Tissue expanders are like placeholders to prepare you for breast reconstruction after a mastectomy. They help create and maintain space in your chest until your body is ready for reconstructive surgery. Although rare, your body can reject the expanders, requiring a plastic surgeon to remove them.

Fortunately, a breast tissue expander complication doesn't mean you can’t eventually proceed with breast reconstruction. In fact, studies estimate that almost 80 percent of those with tissue expander complications have long-term success with reconstruction. Here are some things to consider if your body isn’t responding well to tissue expanders.

1. Infection Is the Most Common Reason for Tissue Expander Removal

Infection is the most common cause of expander removal. One study of 162 women with expanders showed about 9 percent got an infection that required them to be removed. Usually, infections happen within the first few weeks of the expander placement, but they can also occur later in the process.

Sometimes, infections can be treated before a removal is necessary. One small study showed 73 percent of participants were able to keep their tissue expanders when treated with antibiotics as soon as the first signs of infection appeared.

Other rare complications include the withering of the skin on a mastectomy flap, tissue expander exposure when an incision opens, and tissue expanders leaking, deflating, or rupturing. Another study of 373 women with tissue expanders reported 11.6 percent had some kind of complication.

Sometimes people also choose to have expanders removed if they change their mind about having breast reconstruction.

2. Several Factors Increase the Risk of Tissue Expander Rejection

The factors associated with expander rejection are similar to the risk factors for other surgical complications. Maintaining good health and hygiene is essential to help reduce the risk of infection. Good nutrition is also essential for wound healing and recovery.

Having a larger breast size or expanders over 400 cubic centimeters (cc) may increase the risk of complications. Studies show mixed results on the effects of tobacco use on expander complications, but quitting smoking is recommended for those undergoing breast reconstructive procedures following cancer treatment.

Sometimes breast surgery complications are unavoidable, regardless of your efforts. If your body rejects the expanders, you may feel defeated and frustrated. Remember this is just one step in your journey, and you have options to get closer to healing, even if the process is delayed.

3. Pay Attention to Your Symptoms After Tissue Expander Surgery

Complications can happen at any step of breast reconstruction. Within the first few days of expander placement, you and your care team will watch for signs of blood clots, infection, abnormal fluid buildup, and flap failure. Your breast surgeon might recommend blood thinners, compression stockings, and walking around to reduce your risk of blood clots. Be sure to follow any postsurgery instructions.

Painful or swollen legs and fever or flu-like symptoms are reasons to be concerned after expander placement. Be sure to let your doctor know if you have any of these symptoms.

It’s also possible to experience a rupture of the expander. In this case, the expander will deflate, and you may notice swelling in the area. Fortunately, your body can safely absorb the expander contents, but it will need to be removed and replaced.

You’ll go for regular expander fills to increase the size of your expander. During these appointments, tell your doctor about any minor concerns like pain, tightness, and itching sensations. If discomfort with expanders is significantly affecting your quality of life, your health care provider may offer solutions for pain management or dry skin. These could include over-the-counter medication, cold compresses, lotions for itchy sensations, or slower pacing with fills. Your doctor can help you understand what symptoms are normal and which are cause for concern.

One MyBCTeam member said, “I’ve had two expanders in for about a year now. … If you are still expanding them, ask the doctor to go up 50 cc at a time or less, if needed. I’m at 800 cc, and they only bug me when I lay on my stomach to read for too long. They are just uncomfortable.”

4. Call Your Doctor Immediately if You Have Symptoms of Infection or Blood Clots

Tell your oncologist or seek emergency care right away if you experience any of the following signs of infection or blood clots:

• Pain in your chest muscles, chest wall, or upper back
• Chills
• Coughing up blood
• Breast skin discoloration
• Discharge or fluid seeping from the sutures or incision site
• Feelings of sickness
• Fever
• A painful, swollen leg that’s warm to the touch
• Severe itching
• Shortness of breath

These symptoms could be life-threatening, so you shouldn’t wait until your next appointment before seeking medical advice.

5. You’re Not Alone if You’ve Experienced Tissue Expander Rejection

After getting an expander removed, your body will need time to heal. MyBCTeam members have described different outcomes, including receiving a temporary implant, waiting for permanent implant placement, or getting a new expander in preparation for breast implant or tissue reconstruction.

Here are some of their stories:

• “My body was rejecting the expanders, and they had to be removed. They replaced mine with an implant. Either way, they have to put something there to keep the skin stretched, as chemo and radiation have a tendency to tighten and shrink the skin. This will become an issue when it's time to undergo reconstruction.”
• “I had an expander removed. I had to wait three months for healing purposes, and they put a new expander back in.”
• “I had my left expander removed a few weeks after a bilateral mastectomy. It was not replaced until one year later, after radiation and Herceptin treatments. The new expander got infected, but we managed to save it with oral and IV antibiotics.”
• “I had both expanders removed due to a bilateral infection which, I understand, is very rare. I had nothing put back in while I finished chemo. I did not need radiation. My expanders were reinserted, filled, and I just went through my exchange surgery.”

After removing an expander, your doctor will evaluate your circumstances to determine the safest and most appropriate next steps.

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.

How was your experience with expanders for breast reconstruction surgery? Did your tissue expansion cause complications or delayed reconstruction? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.