My Breast Reconstruction Journey Phase One: Tissue Expanders

In this post here, I mentioned I was three weeks post-op, drain free and ready for my first fill. Some of you might be wondering what a “fill” is and what’s a “tissue expander”?

Women like myself who wish to reconstruct their breasts after a mastectomy but who do not have enough body fat to use their own tissue usually use one of two methods.

The first being a newer technique called a “one-step”. The "one step" requires the least amount of surgeries and downtime as implants are placed immediately following the mastectomy.


The second technique is a two-phase approach using tissue expanders later exchanged for implants. This is the reconstruction technique that was right for me.


After my bilateral mastectomy, a tissue expander was placed on each side behind the chest muscle. My surgeon utilized support matrix called alloderm. Alloderm is donated tissue that was stitched to my pectoral muscle to help support the expander and eventual implant.

The tissue expanders are filled with saline over time to slowly expand the muscle and skin to accommodate the implants. I’m pretty tiny so my surgeon only placed 50ccs of saline in each expander at the time of my initial surgery. Most women get more than 50ccs. Since I wasn’t larger chested to begin with and because I had my areola and nipple removed, I had a lot less skin remaining than women who had larger breasts or who had a Nipple Sparing Mastectomy.

When it was time for my long awaited first “fill”, I asked how much we were going to place in the expanders. The surgeon said it’s different for everyone but fill amounts can be anywhere from 30 to 150ccs. It depends how much the patient can tolerate.

I was feeling great, and a bit bold, so I asked for 100ccs. My surgeon's PA inspected my incisions and examined my skin. She then agreed to the 100ccs in each expander as long as I was feeling okay during the fill.

She swabbed the entire breast area with alcohol that stained my skin blue. This easily removable dye is added to visually aid and confirm that everything was sterilized. She used a little magnetic tool to confirm the location of the port, and marked me with an X on each side where the needle from the syringe would go in. It's critical not to puncture the expander.

She started on the left side with a syringe full of 50ccs of saline. The needle went in (I looked away) and she placed 50ccs in the tissue expander. I didn’t feel a thing and was doing great. She then paced another 50ccs for a total fill of 100ccs.

Now for the right side. She placed the needle in and OUCH! That hurt! It caught me off guard as I didn’t feel anything on my left side. She said it’s actually a good sign that I have any feeling at all. And that it’s not uncommon for feeling on one side and not the other but that it wasn’t out of the question that I may regain feeling in both breasts.

The fill of 100ccs on the right side didn’t hurt, but I could feel it going in. It was a very strange sensation. Even more so was the sight of such a large change in the size of the breast mound in just a matter of minutes. I couldn't help but giggle at that. If only puberty had been so easy.

My remaining fills went the exact same way. I never felt anything on the left and I always felt that darn needle going in on the right. I tried to remember that it was good though because it meant that I had feeling in that breast. I can’t complain about that!

My fills were pretty uneventful with the exception of one, my third fill that filled my tissue expanders to their suggested fill volume of 350ccs. I did take some ibuprofen that night as I was a bit sore. Nothing extreme and easily controlled by the little bit of ibuprofen I took. I really feel the botox mentioned here greatly assisted in my expansion process.

For anyone going through this, know that tissues expanders do not look like natural breasts. It's more shaped like a football and the saline will collect in areas of least resistance. They are certainly odd looking; but in all honesty, the look of them really didn't bother me. I knew it was temporary. The feel of them was much more difficult to cope with. They are so hard and expand laterally right underneath the armpit. That was annoying to say the least. For me however, they were not necessarily painful, but certainly uncomfortable.

I had a total fill of 460ccs when I was done. Here’s how my fills progressed.

Now 460ccs on me would look very different than 460ccs on a woman larger or smaller than me. Sizing really depends on your height, weight and rib cage. I’m going to talk more about that in a separate post, but this was my expansion journey. Now that my fills were done, all I had to do was wait to exchange the tissues expanders out for implants.