Hi Deb!

Unfortunately with this type of procedure it's a roll of the dice.  I had 2 failures...one on each side, but was told it's a fairly rare occurence.  Originally I wanted to have some type of FLAP procedure, which I'm sure PJ could tell you more about - but was told that as it is a longer surgery it does carry a risk of failure - you have to have the right combo of muscle/tissue/fat.  Since I had experienced failure with my expanders, I decided not to go with a FLAP, but the implants.  I'm still waiting for the final surgery because mid-way through my plastic surgeon found suspicous looking scar tissue that came back positive for cancer in my chest wall.  Since then things have been put on hold while I went through radiation and possible chemo.

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.)  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.

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.

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.

Also, the most important thing of all - find a good plastic surgeon that is certified and 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 they look right.  To some doctors breast surgery is an art, so don't settle for less than you deserve - OK!

Good luck and keep in touch here!

Angi