How Tissue Expanders Are Used in Breast Reconstruction

If you choose to have your breast or breasts reconstructed after a mastectomy, you have several options, including breast implant surgery. Before the procedure, many patients may have temporary tissue expanders placed. These are implantable, expandable, balloon-like devices used to stretch breast skin and chest wall muscles over several months. Expanders are used so that breast implants can be adequately accommodated.

A tissue expander can be placed during a mastectomy or later on after you've healed.

What Exactly Are Tissue Expanders?

tissue expander
 Verywell / Brianna Gilmartin

Tissue expanders have silicone outer shells and either an internal valve or external port to allow for saline fluid injections that stretch the skin over time.

Your tissue expander should match the shape of the permanent breast implant that you are going to use. These devices come in round, oval, and anatomical shapes, and can have smooth or textured surfaces.

Tissue expanders are not intended to be permanent. They will be removed and replaced with permanent implants during a subsequent surgical procedure.

Before the Procedure

Once you've consulted with your surgeon and decided to have reconstruction with implants, you will have the tissue expanders inserted either during your mastectomy surgery or after you have healed. The most common scenario is for the two procedures to happen simultaneously.

When you have your tissue expanders placed, you should arrange in advance for someone to pick you up and drive you home from the hospital after your surgery.

Tissue Expander Placement

If you are having expanders put in at the same time as a mastectomy, you will remain under general anesthesia during your expander placement. If you're having expanders placed at a later date, local anesthesia combined with a sedative may be used.

The tissue expander may be inserted beneath your chest wall muscles, where it is positioned within a pocket of tissue. A valve is placed, either within the breast or externally. for saline to be injected.

The placement procedure takes one to two hours. It will take twice as long if you are having expanders placed in both breasts.

The muscle that surrounds the expander (and later, the implant) prevents it from sliding down.

The Expansion Process

After you recover from your mastectomy and your incision heals (around four weeks after the surgery) saline will be injected into your tissue expander to gradually stretch the surrounding tissues and create space for a permanent breast implant.

This will be done over a series of appointments and usually takes two to six months.

If your expander has an internal valve, your surgeon will locate the port and add saline through a needle inserted through your skin. Saline goes directly into the external ports.

You will feel some pain as your muscles stretch, but this usually subsides in a day or two. If pain persists or worsens, contact your surgeon.

A newer form of expansion fills the expanders with carbon dioxide instead of saline, as a remote-controlled expander releases the gas from an internal reservoir. Your healthcare provider can let you know if this is an option for you and what the pros and cons might be.

Staying Comfortable Between Fills

Here are some things you can do to be as comfortable as possible between tissue expansions:

  • Avoid strenuous exercise or activities such as jogging, jumping, and running, which may cause your breasts to bounce.
  • Avoid strength-training exercises that will tighten or bulk your chest muscles.
  • Wear soft, supportive bras without underwires. You may want to use a breast form or padding to maintain a balanced appearance until the expansion is complete.
  • Wear loose blouses, tops, and sweaters that won't rub against your breasts.

Removing and Replacing a Tissue Expander

Once your chest tissue has been stretched enough, the expander and the valve will be removed and replaced with a permanent implant. This surgery will take place four to six weeks after the last saline fill.

However, if radiation therapy is part of your breast cancer treatment plan, most surgeons prefer that you receive it while you still have the tissue expander so that any scar tissue caused by the radiation can be removed before placing the final implant. In some cases, radiated skin isn’t the best environment for an implant. Your cosmetic surgeon can advise you on what's best in your situation and how it may impact your overall timeline.

Removal of tissue expanders is usually done as an outpatient procedure. It takes about one hour for each side. You will be able to go home once you have recovered from the anesthesia.

Risks and Considerations

In addition to the usual risks of surgery, specific risks and potential complications of tissue expanders include:

  • Infection: An expander with an external port poses a small risk of infection, so it's important to keep the port clean. If necessary, an infection can be treated with antibiotics. In some cases, the expander may need to be removed for several months until the infection clears. A new expander can then be inserted.
  • A rupture, leak, or break in the expander: Saline solution that leaks out won't harm you and will be absorbed into your body, but you will need another procedure to fix or replace the expander.

While not health risks, you should also be aware of some realities of tissue expanders that will have an impact on how your breast appearance:

  • Lumpiness: Tissue expanders may ripple and their edges may show through or be easily felt. Permanent implants should not create these problems.
  • Asymmetry: Tissue expanders will be overfilled so your skin can stretch and drape when your permanent breast implant is placed. If you have only one expander, your breasts will be asymmetrical until you receive your implant.

