Breast Tissue Expanders After Mastectomy Plastic Surgeon in Washington DC

[@jenniferpollard6031]

As a breast cancer survivor and a person who has had intense and high contact with medical professional, might I share that I enjoyed this educational presentation for its clarity and its aesthetic dimensions.

[@alittlesugaplease1748]

This is a great video. I'm 48 years old, 4 weeks post bilateral mastectomy with tissue expanders placed. I wish I had seen this video prior to my surgery. I might have gone flat. I'm sure at the end of this process I will be happy that I endured the extreme amount of pain and discomfort but for now I'm pretty miserable. I was a 36DDD prior to this and I am sure I will not get anywhere near a full C due to the time it would take to stretch my skin back out. I had no clue these expanders were sutured into the muscle prior. Also while these feel soft on the outside, on the inside they feel like ninja stars being pressed into my chest. I'm hoping with each expansion they get a little less painful but I don't know. I was totally numb on one side for my first expansion and NOT on the other. The fullness, burning and pulling that night was better for the most part by morning. I wish there were a better way but it is nice to know there are actual reasons for these expanders to be in place. Looking forward to my swap surgery as soon as I'm able.

[@mirnahumphreys7690]

Expanders are so uncomfortable. I feel like I have 2 bricks on my chest. I finally told my doctor I can’t add anymore saline to it. I think I got only about 200 mls plus what he added the day of the surgery. Idk about anyone else, but it has been really uncomfortable for me.

[@carolinekaplan542]

Dear doctor. I had a mommy makeover with breast reduction and lift last year. My beloved baby sister at 45 years old had a double mastectomy yesterday and needs chemo and radiation expanders and die flap reconstruction. This video was very comforting taking me through the procedure she will undergo. Even though I’ve recently had my procedure this video really let me know the extent of her issues. We are rotating taking care of her over the year. This let me know what is going on with a better sense of the issue involved. I know that bra support , using scar solutions after healing and having a Chinese silk five blessing and longevity jacket helps as well. All my girlfriends that had implants without cancer ended up having issues decades later. Natural is best. Please keep telling the women to get help. Simply unloading the dishwasher to lift glasses up to a top shelf is difficult post surgery. Thanks again for the video. God bless you for your efforts and talents for your patients.

[@sindeekaye2223]

He's amazing! He explained everything in perfect and very clear detail. Thanks!

[@emilybernier3491]

Thank you for content on mastectomy and reconstruction. Super helpful to know what the options are and the step by step process taken.

[@lisasooy5317]

Very clear explanation of women’s choices. Thank you!

[@marlynlamouza7620]

Dr my right lymphe nodes removed the expander is not holding well & painful what shall i do ?

[@magguietips2097]

How long does a patient need to wait in order to get the implants?

[@Sherberandrad_SR]

Usually about 6-8 weeks at a minimum, depending on the amount of expansion that's needed to reach the desired volume.

[@Just_Yaya]

Let me make this clear. 18:03 IT DOES HURT You doctors may think it doesn't but IT DOES. I had my dose today and I can hardly breathe because of the pressure.

[@lisa227382]

I had expanders placed two weeks ago. The skin has zero feeling. The incisions didn't hurt because...no feeling. The muscle behind the expanders is sore but not horrible. I can feel pressure but no pain as far as on the outside of my breast.

[@Sherberandrad_SR]

Thank you for your comment which we've reviewed with Dr. Rad. He completely agrees that pain management is an important part of overall breast cancer care. For this reason Dr. Rad follows the ERAS protocol (a global protocol developed by anesthesiologists to reduce pain while minimizing opioid narcotic pain medicine use) and he treats his patients with both injectable pain medicine (Exparel, or liposomal bupivicaine), non-narcotic pain medicines (Tylenol, NSAIDs and Gabapentin), and narcotic pain medicines (Oxycodone, Valium). This combination results in significant pain reduction while minimizing side effects that are common with pain medicines so that patients can recover quickly.

