This information will help you learn how to care for yourself after your breast reconstruction surgery using a tissue expander and will help you get ready for the tissue expander process.
This resource is meant to add to, not replace, discussions with your doctors and nurses. Some of the material may not apply to you. Be sure to ask your plastic surgeon or nurse if you have any questions.Back to top
About Breast Reconstruction Using a Tissue Expander and Implant
After your mastectomy (surgery to remove your breast), you will have a breast reconstruction surgery using a tissue expander. A tissue expander is an empty breast implant that your surgeon will fill with normal saline over 6 to 8 weeks until it reaches the breast size that you and your surgeon decided on. In this type of reconstruction, your surgeon will either make a pocket under a large muscle in your chest and place a tissue expander in that space or place the expander above the large muscle. Your surgeon will discuss the placement of the expander with you at your presurgical consultation.
About 4 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 permanent implant will be placed.
Some people also want to have nipple and areola (the brown or pink circle around your nipple) reconstruction. If you decide to have nipple reconstruction, you’ll need to wait about 2 to 4 months after the permanent breast implant is placed.Back to top
What to Expect After Your Surgery
After your surgery, you will wake up in the Post-Anesthesia Care Unit (PACU) or your recovery room. You will have:
- An intravenous (IV) line. You will receive fluids, antibiotics, and pain medication through the IV.
- Small plastic drains, called Jackson-Pratt® (JP) drains, below or near each incision (surgical cut). They collect fluid from around your incisions after surgery. The drains are secured with a suture (stitch) and usually stay in place for 1 to 2 weeks after surgery.
Your PACU nurses will answer any questions you may have. Your family will be allowed to visit you for a short time in the PACU. You’ll be taken to your room the evening of your surgery or the morning after.
Your nurses and nursing assistants will care for your JP drains while you’re in the hospital. Many people go home with drains in place. If you go home with drains in place, your nurses will teach you how to care for them and give you a resource called Caring for Yourself After Your Breast Implant Surgery. Your drains will be removed 1 to 2 weeks after your surgery. You can also watch the video below to learn how to care for your drains.
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 will be closed with sutures (stitches). These sutures will dissolve and don’t 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 isn’t completely filled when it’s placed. Before you go home and with your nurse present, you should look at and feel your breast and incision during the dressing changes to help you become familiar with it. You may be able to feel the port that’s used to fill the tissue expander under your skin.
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 get better. You can take pain medication when you need it. Be sure to ask your doctor or nurse for it. Controlling your pain will help you recover better and become active as soon 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 slowly get better over time, but some amount of numbness may be permanent.Back to top
Caring for Yourself at Home
When you leave the hospital, your incision will be covered with a gauze pad. Continue to wear your surgical bra 24 hours a day until your doctor gives you other instructions.
Don’t shower or wet your dressing for the first 48 hours after your surgery. Your surgeon will let you know how you should shower after the first 48 hours. You may be able to take a full shower or you may need to shower only from your waist down.
Your drains will be removed 1 to 2 weeks after your surgery. You may take a full shower 24 to 48 hours after your drains are removed.
When you can start showering, take a shower every day to help keep your incision clean. Before entering the shower, remove your bra and the gauze pad covering your incision. Check the temperature of the water first with your back or hand because numbness may prevent you from feeling heat in the affected area.
Wash with warm water and gentle, fragrance-free soap. Gently clean your upper incisions and drain sites and rinse well. Don’t aim the shower stream directly at your reconstructed breast. Aim it at your upper back or your arm and run softly over your reconstructed breast. Allow soap and water to run over your incisions and drain sites, and rinse well. Pat your incisions dry with a clean towel. Don’t rub them.
Don’t take tub baths until your incisions and drain sites are fully healed because soaking may increase the risk of infection. You may be able to take tub baths about 6 to 8 weeks after your surgery but speak with your doctor before you do.
Check your incisions and drain sites
After your shower, look at your incisions 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:
- A fever of 101° F (38.3° C) or higher
- Increased redness of your breast
- Increased swelling of your breast
- New drainage from your incision
When you finish checking your incisions and drain site, place a clean gauze pad over your incision and put on your bra.
You can shave under your arms about 2 weeks after your surgery. Only use an electric razor to shave under your arms 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.
Don’t use deodorant until after you have put your bra on. This will prevent the deodorant from getting on your incision and causing an infection. Don’t use deodorant on the side of your surgery if there is any break in the skin there.Back to top
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.
