Breast Reconstruction with Tissue Expander

There are several techniques available for breast reconstruction following mastectomy for breast cancer. While some surgeons offer flap procedures, such as TRAM flap, latissimus dorsi flap, as well as microvascular flap procedures, Dr. Casso prefers a simpler method which involves creation of a space under the skin and pectoralis muscle on the chest wall for insertion of a tissue expander, which is like an empty balloon. Beginning about a month after surgery, the patient undergoes monthly injection of saline into the expander in Dr. Casso’s office. The expander port is localized, local anesthesia is injected, and the expander is partially filled. When the expansion starts to feel tight for the patient, the expansion is terminated. In about another month, after stretching and relaxation of tissues has occurred, the process is repeated.

Typically, it takes about 6 months for the desired expansion to occur. At that time, another surgical procedure is performed. This involves removal of the expander and associated scar tissue, and replacement with a permanent implant.

For patients desiring nipple-areolar reconstruction, a third procedure is performed.

Patients interested in breast reconstruction are seen in consultation to discuss their options.

Patients who desire flap reconstruction are referred to outside institutions.

It is Dr. Casso’s preference to defer surgery until the patient is well healed from mastectomy.

Patients undergo breast reconstruction with tissue expanders under general anesthesia at Houston Methodist St. John Hospital. Most patients elect to go home in the afternoon after surgery, although an overnight stay is an option.

Postoperative pain is generally moderate, and well-controlled with oral pain medication.

Patients are seen the following day, if possible, and dressings are changed. Patients are allowed to shower in 3 to 4 days. Sutures are removed in about 10 days. Patients may return to light work in about a week, but vigorous exercise is discouraged for about six weeks.

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