Tissue expander > final fill > exchange for implants

Ilovethemoon

Hello!

I had BMX 3/20/20 with tissue expanders placed and initial fill. Had in-office fill 4/7 and 4/14. Final fill scheduled for 4/21. I'm now scheduled for exchange for silicone implants 4/29/20. That's 8 days after fnal fill, about 5.5 weeks after initial placement. Chemo is to start soon and is expected to be last 5 months. I then may need radiation tx (still need to meet with RO) which would likely start 4 weeks after chemo ends if I need it. PS recommends to do exchange before chemo starts.

Most things I have read indicate most PS want to wait at least 4 weeks after final fill before exchange - to allow the tissues to really get stretched, to allow a capsule to form?

My question is: are there others out there who have also had this quick of a process, and if so, did it work out okay or did you have complications because the process was too fast and the tissues didn't have enough time to stretch/a capsule hadn't formed, etc.?

Thank you!

Lostchick

hey. I wish a had answers for you but I'm just posting to follow along as I have the same diagnosis day (2/20) and am hoping to follow a similar path. My bmx with reconstruction is not scheduled until 5/12. I did have a sentinel node biopsy and nipple delay procedure done on 4/28. As of now, I'm still not sure of staging or anything until I get those results back. At this point they don't think I will have to do chemo 🤞. I have heard that the tissue expander are not very pleasant and I'm not a huge person so I'm hoping that the fill time is not very long (similar to yours). Best of luck to you. I hope you (And I)get some answers soon and that everything works out for you!

Tunik

So, I'm on a slightly different path. I had chemo first, then surgery/expanders and now getting ready for radiation. I was told that I need to finish my fills before I start radiation. Then, roughly after 6 months after radiation I would have my exchange. My understanding is that it is challenging to expand the irradiated side and it typically contracts during radiation. I don't know how things would work if you already have your implants in. Have you been expanded more on the side potentially to be irradiated? I've been getting my fills every week. It seems like by the time of a new fill, the skin adjusts ok.

SpecialK

ilovethemoon - if I were in your shoes I would leave the expanders in place during chemo, if you need rads overfill that side, then wait six months, and then have exchange surgery. My rationale is that having exchange surgery now, then starting chemo in short order opens up the possibility for infection and implant loss since your immune system is compromised, and/or delay to your chemo. There is a window of optimal start to chemo which is 30 days, less effectiveness at 60, less again at 90, you would be delaying to have more surgery and then heal, even if everything goes perfectly. Secondarily, if you have implants in place and then radiate, you increase potential for capsular contracture and/or distortion of the implant by shrinking tissue and muscle. Keeping the expander is more of a firm placeholder, particularly with it over-expanded on the rads side. While expanders are not the most pleasant I wouldn't want to hurry the exchange surgery and have regrets later, radiated skin doesn't stretch well in the event you need a re-do. Most plastic surgeons I have seen like to leave expanders in place, then radiate, then wait, then exchange. The exception to that is direct to implant patients who have to roll the dice if they need rads.

MinusTwo

I agree with Special K. I had my expanders in from February - September, with at least 2 months pause after filling. Below is a link to the exchange forum. Lots of helpful discussion.

https://community.breastcancer.org/forum/44/topics...