Most people are familiar with breast implants, but expanders are a less-often discussed step in the breast reconstruction process. Similar to deflated breast implants, tissue expanders are initially empty and gradually filled with saline solution to stretch the skin and tissues before the final implants are inserted. They are typically implanted during the mastectomy procedure to prepare for reconstruction.

After placing an expander in your chest, the surgeon gradually fills it over the course of several weeks, giving your body time to adjust and make room for a fully expanded implant. Here are some questions and answers to give you a better idea of what to expect with tissue expanders.

Are Expanders Always Necessary?

Not everyone who gets implants or other breast reconstruction surgery receives expanders. In a direct-to-implant reconstruction, implants are placed during the mastectomy, before the surgeon even wakes you up.

Some members of MyBCTeam have said they didn’t need expanders because they had implants before breast cancer or opted for small implants. Although the one-step process may seem like a simpler option, it’s not the best choice for everyone, especially if you haven’t decided on your preferred type of reconstruction. In addition, you’ll need to choose a plastic surgeon and breast surgeon who work together in the same hospital if you plan to get both procedures back-to-back.

Only a board-certified plastic surgeon can determine if you would benefit from expanders as the first step to reconstruction. And sometimes, plans can change during the operation. For example, your surgeon may decide that the skin needs more time to heal,and that an expander is a better choice than moving straight to implants. They may also discover that there’s not enough space for an implant, and the skin or muscle needs to stretch.

Additional factors that go into the decision include:

• The amount of preserved breast tissue
• The size of the opposite breast
• The size of the implants
• The presence of any other underlying health conditions

You should go into surgery with a plan and expectations but also understand that your surgeon may need to change course either during the surgery or after, to ensure the best outcome.

How Long Do You Need Expanders?

Typically, the expansion time takes between three to seven months — but if you’d prefer to wait longer before the next steps in reconstruction, that shouldn’t be a problem. Surgeons often recommend holding off reconstruction until completing certain cancer treatments, like radiation.

Ultimately, the expanders need to reach a size that’s 30 percent larger than the future implant before it’s time to do the exchange. If you get expanders and later decide you don’t want to move forward with implants, your surgeon can remove them and discuss other options with you.

One MyBCTeam member was told to wait a year before doing the exchange: “I have my expanders (spacers) in, and they said I have to wait a year for implants. They want to make sure my skin is healed. I had my surgery in March and finished radiation at the end of June.”

What Are the Benefits of Tissue Expanders?

Despite some drawbacks to using tissue expanders, like the extra waiting time or the sometimes painful expansions, your surgeon will recommend them only if they believe the pros outweigh the cons. Using expanders as an in-between step in breast reconstruction surgery can increase the chances of achieving symmetry and lower the risk of problems compared to doing the whole procedure in one stage.

Delaying reconstruction with expanders can give you more time to think about your next steps, including what size and type of implant you’d like. It can also allow you to arrange for the help and support you’ll need after surgery for breast augmentation.

Many MyBCTeam members have shared their experiences with weighing decisions about reconstruction. “I was going to do reconstruction at the same time as my mastectomy, but the plastic surgeon that works with my surgeon did not take my insurance, so I opted to wait for reconstruction,” one member wrote. “Since the surgery, I’ve been so happy about not having to wear a bra that I’ve been leaning toward not having reconstruction. I’m very undecided on this issue.”

“Reconstruction is a very personal decision. Your feelings are as important as any other factor. You will be more satisfied and healthier if you feel well-informed and take an active role in this decision,” another member said. “You should meet with your general surgeon and plastic surgeon and understand the risks, pain, and post-surgery effects mentally and physically.”

Expanders allow you to take a step back and research your options, such as which surgeon to choose and the differences between silicone implants and saline implants. Rather than trying to make these decisions while facing the stress of an upcoming mastectomy, a delayed reconstruction lets you take the process one step at a time.

Expanders vs. Implants

Most members of MyBCTeam say they felt relieved after getting their expanders exchanged for implants.

“No one hated expanders more than I did! I counted the months, weeks, and days until the exchange. After 18 months, I can say it was not a fun process, but now it’s a distant memory, and it was worth it,” shared one member. “You will feel exponentially better each day after the exchange. The first few days, you are tender from the surgery, but your chest is more comfortable. You’ll need pain meds for about 72 hours, then acetaminophen (Tylenol) is fine. Two weeks after the surgery, I was back on a treadmill. After four weeks, I was able to start lifting my arms. I could sleep on my side again after about four weeks. I had issues with nerve-regeneration sensitivity (some people don’t get this) and pain, which subsided after nine months. Sometimes, it still pops up for a few minutes at night, but it’s nothing I can’t handle.”

Another member described their experience: “The expanders were the worst part of everything that I have been through. They were six months of hell. They hurt all the time, especially after fills. I could beat on my chest like a gorilla,” they explained. “After radiation, I had the implant surgery. It was the best surgery of my life! The nurses said I’d feel the difference as soon as I woke up, and oh my goodness! I touched them, and they were so soft and so much lighter. I was home in a few hours, up and moving around.”

It’s important to keep in mind that expanders are temporary. After enduring breast cancer diagnosis and treatment, it may not be easy to accept that there’s another step instead of immediate reconstruction. However, connecting with others who have been through the process and hearing how satisfied they are with their results can give you a much-needed boost to keep marching forward.

Talk With Others Who Understand

MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 64,000 members come together to ask questions, give advice, and share their tips with others who understand life with breast cancer.

Did you have tissue expansion before implant placement? How was your experience with expanders and reconstruction procedures? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.