In the April 2015 issue of Plastic and Reconstructive Surgery Journal there was an article on when to start expanding a breast tissue expander after reconstruction. The usual story is this:
- You get breast cancer.
- You have a mastectomy (total removal of the breast) with immediate placement of a breast tissue expander at that surgery.
- During that first surgery you inflate the tissue expander some in surgery.
- You wait about 2 weeks, and then in the office you expand the tissue expander every 2-3 weeks until you get to the desired size.
- If you need chemo, you time the expansion with the chemo
- You try to make sure you are fully expanded before radiation if you need radiation.
Their question: is there a reason to wait to start to do any expansion?
They chose to wait 6 weeks. When they did the second surgery to replace the tissue expander with the final implant, they took some of the capsule which formed initially and analyzed it. They thought it may be better to allow the textured expander implant to adhere and form the capsule before starting to stretch the capsule. They looked at things like biofilm, double capsules, and the histology of the capsule itself.
What did they find?
They found the capsule did look different when they waited to start the expansion. They are not sure though if this difference will cause a clinical difference in how reconstructions go. They recommend further study.