Dr. Marga is a board certified Plastic Surgeon with additional training as a Certified Lymphedema Therapist. She is the Founder of the National Institute of Lymphology and serves as a Medical Advisor to the Norton School. Dr. Marga promotes the the highest standard of lymphedema care for surgical patients nationwide.
Temporary Saline-Filled Spacer to Permanent Saline/Silicone-Filled Breast Implant
Patients may be offered skin sparing mastectomies as a part of their coordinated patient care plan. A saline-filled "baby-sitter" tissue expander can be placed under the pectoralis major muscle and Allodermô internal bra and filled with saline to a size that approaches your current breast size as a Stage 1 procedure. The tissue expander is used as a temporary spacer.
If this size is acceptable to you, you may not require any additional tissue expansion...which means limited office visits!
You may decide to increase your breast size and this can easily be accomplished by adding saline to the expander at any time prior to Stage 2 (placement of a permanent saline or silicone filled breast implant) of your reconstruction. Though less common, you may elect to have a smaller final reconstruction. If so, saline can be removed from your temporary tissue expander therefore allowing the skin envelope to "shrink" prior to your Stage 2 procedure.
Regrettably, not all mastectomies are created equal. Very dense breast tissue may make your mastectomy difficult for your oncologic surgeon. What this means is that the remaining skin may be injured by the mastectomy procedure. This injury may be apparent in the operating room and Dr. Marga may either: a.) defer the placement of your tissue expander till a later date, or b.) place your tissue expander with a minimal amount of saline within it making tissue expansion a distinct requirement.
Some skin injuries are not apparent until several hours or days after surgery. If you have had significant amounts of saline placed in your tissue expander and your skin shows signs of injury hours or days after surgery, Dr. Marga may remove some of the saline from your tissue expander in order to reduce the pressure on the overlying skin flaps. A reduction in the amount of saline in the tissue expander may decrease the zone of injury to the chest wall skin - tissue expansion then can be attempted at a later date.
When mastectomy skin flaps are severely injured "full-thickness", additional surgical procedures may be required to remove unhealthy skin that likely will never heal or will result in a less-than- acceptable cosmetic result. Most oncologic breast surgeons depend on plastic surgeons to perform these surgical procedures. Rest assured, all skin that is removed by Dr. Marga is submitted to pathology for review should such information be important to your complete cancer care plan.
A saline-filled tissue expander offers the most flexible approach to implant-based reconstruction because it allows for easy increase or decrease in the amount of saline contained within it. A tissue expander is highly encouraged over a non-adjustable permanent breast implant for use as a "spacer" because of its post-operative adjustability. Its only downside is that tissue expanders may not be compatible with MRI screening. Dr. Marga typically avoids MRI scans in patients with tissue expanders in place. This may affect your ability to screen the contra-lateral breast with MRI; or it may make CT over MR angiography a requirement in planning for a perforator flap should you elect to change your final reconstructive plan.