[@daniella8400]

@Patricia Bartosik I’m 32 so I’m not okay with having no breast

[@me-xx2gl]

I am late to the party. 6 weeks ago, I had a double mastectomy. Had expanders in. The whole process is more painful than I ever imagined. (Along with those lovely drains) I am 74 and overweight. My breasts were 4D, so doc is putting a larger side implant. Not looking forward to next few months.

[@me-xx2gl]

Ain't numb folks. Lots of zingers. Fantom pain.

[@marcodeluca4068]

So plastic surgeon says that to use the flap with a nipple sparing at same time is a risk because two areas have to heal and we don’t know if fat implant could induce cancer. Is this true and if not why ?

[@nannetter9134]

Is it possible to do a combination of DIEP flap and implants? I’ve been told that just implants alone after mastectomy tend to not feel natural because of the lack of surrounding breast tissue like in a traditional breast augmentation. I’m wondering if DIEP plus implants would be an option to mitigate that unnatural feeling. Also - I’ve been seeing that in cases of mastectomy reconstruction, a lot of surgeons place the implant above the muscle vs under. Does a mastectomy change the idea that sub muscular is better aesthetically?

[@Sherberandrad_SR]

Thank you for your excellent questions: Yes, it is possible, and sometimes the best option for patients, to combine implants under DIEP flaps for the best result. The implants provide additional volume, and the DIEP flap tissue provides natural tissue feel, reduces rippling, softens contour transitions, decreases risk of capsular contracture, and softens radiated breast skin. Dr. Rad specializes in microsurgery and offers the DIEP+implant option to patients who benefit from this approach. With regard to your 2nd question, placing implants above the muscle in reconstruction is now the gold standard because it avoids the "animation deformity" (abnormal movement of the implants under the muscle) which is a significant problem in reconstruction, whereas it is usually not an issue in cosmetic breast augmentation (and also risk of cap con is less in sub-muscular breast aug). Yes, mastectomy does change the risk/benefit balance in favor of above-muscle implant placement. We hope this helps.

[@mfishe1]

Due to high family history, and having 3 biopsies on the same breast, I have decided to have a prophylactic bilateral mastectomy. I am trying to decide on fat transfer or implants.

[@mrsdiaz614]

How are you doing? Have you started the process yet on getting the surgeries?

[@crystal1663]

Same , all the breast in your decision xx

[@mariahixon3646]

ty for your feedback it was helpful to me to understand the procedure after my procedure its more detailed how you explained it 😁

[@Sherberandrad_SR]

Maria Hixon you’re welcome, we’re so glad it helped you!

[@brendalepore5610]

Great, much needed information! Thank you!

[@mercedesyoung5906]

Great detail explanation and forgot to explain how many visits for saline filling before reconstruction. Is it done before or during radiation treatment?

[@Dawn-xi9zt]

Hello, I have skin sparring expanders. I start radiation this Thursday. They completed my fills in 3 visits before I could start radiation. It was explained that I wouldn’t start radiation treatment until I was finished with my fills. I hope this helps and good luck!

[@debbiejenkins4039]

Thank you. Im about to undergo this.

[@noorbinaqeel2819]

Excellent explanation 😍👍👍👍

[@dominiquecote1838]

Thanks again for your quick and very detailed.response I feel better and will be able to discuss with my team a plan of action that should be safe and the most optimal for me . I would still prefer expanders as Diep flap scares me a bit . Long surgery and recovery however my PS Had said at the time I could also have that option but at the time he was leaning for expanders . Dominique

[@Sherberandrad_SR]

You're very welcome. Although the DIEP flap surgery has a reputation for being a long surgery with long recovery, it depends on your surgeon and your team. Dr. Rad routinely performs bilateral (double) DIEP flap surgery in under 6 hours (very efficient) with a >99% success rate and 10 days of recovery, whereas some 2-surgeon teams take over 20 hours with poor success rates. Patients in the "right hands" and "right environment" can do very well.

[@yaassss5531]

This man is beautiful! 😍

[@marcmarc2598]

Why avoid using flaps at the same of mastectomy to reconstruct breast. Wouldn’t this provide blood to the area better. Also a spacer will change the shape of the breast from its natural look.

