This is the most common type of breast reconstruction because it involves less of your body to be operated upon and is not as great of a recovery period all at once like the other two methods.  This method is usually started at the time of the mastectomy(ies) as immediate reconstruction.  Once the doctor performing the mastectomy(ies) is finished with their part, we begin the placement of the tissue expander(s).  After the tissue expander(s) is/are placed in the pocket(s), a temporary drain is placed on the operated side or bilaterally (depending on unilateral-one side or bilateral-both sides) and the incision(s) is/are closed. 

Usually the patient will wait until the drains are removed before starting the fill process, but others wish to start immediately, given their pain level is tolerable.  Usually the drain(s) are finished by two weeks but it varies from patient to patient.  The drain amount must fall below 20 cc in a 24 hour period before it is safe to remove the drain(s).  If the drains are removed too early, a pocket of fluid called a seroma will begin to develop and the patient is required to come into the office every other or every couple of days to have the fluid aspirated out of the pocket with a needle until the pocket eventually stops collecting fluid.

Once the patient begins the fill process, the patient will return to the office once a week or twice a week, depending on pain level after each fill and what the patient is comfortable with.  Each visit we will use our magnetic marker to mark the spot we need to inject through a self-sealing valve within the tissue expander.  Usually we fill 60 cc each visit unless it causes too much pain requiring pain medication for days after the fill, then we would cut it back to 30 cc each visit. 

It is up to the patient to decide how big they want their implants to be.  We usually continue to fill until the patient says they have reached their desired size.  The next step is to wait 6 weeks and allow the skin to adjust to the volume within the expander.  After 6 weeks after the last fill, we can schedule the replacement of the tissue expanders with permanent implants.  After that surgery we will show you how to do breast softness exercises that will keep the breast(s) soft and moveable.

The next step is nipple reconstruction, and we strongly advise the patient to be absolutely sure they are completely satisfied with the result at this point before placing the nipples.  If the breast(s) need any sort of modification for symmetry (to make them look the same), that needs to be done before placing the nipples.

Once the nipples are reconstructed, we ask the patient to wait another 6 weeks to be completely healed before scheduling the last step, which is the tattooing of the areola(e).  The tattooing is done in the office, wide awake and tolerated well.