Skin-Sparing Mastectomy With Expanders: What to Know

During this approach, the surgeon removes the breast tissue through an incision that may include the nipple and areola, depending on the treatment plan. The outer breast skin is usually kept to form a covering for reconstruction. Whether the nipple can be preserved depends on the tumour's location, its relationship to the nipple, and surgical safety.

A tissue expander is an empty implant-like device placed beneath the skin and chest muscle or in front of the muscle, according to the reconstruction plan. It is gradually filled during follow-up visits so the skin and surrounding tissues can accommodate a future implant or another reconstructive option. The expander is not always the final device.

This surgery may be considered as part of treatment for breast cancer or Paget disease of the breast. Reconstruction can be immediate or delayed, and other cancer treatments may affect the timing.

Before surgery, ask how the incision will be positioned, whether lymph nodes will be assessed, and which reconstruction stages are planned. Tell the team about medicines, allergies, smoking or nicotine use, and any previous chest operations. If chemotherapy before surgery is planned, confirm how it changes the surgical schedule.

After the operation, you may have dressings, drains, tightness across the chest, and limited arm movement for a while. Keep the incision and drains as instructed, take prescribed medicines according to the plan, and attend appointments for wound checks and expander filling. Gentle movement is often introduced gradually; follow the restrictions on lifting, driving, bathing, and exercise provided by your team.

The reconstructed breast may feel firm or different from the other side. Scars, altered sensation, and changes in shape can evolve as healing continues. A later procedure may be needed to exchange the expander or adjust the reconstruction.

Contact your surgical team promptly if redness spreads, pain or swelling increases, the incision opens, the skin changes colour, drainage becomes cloudy or foul-smelling, or a drain stops working or moves out. A sudden change in the reconstructed area should also be reported.

Seek urgent medical help for trouble breathing, chest pain, fainting, heavy bleeding, or a high fever with marked weakness. Use the emergency number available where you live if you cannot reach the surgical team.

Ask: Which skin and nipple areas will be preserved? Where will the expander sit, and how will it be filled? What reconstruction choices remain if radiation or other treatment is needed? Which symptoms should lead me to call the team the same day? When can I return to work, sleep on my side, drive, and move my arm normally?