There are two broad categories of breast reconstruction for mastectomy. There is expander-implant reconstruction and autologous flap reconstruction. Tissue expander and implant reconstruction is often selected in patients who have not undergone radiation therapy. At the time of mastectomy, a tissue expander is placed at the location of the mastectomy pocket and often in conjunction with an acellular dermal matrix such as Strattice or Alloderm. The mastectomy skin is allowed to heal with the expander deflated, and, often in conjunction with hyperbaric oxygen.
During the expansion process, patients may change their minds about the size of breast reconstruction they might want. This can commonly occur as patients may choose to go smaller or larger than they originally anticipated. The tissue expanders are typically heavy, hard, and firm. When the implants are placed, this changes dramatically and implants are soft. The ultimate implant reconstruction may look significantly different than the tissue expander stage of reconstruction. Typically we tell patients that if they can wait one year from the time of tissue expander placement to implant exchange, this tends to yield a more consistent result.