This resource describes how to care for yourself after a mastectomy with breast reconstruction using a tissue expander. This material will also help you prepare for the tissue expansion process. A mastectomy is surgery to remove the breast.
This material is in addition to, but not a replacement for, consultation with medical professionals. Some of the information presented here may not apply to your case. Ask your plastic surgeon or nurse if you have any questions.
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About breast reconstruction using a tissue expander and a permanent implant
A tissue expander is an empty breast implant. Your surgeon will place it during your mastectomy. Typically, hospital stay after mastectomy with breast reconstruction lasts less than 24 hours. This means you will be able to go home on the day of your surgery.
After placing the tissue expander, your surgeon will fill it with fluid or air for 6 to 8 weeks. As it enlarges, it will stretch the tissue around it and create space for a permanent breast implant. For more information, see What to Expect During the Tissue Expansion Process.
Your surgeon will stop filling the tissue expander when your breast reaches the size you agreed upon. It will be replaced with a permanent breast implant. For more information, see the section “After the Tissue Expansion Process Is Complete.”
Placement of tissue expander
There are 2 ways to place the tissue expander:
- Placement under the muscles . In this case, the surgeon places the expander under the pectoralis major muscle. A pocket is formed under the muscle where the tissue expander is placed. When the tissue expander is placed under the muscles, it fills with fluid. After a mastectomy, your skin will be weak and prone to damage. Your muscles will serve as a barrier between the skin and the tissue expander. This will help relieve pressure from the dilator while the skin heals.
- Located on top of the pectoralis muscle . In this case, the surgeon places the expander over the pectoralis major muscle. A mesh called an acellular dermal matrix is also placed around the expander. The mesh will support the expander while the skin heals. Over time, the mesh will dissolve. There is no need to remove it. When a tissue expander is placed over muscle, it may first fill with air instead of liquid. After a mastectomy, your skin will be weak and prone to damage. Because air is less dense than water, the dilator will put less pressure on the skin during the first time after surgery. Your surgeon will replace the air in the tissue expander with water approximately 2 weeks after surgery.
During your preoperative consultation, your surgeon will discuss with you how to position the tissue expander.
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What to Expect After a Mastectomy and Tissue Expander Surgery
After your surgery, you will be moved to the Post-Anesthesia Care Unit (PACU) or recovery room. If your surgery was performed at Josie Robertson Surgery Center (JRSC), you will wake up in your room. You will have:
- Intravenous (IV) drip. You will be given fluids, antibiotics, and pain medication through an IV line.
- A small plastic Jackson-Pratt® (JP) drain near each incision (surgical cut). It serves to drain and collect fluid that is released from the incisions after surgery. It is fixed with a suture and most often remains for 1-2 weeks after surgery.
The nurses in the recovery room will answer any questions you may have.
Drainage JP
While you are in hospital, your drain will be looked after by nurses and nursing staff. Your nurses will teach you how to care for your drain at home. You will be given the Jackson-Pratt Drain System Maintenance material.
Drains are usually removed 1–2 weeks after surgery.
Surgical incisions
After surgery, you will be given a bandage to cover the incision where your mastectomy was performed. A bandage made of regular gauze or gauze with transparent adhesive tape is applied to the incision. It will be held in place by a surgical bra.
The surgical incision in the breast will be closed with internal sutures. These stitches will dissolve on their own, so they do not need to be removed. You may see redness on the skin and small spots of blood on the gauze covering the incision. You may also experience tenderness and bruising around the incision area. This is fine.
Immediately after a mastectomy, the operated breasts may be smaller than the breasts before surgery. This is because the tissue expander is only partially filled when placed. Before you leave, when your nurse changes your dressing, examine your breast and incision to see how it looks and feels now. This will help you get used to it. Under the skin, you can feel the port used to fill the tissue expander. This is fine.
Pain and sensations
After the operation, you will experience some discomfort. You may experience a burning sensation around the incision. Itching may occur at the drainage sites. There may also be increased sensitivity in the lower chest. Over time, these feelings will pass. If necessary, you can take pain medication and a muscle relaxant. You will be given them when you leave the hospital. Reducing pain will help you recover better and resume activity as quickly as possible.
