Tissue Expansion with Saline in Breast Reconstruction

What is a Tissue Expander and What To Expect from the Expansion Procedure

Tissue Expansion Procedure
Tissue Expansion Procedure. Image courtesy A.D.A.M.

During breast reconstruction, some women receive an implant during their mastectomy surgery. Other women require a short-term tissue expander that is gradually filled with saline prior to a breast implant.

Let's learn more about what the tissue expander procedure entails.

The Basics on Tissue Expanders

Placing tissue expanders before an implant is called two-stage breast reconstruction. This is sometimes done to allow for a woman to receive other treatments, like breast radiation.


In addition, according to the American Cancer Society, a short-term tissue expander is used when the surgeon does not think the skin left from the mastectomy is ready to support a full-size breast implant. 

When your tissue expanders are implanted they are in a deflated state, so when you wake up from surgery, don't expect to see instant new breasts!

Tissue expanders will be enlarged gradually, during weekly tissue expansion treatments, when they will be filled with saline, or a salt-water solution.

Your tissue expanders will remain in place for several months or until you finish treatment for breast cancer. A second surgery is required to remove your tissue expanders and replace them with your breast implants.

What To Expect From An Expansion Treatment

Expansion treatments, also called "fills," will start three or four weeks after your mastectomy scar heals and surgical drains come out. Here's what to expect from an expansion treatment.

  1. You will undress from the waist up and sit in a comfortable exam chair. You may be given a paper exam jacket to wear. The chair may be tilted back for comfort, stability, and to allow your natural breast tissue to settle. Some clinics use a regular exam table, on which you just lie back.
  2. A nurse or technical assistant will prepare a large syringe of sterile saline solution. The syringe is marked with volume so the surgeon can keep track of the total saline used. A flexible catheter and needle, or a long straight needle will be attached to the end of the syringe. Don't worry -- the total volume of saline won't be injected all at once.
  1. Your surgeon will use a port locator or detector to find your port valve beneath your skin. A port locator is similar to a builder's stud finder -- it holds a cylindrical magnet that guides your surgeon to the access port. Your skin may be temporarily marked with the port's location.
  2. The skin over your port may be numbed. Your skin will be swabbed with iodine, to prevent infection. The needle from the saline syringe will be inserted through your skin and the outer layer of muscle into the valve.
  3. Your surgeon will slowly inject saline fluid into your tissue expander and you will be able to see how your skin and chest muscles respond. You will feel some pressure, and perhaps some pain. If you do feel pain, let your surgeon know immediately. The amount of saline used at each session will be logged for future reference.
  4. Once enough saline has been added to the expander for your appointment, the needle is removed from the self-sealing valve, the iodine is cleaned from your skin, and a small dressing or bandage will be placed over the puncture point.
  1. You can get dressed and go about your normal routines. 

Expansion Takes Time And Is Safe

Your expander will be filled weekly over a period of about two to three months. Your tissue expander will be overfilled, making it larger than your natural breast. Keep in mind that the stretching is needed to create a tissue pocket for the permanent implant, and soften the skin and muscle for the drape and contour of a breast.

Your tissue expander can remain in place for a year or longer, if needed — some expanders serve as the final implant. If you are having chemotherapy after your expansion is complete, the expander can stay in place until chemo treatments are finished. If a tissue expander ruptures and leaks, some saline solution -- saltwater -- will harmlessly leak into your body. A ruptured expander must be replaced with another expander or a permanent breast implant.

Exchange Surgery Is Scheduled After Expansion

A second surgery will be needed to remove the expander and exchange it for a permanent breast implant. Your skin and muscle will retract and settle over the breast implant, and should match the size and shape of your natural breast. The exchange surgery is usually done on an outpatient basis with a fairly quick recovery. Nipple and areola reconstruction can be done later, if desired.


American Cancer Society. (2015). Breast Reconstruction After Mastectomy. Types of breast reconstruction. Retrieved October 20th 2015.

National Cancer Institute. (2010). Breast Cancer Treatment (PDQ®). Reconstruction.

Continue Reading