“One more fill,” wrote a MyBCTeam member. “My breast is rock-hard with this tissue expander. I cannot imagine having two expanders. How does it feel to have tissue expanders in, girls?” they asked. Another member replied, “It feels like you’re wearing an underwire bra that’s two sizes too small, 24/7.”

In the oncoplastic surgical procedure known as “two-stage implant breast reconstruction,” tissue expanders — which are empty breast implants — are used to create space gradually. Your doctor fills them with saline solution (salt water) to get your breasts ready for implants after a mastectomy. This procedure combines cancer removal with plastic surgery methods to get better results. When the expansion is completed, after about six to eight weeks, the tissue expanders are exchanged for silicone or saline implants. Expanders may be uncomfortable, but they’re a temporary step on the path to breast reconstruction.

If you have tissue expanders, you may be eagerly counting down the time until the placement of permanent breast implants. Here’s what you should know about sizing goals and the differences to expect once the exchange happens.

How Big Do Expanders Need To Get?

Expanders have an important role in the success of two-stage breast reconstruction. Most people should plan to have expanders for six to eight weeks before the exchange procedure, or longer if chemo and radiation therapy are needed first. Your doctor can advise you on the right pacing for expansion based on your unique situation.

Expanders may need to exceed implant size by 10 percent to 20 percent before you’re ready for the exchange surgery. That means your final implants won’t be as large as your expanders in their final stages. Your breast surgeon should be able to give you an idea of what to expect from the expansion process as you plan the second stage of breast reconstruction. Communicating with your health care providers throughout the process is essential so you feel comfortable and satisfied with your final results.

Pacing Yourself Through the Expanding Process

There’s no official protocol or consensus for the best rate of expansion. Some doctors suggest inflating the expander with 20 percent to 30 percent of the goal volume right away when it’s inserted. Others say the expander should start completely deflated and go from there. The initial volume will also be based on whether the expander is placed under the chest muscle.

One MyBCTeam member encouraged others to take their time with expansion to minimize pain. “If you’re still expanding them, ask the doctor to go up like 50 cc [cubic centimeters] at a time, or less if needed,” they suggested. “I’m at 800 cc, and the only time they bug me is when I lie on my stomach to read for too long.”

If you’re uncomfortable during the expansion process, you can talk about pain management options with your health care team. Keeping your mind focused on the upcoming exchange surgery can help you adapt during this transitional time.

Choosing the Right Size for Implants

Expanders give you a chance to take a step back and think about your options for reconstruction. While you may have a specific cup size in mind before your mastectomy, people sometimes change their minds after the procedure or while the expanders are in. It’s OK to talk to your plastic surgeon about going bigger or smaller before deciding on implants. Expanders allow you to weigh your options and think about what different implants will feel like when you make your final decision.

Studies show that larger breast implants come with a higher risk of complications, especially when the expansion happens too fast or not fast enough. Specifically, researchers have found that people with a C cup or larger had a higher risk of infection after surgery. If you’re interested in larger implants, your surgeon can help assess your risk for complications based on other factors, including your age, weight, lifestyle habits, and general health.

How Do Implants Feel Different Than Expanders?

Most members report feeling relieved after the exchange surgery. A member of MyBCTeam wrote, “Good news: The implants are comfortable 😊.”

Another shared, “The expanders felt pretty uncomfortable for the 10 months that I had them. But I’m very glad I went with this option. When I had them exchanged for implants, 98 percent of the discomfort went away,” they reported. “Most of the time, I hardly even notice them, which is a total contrast to expanders. I was aware of those suckers 100 percent of the time.”

It’s important to be realistic about your implant expectations. Although implants have a generally high satisfaction rate, revisions or lingering issues can sometimes happen. Be sure to continue sharing your progress with your health care team and relaying any concerns about pain or discomfort. If you’re concerned about your expanders, or unhappy with your implants or the results of your reconstruction surgery, there may be additional steps you can take to improve the outcome.

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.