Other common sensations that may occur after surgery include:
- Numbness under the arm and over the chest on the treated side. The treated side is the side where the surgery was performed.
- Warmth in the hand on the operated side.
- Sensation of water running down the arm or chest on the treated side.
These sensations are caused by the fact that during the operation some of the nerve endings were cut off. Over time, these sensations will decrease, but numbness in some areas may remain.
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Self care at home
When you leave the hospital, gauze will be placed over the incision sites. Spots may appear on the gauze pad for 24–48 hours (1–2 days) after surgery. If you have any discharge (fluid coming out) from your incision, call your doctor.
Unless your doctor instructs you otherwise, wear a surgical bra 24 hours a day. Take it off when you shower.
Taking a shower
Do not shower or get the dressing wet for the first 48 hours (2 days) after surgery. After 48 hours, you may be allowed to shower all the way down to your waist. Follow your surgeon's instructions for showering. Some guidelines are given below.
- Once you start showering, do so every day to keep your incisions clean.
- Remove the surgical bra and gauze from the incision before showering.
- First check the water temperature with your back or hand. Numbness may prevent you from feeling warmth in the treated area.
- Wash with warm water and mild, unscented soap. Gently rinse the incisions and drainage sites. Rinse thoroughly.
- Do not direct the water stream at the operated breast. Direct it towards your upper back or arm. The water should gently wash the operated mammary gland.
- Gently pat the incisions dry with a clean towel. Don't rub them.
Your healthcare provider will remove the drain 1 to 2 weeks after surgery. Do not get the dressing wet for 24 to 48 hours (1 to 2 days) after removing the drain. This also applies to taking a shower. Your surgeon will tell you how long you should not keep the bandage wet.
You will be able to shower completely within 24 to 48 hours after the drain is removed. Follow your surgeon's instructions.
Do not take a bath until the incisions and drainage sites are completely healed. Taking a bath may increase the risk of infection. You may be allowed to bathe 6 to 8 weeks after surgery. Talk to your doctor before taking a bath.
Inspection of cuts and drainage installation sites
After showering, carefully inspect the incisions and drainage installation sites. Do this in front of a mirror in a well-lit room. Contact your plastic surgeon or nurse if you have any of the following signs:
- temperature 100.4°F (38.0°C) or higher;
- increased redness around the breast;
- swelling of the mammary gland has increased;
- new discharge appears from the incision;
- large bruises;
- More than 30 ml of blood discharge per hour accumulates in the JP drain.
After inspection, place a clean gauze pad over the incision. Wear a surgical bra.
Shaving
You can start shaving your armpits 2 weeks after surgery. Use only an electric razor on the treated side. This makes it less likely to get a cut in an area of reduced sensitivity. A cut can lead to infection.
Using deodorant
Use deodorant only after putting on your bra. This will prevent it from getting on the incision and causing infection.
Do not use deodorant on the treated side if there is any damage to the skin there.
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Safety rules during classes
When purchasing an expander, you need to check the strength of the handles to avoid injury.
Safety rules that should be followed when working with an expander:
- When attaching one side of the equipment to the wall, it is important to ensure that the connection is secure. If one end comes unhooked during training, you can injure yourself with the handle and ruin the interior of the room.
- A common problem, especially among girls, is that the handle slips out. This needs to be monitored, otherwise you can again get injured.
- When purchasing sports equipment, you need to check the strength of the attachment of the handles to the spring. There are common cases when the spring breaks at maximum tension. This is fraught with dislocation, muscle strain and injury to the skin.
In budget models, springs often break when tensioned, so you should not skimp on purchasing sports products. It is better to give preference to proven and well-established manufacturers.
First follow-up appointment
Your first follow-up appointment will be 1 to 2 weeks after surgery. Your plastic surgeon's nurse will call you after surgery to check on your recovery progress. You will also be scheduled for a follow-up appointment.
During your appointment, your plastic surgeon and nurse will examine your breast to make sure it is healing well. If you have JP drains in place when you are discharged, your healthcare provider may remove some or all of them.
- If the tissue expander is located under the muscle, your healthcare provider will remove the JP drain if your daily fluid output is less than 30 mL (1 fluid ounce) for 2 consecutive days.
