Two Stage Expander-Implant Reconstruction

Two stage breast reconstruction requires two surgeries. The first surgery involves placing an expander under the pectoralis muscle. Two weeks following the surgery, saline or “salt water” is placed into the expander every two weeks through the port inside the expander which is done in Dr. Watts’ office. It take approximately 4-6 weeks to finish the expansion process. Once the expander has reached the patient’s preferred size, we let the skin envelope relax for at least 3 months.

We may wait up to 6 months if the patient requires radiation. A second surgery is then planned to remove the expander and place the permanent silicone or saline implant. This can be performed as an immediate reconstruction; at the time of mastectomy or as a delayed reconstruction where the mastectomy has been completed some time before. This can be performed as a unilateral procedure, for only one breast or as a bilateral procedure (for both breasts). Patients who are not candidates for this procedure include BMI>32, those who smoke and often those with large breasts.

Complications include capsular contracture, mastectomy flap necrosis, infection, hematoma, seroma, DVT/PE, wound healing problems, asymmetry and implant maloposition. Drains may be required.