An Overview of Breast Tissue Expander Rupture

Symptoms, Causes, Treatment, and Prevention

In This Article

A breast tissue expander is an implantable, balloon-like device used to stretch breast skin and chest wall muscles following a mastectomy. Over the course of two to six months, the expander will create a pocket so that a permanent saline or silicone implant can be inserted as part of breast reconstruction surgery. As with all surgical devices, breast tissue expanders come with certain risks, the most common being ruptures and leaks.

Although a rupture is not considered a medical emergency, it requires an immediate response and, more often than not, surgical replacement of the device.

Overall, the risk of rupture is between 3% and 5% over three years and 7% and 10% over 10 years, according to a 2014 review in the Archives of Plastic Surgery.

Signs and Symptoms

The rupture of a breast tissue expander may not be all that noticeable at first. You may experience a gradual decrease in the size of your breast or notice that the shape of your breast has suddenly (or gradually) changed.

For instance, if the rupture occurs at the top of the eggplant-shaped device, the top part of the breast may suddenly flatten. If the rupture occurs near the bottom, you will likely experience an overall deflation of the chest cavity. Because the device is filled with a saline (saltwater) solution, the fluid will gradually be absorbed the body.

A traumatic injury or excessive compression may cause the implant to burst, evidenced by an immediate change in breast size or shape.

The rupture itself may not cause pain unless it was caused by a blunt force or a puncture wound. A traumatic injury may cause bleeding, especially if the external port (where the saline fluid is injected) is disrupted.

If not treated in a timely manner, an infection may develop, affecting both external and internal tissues.

breast tissue expander rupture
Verywell / Gary Ferster

Causes

A breast tissue expander will often be placed during a mastectomy, either under the pectoralis (chest) muscle or over it. If other cancer treatments are planned, a separate surgical procedure may be scheduled after these other therapies are completed.

The implants themselves are quite sturdy and designed to be left in place for months. However, they are vulnerable to rupture if handled roughly or inappropriately. Some of the causes of tissue expander rupture include:

  • Surgical puncture, occurring during the initial implant procedure or a related breast surgery
  • Mammogram compression, in which the radiology technician applies too much pressure during the imaging procedure
  • Traumatic injuries, including sports injuries, falls, or vehicle accidents
  • Overfilling the expander, often in an effort to accelerate the procedure (this can also be very painful)
  • Valve leakage, often caused by a needle puncture or the disruption of the junction between the expander and external port
  • Product defects (rare, but possible)

Risk Factors

There are also factors that may increase the risk of tissue expander ruptures. Surprisingly, they are not what many people imagine them to be.

A 2017 review of studies from Japan suggested that large breast size and smooth expander implants are the only two relevant risks factors for tissue expander ruptures.

A large breast increases the risk of rupture simply because the implant has more room for flexure. Smooth implants are more vulnerable than textured ones because they are prone to twisting and slippage. This is increased risk, however, may be offset by risks related to textured implants and should not be the primary reason for avoiding a smooth implant.

Capsular contraction, the hardening of the breast cavity tissues, can also contribute by reducing the available space within the breast cavity, increasing the risk of overfilling.

Despite suggestions to the contrary, there is no evidence that obesity, older age, diabetes, smoking, or radiation therapy increases the risk of a tissue expander rupture. However, they may slow postoperative healing and/or increase a woman's vulnerability to infection.

Diagnosis and Treatment

A breast tissue expander will almost invariably be removed if a leak or rupture has occurred. The only exceptions may be if the leakage occurred somewhere near the external port or you are near the end of your expansion procedure.

Even if a rupture is apparent, your doctor will order an imaging study (such as an ultrasound or breast MRI) to check for bleeding, infection, or other internal abnormalities.

It is important not to rush into surgery without completing these imaging tests. Your insurance company may deny your claim for a replacement if you have not provided them with evidence of the rupture.

The surgery would ideally be performed by a plastic surgeon, who would use the same incision site to minimize scarring and avoid complications prior to the final reconstructive procedures.

If the rupture occurs near the end of the expansion procedure, the surgeon may recommend removing the expander and moving straight to the permanent breast implant if the cosmetic results are deemed acceptable. This might mean opting for a permanent implant that is slightly smaller than you had originally planned, and each woman must weigh this decision for herself.

Prevention

Breast tissue expanders can rupture for any number of reasons. While there is no way to predict if and when a rupture might occur, there are a number of things you can do to reduce your risk:

  • Choose the right surgeon. Although many plastic surgeons are qualified to perform breast augmentation, you need to find one who is skilled in breast reconstruction. These specialists are trained to deal with complications caused by radiation therapy and other cancer-related treatments. When choosing a surgeon, you can ask what procedures she performs. Some plastic surgeons limit their practice to breast reconstruction after breast cancer, whereas others perform a wide variety of procedures. The larger cancer centers, especially those that are considered National Cancer Institute designated centers, are more likely to have plastic surgeons such as this on staff.
  • Understand your treatment options. There are smooth and textured extenders. There are also surgical mesh and dermal matrix products used to stabilize the expander and help tissues grow. Ask your surgeon why certain products have been chosen, and seek a second opinion if you are concerned about the recommendation. Recent concerns over an increased risk of secondary sarcoma with some implants should be discussed as well.
  • Know your limitations. As much as you may want symmetrical breasts, skin can only expand so much and may not be exactly the same in all cases. This is especially true if there is encapsulation or the expander is placed in front of the pectoralis muscle. Overfilling can lead to the abnormal thinning of breast skin. Some women who have chosen to "go larger" after breast cancer note that their new breasts "get in the way" and wish they would have gone a bit smaller.
  • Request a plastic port. If radiation is a possibility, ask your surgeon for a plastic (rather than a metal) port. Alternately, you can ask if the expansion can be accelerated so that the permanent implant can be inserted before radiation. Surgery after radiation can be much more challenging.
  • Avoid risky physical activities. During the two to six months you'll be undergoing tissue expansion, avoid sports or any activity that places direct pressure on the breasts and may cause you to fall. This includes use of certain gym machines or even yoga poses that require you to lie flat on your chest.
  • Listen to your pain. Whenever the implant is filled with saline, let the doctor know if you are having excessive pain. While it is normal to feel some pain and discomfort after an expansion, it shouldn't be severe enough to keep you up at night or hurt excessively with movement. Overt pain may be a sign that the implant has been overfilled. If your skin feels very tight (taut) or uncomfortable, this is also a sign that the implant may be overfilled.

Newer carbon dioxide-filled tissue expanders have been released in recent years, some of which are patient-controlled. Although less prone to rupture, they tend to be costly and may not be covered by your insurance.

Always speak with your health insurer to know which costs are covered and which are not. Remember that "more expensive" doesn't always mean "better." Listen to your doctor and do your homework to ensure the optimal appropriate care.

Coping

The rupture of a breast tissue expander can be emotionally draining as it adds yet another procedure to an already extensive roster of treatments. There is no minimizing the emotions you may feel. The setback can raise doubts and fears about your mortality and/or appearance or exacerbate feelings of loss and depression.

As much as people may tell you to "hang in there," don't bury your emotions or put on a good face. Share your feelings with friends, family, and your medical team. If you are isolated, find a support group or ask your oncologist for a referral to a therapist or psychiatrist who can help. Don't face these or other setbacks alone. There is help.

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