- If the tissue expander is located over muscle, the JP drains may not be removed for at least 2 weeks. The amount of fluid removed will not matter.
Be sure to shower before this appointment. You will not be able to shower until the drain sites have healed. This usually takes 24-48 hours (1-2 days) after the drain is removed.
JP Drain Removal
Most people describe drain removal as a slight tugging or burning sensation that lasts only a few minutes. You will not need pain medication when the drain is removed.
After the drain is removed, some fluid may continue to leak from the area where the drain was located. Cover the area with sterile gauze or a Primapore™ dressing provided by your nurse. Change the gauze and dressing if they become damp. By this time, the drainage sites most often heal. Do not shower until the drainage site has completely healed.
After the drain is removed, continue to wear a surgical bra or your own support bra. He must:
- be comfortable;
- don't be too tight;
- do not have “bones” (wire frame).
Your doctor may also recommend covering the drain sites with thick gauze pads to provide additional pressure. They prevent fluid from accumulating under the skin.
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How to choose an expander and where to buy
Despite all the advantages of using an expander, it can not be found in every sports store. But you can always buy a tubular expander in online markets, where, as a rule, there is a large selection of expanders of varying hardness. The only disadvantage of online purchasing is that you will not be able to visually verify the quality of the product and check the load. Please note that the stiffness of the expander may vary between different manufacturers, even with the same declared resistance.
What you should pay attention to when buying an expander:
- Tube material. Choose an expander with durable, thick rubber. Try stretching the rubber several times and check if any white streaks or defects remain on the surface.
- Handles. Handles must be made of durable plastic that is resistant to mechanical damage. Check that the handles have a rough, non-slip surface that provides improved grip while exercising.
- Fastening. With strong tension, most often the expander breaks precisely at the place where the handles and tube are attached. Ideally, choose an expander in which these parts are connected with a metal carabiner (found in expanders with replaceable tubes).
- Length. Check if you can perform exercises with an expander where you need to extend it as far as possible (for example, a shoulder press). Some expanders have such hard rubber that even with great effort they are unable to stretch to the required length.
- Additional rubber coating. An expander with a rubber tube covered with braiding or a protective sleeve (casing) is more wear-resistant and reliable for long-term use. Such expanders usually cost more.
The resistance level of the expander is usually indicated in the product description and is determined by the color scheme. The color scheme depends on the specific manufacturer, but most often the following gradation is provided:
- yellow: very light load
- green: light load
- red: medium load
- blue color: heavy load
- black color: very heavy load
Sometimes the resistance level is marked on the handles with numerical symbols: 1 - weak resistance, 2 - medium resistance and 3 - strong resistance. In this case, the color of the rubber does not matter.
In order to increase the variability of exercises with a tubular expander, you need to think about where it can be fixed in the room (for example, a wall, door, wall bars). You can use special wall clamps or door mounts:
A tubular expander is one of the most affordable attributes on the sports equipment market. The cost of an expander is 300-400 rubles, the cost of a set of expanders is 800-1500 rubles. The largest selection of resistance bands is available on Aliexpress at low prices and free shipping.
We offer you several options for tubular expanders on Aliexpress, which you can order right now. The expanders usually arrive within two to three weeks. We have selected several sellers with the most affordable prices and positive reviews. Be sure to read product reviews before purchasing.
Single expanders
Typically, sellers on Aliexpress offer 5 resistance levels of resistance bands (from 5 kg to 15 kg). Each color corresponds to a certain hardness.
- Tubular expander No. 1
- Tubular expander No. 2
- Tubular expander No. 3
- Tubular expander No. 4
- Tubular expander No. 5
Resistance sets
For training with a tubular expander, it will be convenient and profitable to purchase a whole set of tubular expanders of different hardness. This will allow you to train comprehensively, working each muscle group as much as possible. The set usually includes 5 expanders of different hardness (from 4.5 to 13 kg), 2 handles, leg straps, a door holder, and a bag.
- Set of expanders No. 1
- Set of expanders No. 2
- Set of expanders No. 3
- Set of expanders No. 4
- Set of expanders No. 5
What to Expect During the Tissue Expansion Process
During your second or third visit to the doctor, you will have your first tissue expansion done.
