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Guide Glossary
 Surgical Oncology

Why Can't I have an Expander after a Skin-Sparing Mastectomy?




NOTE: Because all the breast skin is PRESERVED during a skin-sparing mastectomy, it is NOT possible to use an expander (or an implant alone) after this procedure. This is because an expander (or implant) MUST be covered with muscle (not just skin) or it will look unnatural, feel unnatural, and may become infected. There is no muscle in the chest which can cover an implant, so immediate implant (or tissue expander) placement is NOT an option after skin-sparing mastectomy.

Another reason why an implant or expander can't be used after skin-sparing mastectomy has to do with the hole in the skin left after skin-sparing mastectomy.

There is no way to close the skin if a circle of it is removed.

The only way for a plastic surgeon to close a circular hole are:

  1. To fill the hole with skin from somewhere else (tram flap or latissimus flap)
  2. To turn the hole into an ellipse, creating a long scar. However, creating a long scar across the breast results in the same kind of scar as a traditional mastectomy and defeats the purpose of a skin-sparing mastectomy.




Summary of why a tissue expander or an implant alone cannot be used after a skin-sparing mastectomy:

  1. These implants must be covered by a muscle and there is no muscle in the chest which can do this. (The pectoral muscle can cover an implant, but only after about 6 months of stretching).

  2. The implant not covered by muscle looks and feels unnatural.

  3. The implant not covered by muscle very often (30-50%) gets infected and has to be removed.

  4. To close the skin with an implant or expander reconstruction, you need to make a long scar across the breast, removing extra skin and defeating the purpose of the skin-sparing mastectomy.