Making Reconstruction Progress with Expanders

This may date me, but do you recall the Chia Pet commercials? “Ch-Ch-Ch-Chia! The gift that grows!” Just add water and your Chia Pet magically grows! The expansion process is like the Chia Pet. Ex-Ex-Ex-Expanders! Just add water and watch your chest magically grow!

What are expanders? When I underwent my double mastectomy I opted for immediate reconstruction. Ah I remember reading that phrase for the first time. I immediately envisioned myself leaving the hospital with permanent implants. Done! One simple step. Why doesn’t everyone pick this option?

Ah my naiveté. Adorable. Don’t worry I only envisioned that for a split second. Then I read what it actually entails. Immediate reconstruction is not so immediate after all.

Immediate reconstruction simply means after your breast tissue is removed by a breast surgeon a plastic surgeon takes over and inserts expanders. Tag your it! A passing of the baton. From that moment forward reconstruction is solely in the hands of your plastic surgeon.

Expanders are inserted under the pectoral muscles. Best-case scenario you leave the mastectomy with an initial fill in your expanders. Then two weeks post-mastectomy you have your second expansion and weekly expansion moving forward.

I was not best-case scenario. Due to both my surgeons’ concern for necrosis my expanders were left empty. The hope was to stress to the surrounding tissue as little as possible. Then a couple weeks post-mastectomy I would have my initial expansion.

That was my best-case scenario, but as you may recall I ended up with necrosis. Thus my initial expansion was delayed even further and did not occur until seven weeks post-mastectomy, not two. The plan was to slowly expand 100ml of saline weekly until I reached my desired goal.

How do expansions work? The expanders themselves have a magnetic port. My plastic surgeon had a special magnet suspended from a chain that he would dangle over my chest. The magnet located and attached to the port through my skin and muscle.

From left to right: the magnet, the sharpie and the dull-tipped pin tool.

If you’re thinking wow your chest was magnetic? It was, but regular refrigerator magnets didn’t work. I tried just for laughs. Nothing. They fell right off. It would have been comical if it had worked.

Anyway, once my plastic surgeon located the port with the magnet, he used a little tool with a dull-tipped pin to push on that location. Then he drew a large black dot with a sharpie on that point. He then cleaned the area with alcohol and stabbed a two-inch-long needle attached to a tube into my chest. No kidding. He wasn’t messing around.

The 50 ml syringes (top left) and the clear two-inch-long needle with green wings and attached tubing coiled around it (bottom center)

The first time he did this he commented I wouldn’t feel anything. He was wrong. I felt the needle stab through my muscle. The second or third expansion when he went to stab me, he repeated this remark and I admitted I could in fact feel it. He apologized, but it didn’t change the process. It was what it what.

Once the needle was in place his assistant handed him a syringe with 50ml of saline that he attached to the tube. He then proceeded to slowly empty the syringe into the expander.

Once the first syringe was empty, he unscrewed it from the tube and attached a second syringe with another 50ml of saline. We repeated this process on both sides. Have you ever watched as a balloon inflates? That is what it was like watching my chest expand. However, not as effortless.

Remember, the expanders were below my muscles. So what where we slowly expanding? My pectoral muscles. Have you ever felt your muscles lock-up or cramp? That is pretty close to the sensation of expanding a muscle.

Expanding 100ml at a time was to make the process bearable. I was prescribed muscle relaxers and pain killers. The only problem? You can’t drive on muscle relaxers. Toting around 3 kids to and from school and activities made the muscle relaxers pretty useless, except at night. I opted to take them before bed, so I didn’t lie there in agonizing pain whilst trying to relax and fall asleep.

What was my end goal with expansions? Well, that was up to me. With reconstruction you get to pick your size. I knew I wanted to be at least the same size as I was prior my mastectomy.

My breast surgeon removed a little over 400grams of breast tissue. My plastic surgeon told me a gram of breast tissue equated to a ml of saline. He always overfilled 100ml to give himself room to work with during the placement of the final implants. 100ml of saline roughly equated to one bra cup size. This meant a goal of at least 500ml of saline to be comparable in size.