- When the tissue expander is positioned under the muscle, the nurse will fill it with fluid through a port. A small needle will be used for this.
- When placing an air-filled tissue expander over the muscle, the nurse will first remove the air. The air will be replaced by liquid.
- When placing a fluid-filled tissue expander over the muscle, the nurse will fill it with additional fluid.
Tissue expansion procedures are prescribed every week or every two weeks. The tissue expansion procedure itself takes only a few minutes. With each enlargement procedure, the operated breast will become larger. It will not take its final shape until the permanent implant is placed.
How to Increase Your Comfort Between Tissue Expansion Treatments
After each enlargement procedure, you may feel tightness and fullness in the breast area. You may also experience some discomfort in your shoulders and back. Most often this goes away within a few days.
After expansion, you may feel pain in the chest area as if after a workout. There are several ways to feel more comfortable between tissue expansion procedures.
- Take warm showers several times a day to help your muscles relax.
- Take over-the-counter pain relievers (those you can buy without a prescription), such as acetaminophen (Tylenol®) or ibuprofen (Advil®).
- Apply fragrance-free moisturizers (such as Eucerin® or Lubriderm®) to your breast skin. Do not apply them directly to the incision site for 6 weeks after surgery or until the scabs fall off.
- Do arm and shoulder exercises as directed by your nurse. You will be given paper copies of all instructions. You can also find these materials here. You may find it easier to stretch after showering because your muscles will be more relaxed.
- Wear soft, supportive bras. Avoid wearing underwire (wire) bras.
Daily routine
After each tissue expansion procedure, you can go about your daily activities. During your recovery period, follow these guidelines to ensure your safety and comfort.
- Within a few hours after taking it, you can return to work and simple household chores.
- The arm on the treated side should not lift more than 5 pounds (2.3 kg) for 6 weeks after surgery. Pets and children are also prohibited. Ask your breast surgeon how many lymph nodes were removed during the operation. Depending on this, your lifting restrictions may change.
Sports activities
- Avoid strenuous exercise for 4 to 6 weeks after surgery or until your doctor says it is safe. For example, you cannot engage in various types of running or jumping.
- Avoid exercises that strain or pump up your chest muscles. Talk to your healthcare provider about when you can start doing this type of exercise again.
Car driving
- You can drive once your shoulder on the treated side has full range of motion and you stop taking prescription pain medications.
- If you travel long distances in your car and the seat belt rests directly on the fabric extender, place a soft pad under the belt. Buckling up in a car is very important, so always wear your seat belt.
Tips for choosing clothes
The tissue expander may be slightly larger than the target size. If you have surgery on one breast, by the end of the expansion process the operated breast may appear larger than the other.
At different stages of breast reconstruction, you can use bra filler to maintain body symmetry. One such filler could be a soft breast pad. The breast shield is a lightweight nylon pouch. Its size can be adjusted to match the size of the other breast by adding or subtracting cotton fluff from the pouch. This helps a lot when the mammary gland becomes larger during expansion.
The breast shield can be purchased from the Breast Boutique at the Evelyn H. Lauder Breast and Imaging Center. Breast Boutique is located at 300 East 66th Street at the intersection with Second Avenue. For more information, call 646-888-5330.
You can put soft gauze in your bra. You can get gauze from your nurse. Change the gauze pad every day to keep it clean.
It is also recommended to wear:
- loose blouses, tops and sweaters;
- dark knitted tops under a loose blouse, sweater or jacket;
- tops with diagonal stripes or asymmetrical prints;
- neckerchief or shawl;
- shift dresses with buttons;
- robes.
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Types of spring expanders
This type of simulator has many varieties.
Carpal expander
Perfect for grip training. Among hand exercisers, the most popular and effective are the “Captain Crash” resistance bands and adjustable resistance bands.
Also included in the class of wrist exercisers is the “cocoon” expander, which in fact is ineffective.
There are also devices that allow you to train each finger separately. But they create little effort and are more likely to be used for fun than for training.
You can watch the video on how to use wrist expanders. Here you will learn about prices for exercise equipment.