[@hhhdkkkdhbdj]

I have poland syndrome (m) 26 yrs old. I have a silicone pec implant but its flat with sharp edging and the axillary fold doesnt appear. Any way fat can survive above my implant and my skin? I have no pec muscle on my right side so you cant inject into it if it doesnt exist. Thank you for your time.

[@Sherberandrad_SR]

gv Thank you for your query. Without a formal evaluation we cannot provide specific recommendations. Dr. Rad has a decade of experience treating thousands of patients with breast reconstruction concerns, including Poland’s syndrome. An in person consultation is best but if you are from out of town then we can arrange a virtual consult with Dr. Rad. Please call 202.517.7299 or email [e-mail]

[@roser462]

Is reconstruction harder or is it more challenging if the patient has "tuberous breasts"?

[@Sherberandrad_SR]

Tuberous breasts may pose more challenges in reconstruction because the breast shape is constricted and generally needs to be stretched and re-contoured. This may require more than one surgery to achieve the final beautiful result.

[@aliciaruiz5381]

Thank you so much 🥰

[@lisa6221464]

Is it possible to do Diep after 3 years with implants? I have suffered with implants for 3 years and wouldn't suggest to anyone. Its constant pain, cant wear a bra because of the pain and the breast look nothing alike in size or anything. Please do your research because not all doctors tell you all that could happen.

[@Sherberandrad_SR]

Yes, it is absolutely possible to do DIEP surgery any number of years after implants. Dr. Rad cares for patients from all over the country who have had difficulty with their implants and who want them removed. Patients are often told that they're not candidates for DIEP surgery, however this is usually because the surgeon is unable to perform DIEP surgery rather than the patient not being a candidate. Dr. Rad would be happy to tele-consult with you.

[@sheila7814]

There is some numbness under armpit and breast. I felt my fills but not too bad. One thing I wasn’t warned about is during first 4 weeks the two breasts may not be same shape or height…. But I have been told they can fix in second surgery. We will see. But either way I am glad to have the B tissue gone

[@marcmarc2598]

Numb you mean you can’t reattach nerves and sensation because I hear other surgeons are doing this.

[@dominiquecote1838]

For. Brca1 patients do you spare the skin of you need to get the skin somewhere else ?

[@Sherberandrad_SR]

Dominique cote Hi Dominique, thank you for your question. The short answer is yes, the skin is spared. For my BRCA patients who need preventive double mastectomy and reconstruction, my approach is to preserve the breast skin and nipple/areola, with the scar placed in the natural under-fold where it can be hidden and out of view. For patients whose nipples are in a naturally lifted and centered position, I can often achieve beautiful results where the scar is virtually invisible and patients look like they’ve had no surgery or augmentation or scarless reduction. If a patient has low nipple position to start, and/or wants smaller more lifted breasts, then I’ll often start with a breast reduction/lift as a first stage, followed by DIEP flaps or implants. This gives patients beautiful results that rival even the best cosmetic results. Hope this helps! Best, Dr. Rad

[@dominiquecote1838]

Thanks for your response but I forgot to mention that ontology being Brca1 I just finished 6 months of neoadjuvent Chemo which my cancer seems to have responded well too . I have therefore opted for tissue expanders . I am seeing both my breast surgeon and plastic surgeon next week to discuss my upcoming DMX with expanders during the same surgery . I already had an initial consult who recommended expanders but at the time thinking surgery would be done first . Since now it is expected that I may need radiation . My question to you is would you still recommend going ahead with expanders and even having my fills before starting this since radiation could lead to complications and in the end not the best esthétique result . I have always had large breast DD and if I was told that the reconstruction could only take place in 6 months to a year after radiation, this would be hard for me emotionally. As I have seen pictures of woman who are simply left with hanging skin and looking totally deformed for many months before starting the reconstruction process which leaves them devastated. I’m that case I would prefer to remain completely flat Im fully aware the priority is the cancer . Because of my brca1 gene and the fact that my mastectomy is not preventative and considering everything I’ve told you , what might you recommend and what further specific questions should I ask my PS ? Thank you for taking the time to answer my questions in such great detail . Dominique

