The first step in a breast reconstruction using implants is usually to insert a tissue expander under the skin and muscle on the chest.
Fluid is gradually added to the expander through a valve just under the skin over a period of 2–4 months. The tissue expander stretches the skin and muscle
to the right size so that an implant can be inserted. The tissue expander is usually inflated until it is larger than the desired breast size. This extra stretching
helps to achieve a better breast shape.
Stretching the chest muscle can be mildly painful or uncomfortable for a day or two after each injection of fluid. Mild pain-killers can help. Some women also experience chest muscle spasms. Moderate arm movement exercises may help to retrain the chest muscle and reduce the amount of spasm and discomfort.
Some women can keep the tissue expanders in place permanently (called single stage breast reconstruction). However, most women have a second operation
to replace the tissue expander with a permanent breast implant (two stage breast reconstruction). This operation is much shorter and less complicated than
the other types of breast reconstruction operations.
For a two-stage breast reconstruction, it may be possible to reconstruct the nipple(s) and areola(s) during the second operation.