Is it always necessary to expand the chest for breast reconstruction?

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JoshLevineMD (Physician - Surgery - Plastic (Verified) ) - 05 / 24 / 2012

Expansion is a technique used in breast reconstruction when implant reconstruction is performed. Implants for breast reconstruction go underneath the chest muscle (pectoralis major). There is not enough space under this muscle such that the implant can be entirely covered at the time of mastectomy. Therefore an expander is placed under the muscle first. The expander is gradually filled with saline until the desired volume is achieved. This allows the muscle to stretch over time to accommodate the implant later on.

The idea is that the final implant must have thick tissue covering it, and skin alone is not enough. In order to avoid expansion, some plastic surgeons are now offering “direct to implant” procedures. To compensate for the lack of muscle coverage, a piece of cadaveric (from a cadaver) dermal tissue is used to support the implant below the muscle.
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