If You're Traveling by Plane

Airport security scanners and metal detectors can sometimes detect the metal valves of tissue expanders. Be prepared before your flight by getting a healthcare provider's note explaining that you have an implanted metal object.

A Word From Verywell

Tissue expansion is a relatively straightforward procedure with minimal risks and side effects. While your reconstructed breasts won't make you look exactly like you did before your mastectomy, regaining your shape may help you restore a sense of normalcy after going through breast cancer.

16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Wagh MS, Dixit V. Tissue expansion: Concepts, techniques and unfavourable resultsIndian J Plast Surg. 2013;46(2):333–348. doi:10.4103/0970-0358.118612

  2. Regan JP, Schaffner AD. Breast Reconstruction Expander Implant. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 

  3. Bertozzi N, Pesce M, Santi P, Raposio E. Tissue expansion for breast reconstruction: Methods and techniquesAnn Med Surg (Lond). 2017;21:34–44. Published 2017 Jul 21. doi:10.1016/j.amsu.2017.07.048

  4. O'Shaughnessy K. Evolution and update on current devices for prosthetic breast reconstructionGland Surg. 2015;4(2):97–110. doi:10.3978/j.issn.2227-684X.2015.03.09

  5. Bellini E, Pesce M, Santi P, Raposio E. Two-Stage Tissue-Expander Breast Reconstruction: A Focus on the Surgical TechniqueBiomed Res Int. 2017;2017:1791546. doi:10.1155/2017/1791546

  6. Strazisar B, Besic N, Ahcan U. Does a continuous local anaesthetic pain treatment after immediate tissue expander reconstruction in breast carcinoma patients more efficiently reduce acute postoperative pain--a prospective randomised studyWorld J Surg Oncol. 2014;12:16. Published 2014 Jan 16. doi:10.1186/1477-7819-12-16

  7. Omranifard M, Heidari M, Farajzadegan Z. The volume of fluid injected into the tissue expander and the tissue expansion. J Res Med Sci. PMID: 25709658 

  8. Quinn TT, Miller GS, Rostek M, Cabalag MS, Rozen WM, Hunter-Smith DJ. Prosthetic breast reconstruction: indications and updateGland Surg. 2016;5(2):174–186. doi:10.3978/j.issn.2227-684X.2015.07.01

  9. Kelley K, Kim J. Human Factors Validation of the AeroForm Tissue Expander System for Breast Reconstruction. Plast Surg Nurs. 2017;37(3):100-102. doi:10.1097/PSN.0000000000000192

  10. Gardani M, Bertozzi N, Grieco MP, et al. Breast reconstruction with anatomical implants: A review of indications and techniques based on current literatureAnn Med Surg (Lond). 2017;21:96–104. Published 2017 Jul 20. doi:10.1016/j.amsu.2017.07.047

  11. Howarth AL, Niska JR, Brooks K, et al. Tissue Expanders and Proton Beam Radiotherapy: What You Need to KnowPlast Reconstr Surg Glob Open. 2017;5(6):e1390. Published 2017 Jun 23. doi:10.1097/GOX.0000000000001390

  12. Li G, Zhang Y, Ma H, Zheng J. Arm port vs chest port: a systematic review and meta-analysisCancer Manag Res. 2019;11:6099–6112. Published 2019 Jul 3. doi:10.2147/CMAR.S205988

  13. Shah AT, Jankharia BB. Imaging of common breast implants and implant-related complications: A pictorial essayIndian J Radiol Imaging. 2016;26(2):216–225. doi:10.4103/0971-3026.184409

  14. Kuriyama E, Ochiai H, Inoue Y, et al. Characterization of the Capsule Surrounding Smooth and Textured Tissue Expanders and Correlation with ContracturePlast Reconstr Surg Glob Open. 2017;5(7):e1403. Published 2017 Jul 25. doi:10.1097/GOX.0000000000001403

  15. Kim SJ, Song SY, Lew DH, Lee DW. Selection of Implants in Unilateral Prosthetic Breast Reconstruction and Contralateral AugmentationArch Plast Surg. 2017;44(5):413–419. doi:10.5999/aps.2017.44.5.413

  16. Manne SL, Topham N, Kirstein L, et al. Attitudes and Decisional Conflict Regarding Breast Reconstruction Among Breast Cancer PatientsCancer Nurs. 2016;39(6):427–436. doi:10.1097/NCC.0000000000000320

Additional Reading

By Lynne Eldridge, MD
 Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time."