You've had your mastectomy; your implant is in place; now what?
It's time to start building your new breast. First step: gradually filling the expander, in order to stretch the tissue and skin on your chest enough to accept the size implant you've chosen.
Filling the expander
Once you've recovered from surgery and your incisions are fully healed, the expansion process can begin. It'll take, on average, 4 to 6 months to complete. You'll visit your doctor's office on a regular schedule (usually every 1, 2, or 3 weeks); this schedule may be dependent on whether or not you're having chemotherapy, and the schedule for that.
The fill process itself doesn't take long. There's a port in the front of the expander, and the doctor is able to reach it via a needle through your skin right over the port. S/he will inject, typically, about 50cc of saline solution (about 10 teaspoons, or just under ¼ cup). It may be more, it may be less; it all depends on how well and how quickly your skin stretches, and any discomfort you may experience. It takes about a minute to complete the injection.
Typically your skin will feel very tight for several days after the fill, and will then start to feel more normal. Women usually classify this feeling as discomfort, more than pain.
However, you may experience muscle pain - in your chest, back, and/or shoulders. Why your back and shoulders? Because as the muscles in front stretch, they pull on the muscles around them. Any pain or discomfort usually responds well to an over-the-counter painkiller, such as Tylenol.
Unfortunately, some women do have quite a bit of pain from the expander itself, rather than the fill process. Perhaps it's not sitting just right, and is pressing on a nerve. If you experience severe enough pain that it affects your daily living, be sure to get in touch with your surgeon to find out what can be done.
Removing the expander, adding the implant
Once the fill process is complete, and the breast skin and tissue are sufficiently stretched to accept the implant, the expander can be removed. If you're undergoing chemo, the surgeon will want to wait until you're done and recovered to perform this surgery - usually a month or so after your final chemo treatment.
This operation is usually done on an outpatient basis; the actual surgery takes about an hour, under general anesthesia. The surgeon removes the expander; does any final "touch up work" to the cavity the expander has formed; then puts the implant in place, and closes the incision.
You probably won't need any drains; and you should be home within a few hours. Most women report feeling immediately better after the expander has been removed; your new implant is soft, unlike the expander, and you'll finally feel like you have a "real" breast.
One hint: While it's tempting to want to get a look at your new breast right away, don't remove any dressings unless the surgeon says it's OK. You'll be experiencing natural swelling from the surgery, and at first you may need those dressings for support. Also, you may be advised to wear a special bra or sports bra full-time for awhile; follow that advice.
Finally, just as after your mastectomy and expander surgery, go easy on the heavy lifting for awhile. Your surgeon will give you a list of "dos and don'ts" - be sure to follow it.
Gradually your implant will settle into place, and your skin will lose its tight feeling. You can't rush this process; and every woman is different, so don't panic if your healing process isn't exactly like everyone else's. You're finally getting back to normal - your "new normal." Give yourself the time you need.