The breast reconstruction technique with an expander and an implant usually involves at least two interventions.
In the first intervention, a temporary placement is made of an implant with expansion capacity which is filled gradually with liquid. Through the regular infusion of liquid (every 1 or 2 weeks) the desired volume of skin expansion is achieved. This first surgical phase lasts approximately two hours. Normally it requires 2 days of hospitalization.
Once the ideal size is reached, two to six months need to pass before proceeding to the second intervention, when a standard breast implant is inserted (of silicone gel) to recreate the shape of the original breast.
This second operation which consists of implanting the prosthesis lasts an hour and a half. The patient needs to stay in the hospital for a day and to rest for a week.
After a few months, the patient can decide to have a third intervention under local anaesthetic and on a smaller-scale to reconstruct the areola and the nipple.
Breast reconstruction with an expander and implant is indicated for patients with small breasts who don’t want the reconstruction with their own tissue because they don’t want any additional scars in the donor zone or because they prefer a simpler treatment which has a quicker postoperative recovery.
There are several advantages to breast reconstruction with an expander and implants. The expanded skin is sensitive and has the same characteristics in terms of colour and texture. Surgery time and postoperative recovery time is shorter. It is a relatively easy technique.
As to disadvantages, we can say that the total time for reconstruction is longer (the installation of the expander, the gradual expansion of it and the replacement of it with the definitive implant). A second operation is required to change the expander for the implant. Finally, the result isn’t usually as natural; the aging of the reconstructed breast is usually different to the other breast.
In 20% of the cases, the complications that are presented are infection, malposition and rupture. In the case of previous radiotherapy, the percentage of complications could increase by up to 60% and usually require extracting the implant. As well as that there could be seromas (accumulation of liquid) or hematomas (bruising). The main long-term complication is capsular contracture, which occurs in 3% of patients and consists of an excess of scar tissue around the implant which causes visible deformity.