Shoulder spring expander
This simulator was popular back in Soviet times. You can use it to train your upper body. It is convenient due to its simple design and easy load adjustment. By the way, the load is selected by removing or putting on the springs.
Wall spring expander
Wall spring expanders were the most multifunctional type of spring-type exercise equipment. They have been used since the times of the USSR, but have since undergone some changes - rubber bands have replaced springs.
The simulator is convenient because it can be attached to a wall bars or directly to the wall. Sometimes expanders are part of the DSK (children's sports complex). Such machines allow you to train almost all muscle groups.
Exercise stick with spring or butterfly
A stick with a spring (or butterfly) exercise machine is another representative of spring expanders. Despite the simplicity of the design, you can use it to pump up your chest and arms.
After completion of the tissue expansion process
Replacement operation
Once the tissue expander reaches the desired size, the next stage of breast reconstruction will be planned. The next step will be surgery to replace the tissue expander with a permanent breast implant. This is called the replacement operation.
If you are not undergoing chemotherapy or radiation therapy, you may have this surgery approximately 6 to 8 weeks after the tissue expansion process is complete. If you are undergoing chemotherapy or radiotherapy, you will need to wait until the treatment is completed.
During replacement surgery, your surgeon will use the same incisions (surgical cuts) that were made during the mastectomy. Your tissue expander will be removed and replaced with a permanent breast implant, which you and your plastic surgeon will choose. The replacement operation takes about 1 hour for each side. If a procedure is performed on another breast to give it the shape and size corresponding to the operated breast, then more time will be needed.
You can go home after you have recovered from anesthesia (medication that will keep you asleep during the operation). This occurs on the day of surgery, most often 3-4 hours after its completion.
Nipple reconstruction and fat grafting
At the final stages of plastic surgery, if necessary, reconstruction of the nipple and fat tissue transplantation are performed. In fat grafting, fat tissue is removed from a part of the body and then transplanted into the breast area. This procedure improves the shape of the breast. Fat tissue is usually taken from the thighs, abdomen (belly), or breasts. For more information, see Fat Injection After Breast Reconstruction Surgery.
About the nipple reconstruction procedure
Some patients also require nipple reconstruction to recreate the nipple and areola. Most often, this procedure is performed 2-4 months after the placement of a permanent implant. Options for reconstruction of the nipple and areola are listed below.
- 3D tattoo of the nipple and areola During this procedure, a doctor's assistant will recreate the nipple and isola through tattooing. A tattoo will not recreate the volume of the nipple. The color and texture of the tattoo will match your natural nipple. For more information, read the material Information about the procedure for tattooing in the area of the nipple and areola.
- Reconstruction of the nipple and isola. During this procedure, reconstruction of the nipple and areola is performed using breast skin. Sometimes reconstruction of the nipple and isola is performed using a skin graft. During skin graft surgery, tissue is transferred from one part of your body to another. The place where the tissue is taken is called the donor site. The place where the tissue is transplanted is called the recipient site. Papilla reconstruction can be performed in the operating room or in a doctor's office. For more information, read the material Reconstruction of the nipple and isola with skin grafting.
- A combination of these 2 procedures.
Depending on your skin and type of reconstruction, 3D tattooing may be your only option for nipple reconstruction.
Talk to your surgeon about which option is right for you. to come back to the beginning
Training with a tubular expander: 8 ready-made videos
If you don’t like to plan classes on your own, then we offer you 8 ready-made YouTube videos with a tubular expander for muscle tone and improving body quality. Classes last from 10 to 30 minutes, you can alternate them among themselves or choose the program that is most suitable for you.
Full body workout with resistance band (30 minutes)
Short full body workout with resistance band (10 minutes)
Full body workout with resistance band (30 minutes)
Full body workout with resistance band (30 minutes)
Full body workout with resistance band (25 minutes)
Full body interval training with resistance band (10 minutes)
Arm workout with expander (25 minutes)
Full body workout with resistance band (20 minutes)
Many people underestimate tubular expanders, not considering this equipment effective in working on body tone and relief. However, this is an erroneous judgment, because an expander is not only a universal and compact piece of equipment, but also an excellent way to efficiently pump up all the main muscle groups.