JP drain removal
During this appointment, your plastic surgeon and nurse will examine your breast incision to make sure it’s healing well. If you went home with a JP 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 feeling that lasts only a few minutes. You will not need to take pain medication for the drain removal process.
After your drain(s) is removed, some fluid may continue to leak from the drain site(s). Cover the area with a sterile gauze pad or the Primapore TM dressing that your nurse gave you. Change your gauze and dressing if they become damp. This drainage is normal and can be expected for 24 to 48 hours after your surgery. By that time, the drain sites are usually healed.
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.
What to Expect During Tissue Expansion
During your second or third office visit, you will have your first tissue expansion. Your nurse will inject normal saline into the tissue expander through the port using a small needle. You will have a tissue expansion appointment every week or every other week. Each expansion appointment takes about 20 minutes.
After each 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 won’t take its final form until the permanent implant is placed.
Ways to be more comfortable between tissue expansions
Here are some things you can do to increase your comfort between tissue expansions:
- Take warm showers.
- Take over-the-counter pain medications (medication you buy without a prescription), such as acetaminophen (Tylenol®) or ibuprofen (Advil®).
- Apply a fragrance-free moisturizer (such as Eucerin®, Lubriderm®) to your breast skin. Don’t 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. Don’t wear underwire bras.
You can continue your normal activities after each tissue expansion appointment. Follow these guidelines while you heal to stay safe and comfortable.
- You can return to work or do light housekeeping a few hours after your appointment.
- If your job involves lifting 10 pounds (4.5 kilograms) or more, you may need to change your work schedule until it’s safe for you to lift heavy weights.
- Don’t lift anything heavier than 5 pounds (2.3 kilograms) with your affected arm for 6 weeks after your surgery. Check with your breast surgeon to see how many lymph nodes were removed because your lifetime lifting restrictions may be different.
- You can drive when you have a full range of motion in your shoulder on your affected side and you aren’t taking any prescription pain medication.
- Avoid forceful exercise unless approved by your doctor. For example, don’t jog, jump, or run.
- Don’t do any type of exercise that will tighten or bulk your chest muscles.
- When traveling a long distance by car, pad your seat belt if it falls directly over the tissue expander. It’s important to wear your seat belt so do what you need to to be comfortable, but don’t avoid wearing it.
- Don’t have magnetic resonance imaging (MRI) done. You can have other imaging tests, such as a bone scan, computed tomography (CT) scan, or x-rays.
- Don’t soak in a pool, bathtub, or hot tub, until your doctor or nurse tells you it’s safe to do so. This is to decrease your risk of irritation or infection at your incision.
- Your surgical sites may have less feeling. Don’t 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. They will give you a letter to take with you explaining that you have a tissue expander.
Your 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 one breast was operated on.
During the different stages of your breast reconstruction, your bra can be padded to help balance your appearance. One way to fill the bra is to use a soft breast form. This breast form is a lightweight nylon pouch. 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 buy the breast form from the Breast Boutique at the Evelyn H. Lauder Breast and Imaging Center (BAIC). The Breast Boutique is located at 300 East 66th Street, at 2nd Avenue. To reach the boutique, call 646-888-5330.
You can also line your bra with soft gauze, which you can get from your nurse. Replace the gauze every day to make sure that it’s 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
- Button-up, loose-fitting dresses
After Your Tissue Expansion is Finished
Once you have finished the tissue expansion, the next stage of your breast reconstruction will be scheduled. This stage is the surgery to remove the tissue expander and place the permanent implant. The surgery will be done 4 to 6 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. You will be able to go home once you have recovered from anesthesia (medication to make you sleep). This is typically 3 to 4 hours after your surgery.
Nipple reconstruction and fat grafting
The last stages of reconstruction include nipple reconstruction and fat grafting if needed. Fat grafting is when fat is removed from a part of your body, such as your thighs, abdomen (belly), breast and injected into your breast area.
If you decide to have nipple reconstruction, it’s usually done about 2 to 4 months after the permanent implant is placed. Nipple reconstruction can be done either in the operating room or in your surgeon’s office. If your reconstructed nipple or areola (brown circle around the nipple) needs to be darkened, you can have it tattooed in your doctor’s office.
If needed, fat grafting will be done in the operating room. It can be done at the same time as the nipple reconstruction.Back to top