitches will dissolve and do not need to be removed. You may see some redness and slight bloodstains on the gauze pad covering your incision. You may also feel tenderness around it. These are normal signs after surgery.
 
At first, the size of your reconstructed breast will be much smaller than your other breast. This is because the tissue expander is not completely filled when it is inserted. Before you go home and with your nurse present, we would like you to gently touch your new breast mound. You may be able to feel the port that is used to fill the tissue expander under your skin.
 
When you leave the hospital, your incision will be covered with a gauze pad. Continue to wear the surgical bra 24 hours a day until your doctor gives you other instructions.
 

First Follow-up Appointment

Your first follow-up appointment after your surgery will be 1 to 2 weeks after your surgery. Call your plastic surgeon’s office to make the appointment once you’ve been discharged from the hospital.
 

Drain removal

During this appointment, your plastic surgeon and nurse will examine your breast incision to make sure it is healing well. If you went home with a drain(s), your doctor or nurse will remove it if the amount of drainage is less than 30 mL (1 fluid ounce) in 24 hours, per drain. Most people describe the drain removal as a slight pulling or stinging sensation that lasts only a few minutes. You will not need to take pain medication for the drain removal process.
 
After the drain(s) is removed, continue to wear the surgical bra or you can wear your own supportive bra. It should:
 
  • Be comfortable.
  • Not be too tight.
  • Not have an underwire.

Caring for Your Drain Site(s) and Incision

Showering

Do not shower or wet your dressing for the first 48 hours after your surgery.
 
If you have a drain(s) that is covered with a clear, waterproof cover, you can shower 48 hours after your surgery.
 
If you have a drain (s) that is not covered with a waterproof cover or the cover has fallen off, you can shower from the waist down while the drain is in place. Once it is removed, wait 48 hours to take a full shower.
 
After your drain(s) are removed, some fluid may continue to leak from the site. This drainage is normal and can be expected for 24 to 48 hours, until the site is fully healed. Cover the area with a sterile gauze pad and change it if it becomes damp.
 
Once your drain site(s) is healed, take a shower every day to help keep your incision clean. Do not take tub baths until your incision is fully healed because soaking it may increase your risk of infection for about 6 to 8 weeks after your surgery.
 
Before entering the shower, remove your bra and the gauze pad. Check the temperature of the water first with your back or hand because numbness may prevent you from detecting heat in the affected area.
 
Wash with lukewarm water and gentle, fragrance-free soap. Gently clean your upper chest and allow the soap and water to run down over your incisions, and rinse well. Do not scrub your incision or direct the shower stream at your reconstructed breast. Pat your incision dry with a clean towel; do not rub it.
 
Only use an electric razor to shave under your arm on the affected side. This is to prevent getting a cut, which you may not feel due to numbness. A cut could lead to an infection.
 
After your shower, inspect your incision and drain site(s) carefully. To do this, stand in front of a mirror in a room with good lighting. Call your plastic surgeon or nurse if you have any of the following signs or symptoms of infection:
 
  • New skin redness
  • New drainage from the incision
  • New increased swelling
  • A temperature of 101° F (38.3° C) or higher
When you have finished the inspection, place a clean gauze pad over your incision and put on your bra.
 

What to Expect During Tissue Expansion

During your second office visit, you will have your first tissue expansion. Your nurse will insert normal saline into the tissue expander through the port using a small needle. Each expansion appointment takes about 20 minutes.
 
After the tissue expansion, you may feel some tightness and fullness in your breast area and some discomfort in your shoulder or back. This usually gets better within a few days.
 
After each expansion, your reconstructed breast will become larger. However, the breast will not take its final form until the permanent implant is inserted.
 

