Hi! Sorry I didn't get to you sooner, but I was away from the computer all day across town at a birthday party.
In July of 2007 I wanted to attempt reconstruction again on my R breast (my first failed as you will read later), while opting to have my L breast removed (due to too many scares with lumpy breast tissue.) I wanted immediate reconstruction to be done all at the same time.
My R breast, went through a modified radical mastectomy that took all my skin, some chest wall and my nipple - I was not offered an alternate surgery or approach. When I chose to remove my L side I was offered a choice as what I wanted to do with my breast. I was told that by removing all the tissue, the nipple and the majority of the skin, I would lower any remaining chances of cancer in that breast. The risks between skin sparring and/or keeping your nipple are all very low, but I figured he might as well just take it all, so they at least matched in every aspect.
What I can tell you of the expander process is that it is fairly easy. You can chose to do it following your mastectomy (immediate reconstruction) or they may ask you to wait a few months to heal before trying depending on your individual circumstances (chemo, radiation, etc.) my first attempt I was told I had to wait cause I did chemo and stuff. But each cancer, treatment, procedure, and experience is different. Once you are ready, your doctor will place silicone expanders beneath your muscle that have this small valve that includes a very small piece of metal in it. During the surgery he will fill them just a bit with saline, but not much cause he doesn't want you to feel too uncomfortable with them. From what I understand they are also folded when they are placed - it all depends on if he opens you all the way up or if he does it through a small incision. When you wake up you will have drain tubes coming out of your sides and they will stay there till less than 30cc's a day is draining of this pinkish fluid. The drains are a pain - makes it very difficult to be comfortable with them and you have to watch them carefully cause since they drain, they can also backflow and cause infection to travel back into the body....so watch them and make sure the suction is working correctly. The drains are usually removed within the first few days to 2 weeks.
Approximately 6 weeks following your initial surgery you will go in for your first fill. Even though it is a rather large needle that goes through your muscle into the valve, the pain is very minimal, however I do recommend taking a Motrin or something prior to going just to ease the discomfort you will be filling after the fill. Your doctor will have a set amount he'll want to fill, or he'll stop whenever you feel "tight". The tightness will last the first few days, but will be gone before it's time for your next fill. Depending on how large you want to be and how much saline you can tolerate each fill, you should generally be done in about 4 weeks then it will be time to swap them out for your implants.
Things you'll want to do are:
-Take it easy following any surgery - don't lift or carry anything over 5 lbs. Don't do moderate arm exercizes. You can use yoga bands to help gain mobility, but no lifting weights, etc. for the first few weeks.
-Gently massage your breasts to stimulate circulation/blood supply. This will help keep your breasts soft and prevent scar tissue from forming.
-Your doctor may also want you to massage or push your expanders into a certain spot. It's important for the right area to stretch out and you don't want your implants too in, out, up or down. If your expanders shift (which can and does happen) your doctor can make "pockets" for your implants to go in so they are kept in place.
-Keep the incisions clean - use antibacterial soap and/or saline several times a day to clean the area. Put Bacitracin ointment on the incision and cover with gauze and surgical tape. When possible do let the incision go unbandaged so it can breathe.
-If the incision starts to bruise or turns black call or see you doctor right away. When mine failed it all started with the incision turning black which lead to dying tissue and a hematoma (large bruise).
Should everything go as planned you should go from expanders to implants within 3 months. Then you wait another 3 months or more to heal before doing the surgery/tattoo for the nipples/aerolas - unless you are keeping yours.
Providing that you keep the areas clean and provide yourself with time to heal, everything should go according to plan. It's really hard to say what or why one might fail - afterall it is a foreign object being placed within your body. My 2 attempts that failed were only in the beginning. I've had a total of 7 breast surgeries and only had problems on 2 occasions - one on each breast. This last attempt has been put on hold cause my plastic surgeon found suspicous scar tissue during surgery that tested positive for cancer. So I've had cancer twice within 3 years - and my current expanders are just sitting in me waiting to be filled while I heal from my radiation burn and find out if I'm doing chemo or not.
Oh, and the most important thing of it all is to make sure you find a good plastic surgeon that isn't just certified but one that you feel comfortable with and isn't in a rush to finish a project, but rather take his time to make sure you are happy and that they look right. To some doctors breast surgery is an art, so don't settle for less than you deserve - OK!
I love my plastic surgeon because he literally saved my life by catching that cancer recurrence when he did!
Good luck and keep in touch here! I hope I was able to help you!