If I am honest my second expansion secretly delighted me. In one day my breasts doubled in size. I will never be able to say that again. That very fact made me laugh. With all the heaviness of the mastectomy and reconstruction process, finding humor in any little thing lightens the mood and lifts the spirits!

The process of expanding was not all smooth sailing. Each expansion came with the possible risk of infection. If an infection occurred the expander would need to be removed. Every expansion was preceded with waiver that required a signature that I was aware of the risks.

With my track record thus far with complications I would be lying if I didn’t admit this scared me. Side effects or complications were no longer just an obligatory conversation. Complications were a very real risk.

My first few expansions went without a glitch. Until my third visit when I was denied an expansion. When the plastic surgeon went to locate my port with the magnet he paused. What happened here? Did you bump something or did something rub against you?

I looked down to where he was gesturing. A portion of my necrosis surgery scar was literally missing a layer of skin. As if it had been rubbed or shaved off. Just an open wound.

In all honesty, I had no idea. I had felt nothing. He put down the magnet. Instead of an expansion he put bacitracin and a bandage on my wound.

No expansion. The skin was too thin, and any wounds needed to heal before being stressed. I wanted to cry. I know it may seem minor, but it was so disappointing and frustrating.

My expansion timeline had already been delayed and drawn out from necrosis. Now it was drawn out even more as I waited for my new wound to heal. My next expansion would be delayed for two more weeks.

After my fourth expansion I woke up the next day with a rash on my chest. Panic!!! My first thought was infection. After everything I had endured, I was not going to lose my expanders and start over. Or worse, not be able to reconstruct at all.

I know I overreacted, but I couldn’t help it. I called my doctor’s office. My doctor was surprisingly unphased. He instructed me to take an antihistamine. The thought had honestly never occurred to me. Dealing with rashes was not a common occurrence for me. The rash cleared. Disaster averted.

You can imagine I did some serious thinking after that scare. My conclusion? I was good. I was happy with that size. Better to settle than continue to risk infection. Right?

So the following week I told my plastic surgeon I was happy with my present size. He still expanded me though, remember he wanted 100ml of overfill?

After my 5th expansion he told me we would wait six weeks before the final surgery to replace the expanders with the permanent implants. With all my delays six weeks put my surgery right before a family vacation to Disney World and my children’s summer break.

I asked him if we could delay so I could take the summer off. I wanted a break so I could actually enjoy our vacation and the summer with my children. He told me there was no rush. All I needed to do was schedule a pre-surgery appointment two weeks prior to my next surgery date.

After taking a summer to live with that size, which theoretically should have matched my pre-mastectomy size, I decided to expand again. I found that matching my previous volume had the result of appearing much smaller in size. How did I come to this conclusion? By wearing different outfits I had worn before my mastectomy.

I concluded the difference came from bras. My foobs appeared like my pre-mastectomy natural breasts had when I wore a sports bra. You know, that more compressed look? Regular bras give you a completely different shape and appearance.

I didn’t wear bras after my mastectomy. Initially I wore a bandage on my chest and then camisoles. For nine months I didn’t wear bras. This allowed for everything to heal. There was also no need for a bra.

Ex-Ex-Ex-Expanders!  Just add saline and watch your chest grow…

Fake boobs, or “foobs,” as I like to call them are totally different than natural breast tissue. Foobs are comparable in shape to your natural breasts in a bra. Bras, even without any sort of push-up features, naturally lift your breasts. Foobs are permanently frozen in that lifted state. They don’t really move.

From left to right my chest expansions.  The far right image shows me with the 100 ml overfill.

That said, adding a little more bumped me up to how my natural pre-mastectomy breasts looked in a bra. My intent was never to be larger. I just wanted to match what I had before. To do that, I discovered I needed to fill an additional 150 milliliters. Then my frozen foobs matched the appearance of my natural pre-mastectomy breasts in my cloths.