Increasing your comfort

Between tissue expansions, here are some things you can do to increase your comfort:
 
  • Take warm showers.
  • Take over-the-counter pain medications, such as acetaminophen (Tylenol®) or ibuprofen (Advil®).
  • Apply a fragrance-free moisturizer (e.g., Eucerin®, Lubriderm®) to your breast skin. Do not put the moisturizer directly on your incision for 6 weeks after your surgery.
  • Do the upper arm stretches and other exercises as instructed in the Exercises After Breast Surgery resource your nurse gave you.
  • Wear soft, supportive bras. Do not wear underwire bras.

Daily activities

After each tissue expansion, you should continue your normal activities. You can return to work or do light housekeeping a few hours later. You can also drive when you have full range of motion in your shoulder on your affected side and are not taking any prescription pain medication. However, follow the restrictions on physical activity below:
 
  • Avoid vigorous exercise unless approved by your doctor. For example, do not jog, jump, or run.
  • Do not lift any objects heavier than 5 pounds with your affected arm for 6 weeks after your surgery. Please check with your breast surgeon if you have had a large number of lymph nodes removed—your lifetime lifting restrictions may be different.
  • If your job involves lifting 10 pounds or more, you may need to change your work schedule until it is safe for you to lift heavy weights.
  • Do not do any type of exercise that will tighten or bulk your chest muscles.
  • When travelling a long distance by car, pad your seat belt if it falls directly over the tissue expander. Do not avoid wearing a seat belt.

Other precautions while the tissue expander is in place

  • You cannot have magnetic resonance imaging (MRI). You can have other imaging tests, such as a bone scan, computed tomography (CT) scan, or x-rays.
  • Do not soak in a pool, bath tub, hot tub, etc., until approved by your doctor or nurse. This is to decrease the risk of irritation or infection at your incision.
  • Your surgical sites may have less feeling. Do not put a heating pad or hot or cold compress on them. This is to prevent burn or damage to your skin.
  • The tissue expander may set off airport security devices. Tell your doctor or nurse if you plan to travel; you will be given a letter to take with you.

Clothing tips

As your plastic surgeon explained to you, the tissue expander will be over expanded. As you near the end of the expansion, your reconstructed breast may look larger than your other breast (if only 1 breast was operated on). To help balance your appearance, you can fill your bra with a soft breast form. This can be purchased from the Breast Boutique at the Evelyn H. Lauder Breast Center (300 East 66th Street, 646-888-5330). This breast form is a lightweight nylon pouch, and the size can be adjusted to match your opposite breast by adding or removing the cotton fluff inside. This is especially useful as your breast mound becomes larger during expansion.
 
You can also line your bra with soft gauze. Replace the gauze frequently to make sure that it is always clean.
 
Some other clothing tips include wearing:
 
  • Loose blouses, tops, and sweaters
  • Dark knit tops under a looser open blouse, sweater, or blazer
  • Tops with diagonal stripes
  • Asymmetrical prints
  • A neck scarf or shawl

After Tissue Expansion Is Completed

Once you have finished the tissue expansion, the next stage of your breast reconstruction will be scheduled. This stage is the removal of the expander and placement of the permanent implant during surgery. The surgery will be done 6 to 8 weeks after the expansion is completed so that your skin can rest. This date may change if you need other treatments such as chemotherapy or radiation therapy.
 
The surgery to take out the tissue expander and insert the permanent implant takes about 1 hour for each side. If a matching procedure is done on your other breast to make it match the shape and size of your reconstructed breast, it takes more time. The surgery can usually be done in the Surgical Day Hospital (SDH). You will be able to go home 3 to 4 hours after your surgery.
 
The last stages of reconstruction include nipple reconstruction and fat grafting, if needed. If you decide to have nipple reconstruction, it is usually done about 2 to 4 months after the permanent implant is placed. Nipple reconstruction can be done either in the SDH or in your surgeon’s office. If your reconstructed nipple/areola needs to be darkened, tattooing of the area can be done in the office. If needed, fat grafting will be done in the operating room in the SDH. It can be done at the same time as the nipple reconstruction.