[@Sherberandrad_SR]

Dominique cote Hi Dominique, the good news is that your plastic surgeon’s plan to start with expanders is safe and reasonable. I would do the same for the reasons your mention: to avoid complications and to obtain the best aesthetic result. Radiation definitely causes damage and shrinkage of tissue so, if you’re wanting tissue recon then it’s best to have expanders first. However, for your 2nd stage of reconstruction, my approach for my patients who want tissue reconstruction (DIEP, LSGAP, TUG, etc) is to perform this step 4-6 weeks (not months) after the end of radiation therapy (RT). Recent scientific studies indicate that it is perfectly safe and low risk to perform the DIEP flap in this early phase after RT because the inflammation and damaging effects of RT have not set in yet. In the past we (plastic surgeons) have waited the 6-9 months after RT because we previously thought it wise to wait for all the healing to be complete, but in fact the scar tissue that forms makes it even more difficult to perform the blood vessel connections. So I recommend you ask your PS if s/he would be comfortable performing your DIEP flap recon within 4-6 weeks after RT finishes. I’ve had 100% flap success in 12 patients thus far using this approach. On the other hand if you’re having implant recon then it may be reasonable to do a rapid expansion and then the implant exchange and fat grafting before RT starts. However your oncologists have to be comfortable with this to be sure your RT is not delayed. Keep in mind that every physician and surgeon has his/her unique approach and it’s not a question of right or wrong. More importantly everyone on your team has to be comfortable with your plan of care and it sounds as though you’re in good hands. I wish you all the best in this challenging phase. - Dr. Rad

[@liannebenn2097]

I feel very lucky to be doing this at 62 when I just don't care enough to put myself through this. In fact I think not having boobs will be much more comfortable. I plan to be an art canvas for a tatoo instead. There will be enough to go through without optional extras.

[@lynn.d1015]

Breast reconstruction looks horrible!!! I had two lumps removed and the doctor recommended removing both breast . Reconstruction looks so terrible I will take my chances with cancer.

[@Sherberandrad_SR]

We appreciate that all women have choices in whether or not to pursue reconstruction, and certainly "going flat" (i.e. not having reconstruction) is an option. However, irrefutable scientific evidence proves that breast reconstruction has a tremendous POSITIVE impact on patients' mental and physical wellbeing. For this reason Dr. Rad is committed to providing reconstructive care to his patients which, as you'll be able to to tell from his patient reviews, make a world of difference in his patients' lives.

[@lynn.d1015]

SHERBER+RAD you completely miss my point. Breast reconstruction surgery looks horrible!!!! Results need to improve drastically!!!!!!!

[@Sherberandrad_SR]

@@lynn.d1015 We appreciate your perspective. While reconstruction can only approximates a woman's natural appearance, the best work can often look and feel very natural and restore what cancer surgery takes away. The key is finding the right surgeon with the experience, skill and team.

[@MM-vh1bx]

Hi Ihave aquestion do you took radtion. C the radtion only makes the reconstruction looks ugly.and horrible

[@liannebenn2097]

@@Sherberandrad_SR Possible on patients' physical wellbeing? Why on earth should that be? Mental wellbeing will depend on each patient. Perhaps older women who see life from a more spiritual level and are also more likely to choose flat have more age related physical problems. That doesn't mean reconstruction will cure them! Statistics can be used to prove anything. Was the work you base this statement on age correlated and based on a large population? Did the flat closures have equally experienced surgeons? Did they know to demand aesthetic flat closure or were they left terriblly disfigured because surgeons think it isn't important once it won't be round and feminine anyway. Too much of the surgeon's viewpoint is often projected on the patient. Those who love boobs on themselves or others don't get it. I have seen so many pictures of women scarred horribly by being treated as pieces of meat in flat closures it shows disgusting disregard. An expert flat closure is simplest medically and has much less risk of physical complications. Indeed it also leaves plastic surgeons with less income.

[@marthagardener526]

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