Tissue expanders are like placeholders to prepare you for breast reconstruction after a mastectomy. They help create and hold space in your chest until your body is ready for breast reconstruction surgery. Although this is rare, some tissue expander complications may mean the expander needs to be removed by a plastic surgeon.

Fortunately, having a problem with a breast tissue expander doesn’t mean you can’t have breast reconstruction later. Rates can vary, but one study found that 79 percent of people with tissue expansion complications had long-term success with breast reconstruction.

“I went through an infection. Had the expander removed,” a MyBCTeam member said. “Went through it again, and I had no problems. Total success. I had the implant placed above the muscle — what a difference. It’s been about 1.5 years now with my implants.”

Here are some points to consider if you’ve been having issues with tissue expanders.

1. Infection Is the Most Common Reason for Tissue Expander Removal

Although infection is the most common cause of tissue expander removal, it happens only in a small percentage of cases. One study showed that it occurs in about 9 percent of cases on average.

Usually, infections happen within the first few weeks of the expander placement, but they can also happen later in the process.

Sometimes, infections can be treated before a removal is necessary. One small study showed that 73 percent of participants were able to keep their tissue expanders after starting antibiotics at the first signs of infection.

Other complications include:

• Mastectomy flap necrosis, which means the skin over the surgical site dies because it doesn’t get enough blood
• Tissue expander exposure when a surgical incision opens
• Tissue expanders leaking, deflating, or rupturing
• Pain
• Seroma (fluid buildup)
• Hematoma (pooling of blood under the skin)

Sometimes, people also choose to have expanders removed if they change their mind about having breast reconstruction.

“I had a single mastectomy. Supposed to have reconstruction, but the tissue expander got infected. So I decided to forgo the reconstruction and went flat,” a MyBCTeam member shared.

2. Several Factors Increase the Risk of Tissue Expander Complications

The factors linked to expander complications are similar to those for other surgical complications. Staying as healthy as possible and keeping the area clean can help lower the risk of infection. Good nutrition can also support wound healing and recovery.

Having a larger breast size or expanders over 400 cubic centimeters (cc) may increase the risk of complications.

If you smoke, your doctor may recommend quitting before tissue expander placement or breast reconstruction after cancer treatment. Smoking can slow wound healing.

Several other risk factors can increase the risk of infection with a tissue expander, including:

• Chemotherapy
• Radiation therapy
• Diabetes
• High body mass index (BMI)
• Removal of lymph nodes with mastectomy

Sometimes complications can happen even when you do everything right. It can be frustrating, but this is one step in healing and returning to your usual activities.

3. Pay Attention to Your Symptoms After Tissue Expander Insertion

Complications can happen at any step of breast reconstruction. Within the first few days of expander placement, you and your care team will watch for signs of blood clots, infection, abnormal fluid buildup, and flap failure.

Your breast surgeon might recommend blood thinners, compression stockings, and walking around to reduce your risk of blood clots. Be sure to follow any postsurgery instructions.

Painful or swollen legs and fever or flu-like symptoms are reasons to be concerned after tissue expander placement. Be sure to let your doctor know if you have any of these symptoms.

You’ll have regular follow-up appointments to fill the expander and increase its size. During these appointments, tell your doctor about any symptoms like pain, tightness, and itching sensations.

It’s also possible to have a rupture of the tissue expander. In this case, the expander will deflate, and you may notice swelling in the area. Fortunately, your body can safely absorb the salt water solution that’s inside the expander, but it will still need to be removed and replaced.

If discomfort with a tissue expander is affecting your quality of life, your healthcare provider may offer solutions for pain management or dry skin. These could include over-the-counter medication, cold compresses, lotions for itchy sensations, or slower pacing with fills. Your doctor can help you understand what symptoms are normal and which are cause for concern.

One MyBCTeam member said, “I’ve had two expanders in for about a year now. … If you are still expanding them, ask the doctor to go up 50 cc at a time or less, if needed. I’m at 800 cc, and they only bug me when I lie on my stomach to read for too long. They are just uncomfortable.”

4. Call Your Doctor Immediately if You Have Symptoms of Infection or Blood Clots

Contact your surgical team or get emergency care right away if you have any of the following signs of infection or blood clots:

• Pain in your chest muscles, chest wall, or upper back
• Chills
• Coughing up blood
• Breast skin discoloration
• Discharge or fluid seeping from the wound closure
• Feelings of sickness
• Fever
• A painful, swollen leg that’s warm to the touch
• Shortness of breath

These symptoms could be life-threatening, so it’s important to get medical help right away.

5. You’re Not Alone if You’ve Had Tissue Expander Complications

After having an expander removed, your body will need time to heal. MyBCTeam members have described different outcomes, including placement of a temporary implant, waiting for permanent implant placement, or getting a new expander in preparation for breast implant surgery or autologous reconstruction (tissue reconstruction with their own tissue).

Here are some of their stories:

• “I had an expander removed. I had to wait three months for healing purposes, and they put a new expander back in.”
• “I had my left expander removed a few weeks after a bilateral mastectomy. It was not replaced until one year later, after radiation and Herceptin treatments. The new expander got infected, but we managed to save it with oral and IV antibiotics.”
• “I had both expanders removed due to a bilateral infection which, I understand, is very rare. I had nothing put back in while I finished chemo. I did not need radiation. My expanders were reinserted and filled, and I just went through my exchange surgery.”
• “My body was rejecting the expanders, and they had to be removed. They replaced mine with an implant. Either way, they have to put something there to keep the skin stretched, as chemo and radiation have a tendency to tighten and shrink the skin. This will become an issue when it's time to undergo reconstruction.”

After removing an expander, your doctor will look at your situation and recommend the safest next steps. Depending on your cancer treatment plan or whether you have an infection, your doctor may recommend waiting to have reconstruction.

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