How Tissue Expanders Work


Hey Guys, for some of you this post will not be relevant - but after the 5th person sent me a message on instagram asking me about my breasts, I realized I had a duty to write a blog post and explain somethings.

Before I go into it though, let me give you a 101 for those of you not currrently undergoing a mastectomy with reconstruction.

When a mastectomy is performed, the doctors make an incision and remove as much breast tissue as possible. Often times they will attempt to "spare the skin" especially the nipple. This depends on the location of the tumor and ensuring they get adequate margins (space between the lump aka the cancer and the healthy tissue) because cancer is microscopic. The larger the margins the more likely to get it all out. For example, I was unable to save my nipple (see photos) because the tumor was pressed so close to the skin that they had to remove a very large section of the skin from my chest in order to get good margins.

The removal of all this breast tissue and skin is the mastectomy. Think of it like an amputation, they need to ensure that all the damaged/sick tissue is removed so they work hard to scrape out as much as possible.

After, if you opt for a reconstruction, what you're left to work with is not the same as if, say, you were just going to get breast implants. You've got less skin, and also no breast tissue - both of which are what holds that implant in place. In order to work around that, during the removal of tissue the doctor will insert what's called the chest expander.

The chest expander is a flat, deflated implant with a magnetic pump. This magnetic pump can then be located so a doctor can insert a needle and slowly reinflate the implant, expanding the "chest" slowly. I say "chest" because there are two ways to do this, the most common and most likely to get good results is actually done by inserting the expander underneath the chest wall. This makes the expansion more "uncomfortable" but provides better support long term for the implant.

So that's the basics.

Here's the part that gets confusing.

Once the expander is in you have to heal for a little bit. This time frame varies based on your doctor. During this time your chest is completely flat. Once you are ready, the doctor begins to slowly inflate the expander. You go in on whatever your schedule is (mine was weekly) and they add in as much as you can stand (it's uncomfortable slash potentially painful if you do it too fast.) The inserting the needle part looks scary but feels like literally nothing - those nerves were severed during the mastectomy and have not knit back together yet. That area is totally numb. The painful part is the expansion, which feels sort of like you've done too many pushups.

Once the expander is as big as your chest/skin will allow, then you have to wait.

For me this was the hardest part.

The expander is shaped like a perfect circle. It's hard as a rock. It's located in a weird place on your chest. It does not move at all when your body does. You can feel it scraping against your ribs on the inside.

This is the part where I freaked out. This is what most of the questions I get on instagram are about. This part is horrible, not because of physical pain but because of the toll it takes on your psyche.

It looks bad. Not like sexy, porn star fake boobs.. Like there's an alien shaped like an upside down bowl trying to burst through the skin of your chest.

There is a very strong feeling of "holy shit, is this what I am always going to look like? It's terrible."

No, this is not what it's always going to look like.

The point of the expander is to create a "capsule" of scar tissue.

Hence the waiting. My doctor once told me if you did the swap too early it's "a bloody mess in there" and you can't build a good shape. He explained that the capsule is like a fist of scar tissue. The tissue is strong and shapeable to hold the implant. During the reconstruction, they score the scar tissue (here he expanded his fingers creating space between them) to make the shape of the breast. Then he moved his opened fingers in different shapes to show how he could basically do anything with this "capsule" including matching perfectly the shape of my other, natural breast.

This is the part that I think a lot of people don't understand, hence the blogpost. I recently described it to someone like an orange peel. The fleshy pulp is the soft implant. The peel is the scar tissue capsule. Once it's "healed" you can then shape that peel however you want, something that wouldn't be possible with the thin, papery flesh that covers the individual peels.

This process can be frustrating because it takes about 6 months all in. The mastectomy and expansion is a lot of hurry up and wait. You need to heal, then get opened up again, then heal again. There are many steps, each one taking a varying amount of time depending on your body and how it heals.

But once it's all done, you can have breasts that look like whatever you want. I chose something slightly perkier than natural, but closely resembling my 16 year old chest. Not so pert that people automatically assume they are not natural, but they kind of wonder.

You will have cleavage. They will be soft. You will no longer feel the hard, flat edges of the expander sliding along your ribs. You may even need to wear a bra sometimes (I do to workout, and to sleep because it's more comfortable).

It will get better, they will be gorgeous.

Ask me anything, I am here to answer whatever questions you might have.

Sending lots of love and healing vibes.


  1. You are so wonderful! As one of those creepers who instagrammed you about your boobs, I truly appreciate this post and all the information you provided!!! Thanks a ton.

    1. Definitely NOT a creeper - an inspiration XOXOXOX

  2. Thank you for the post, I have my op next month to insert the expanders, nervous but excited to have boobs again! Found this really helpful ✌️ Xx

  3. Hi Dena, just wanted to thank you for this post! I'm due to get my expanders in next month and am really nervous 😁 your post was really helpful and answered some questions I have in my head..thanks so much ✌️ Xx

    1. Hey Girl! So sorry for not responding sooner - your comments ended up in my filter (no idea why! blogger fail) but I am sending you lots of good energy and healing vibes. By now you should be getting closer to having those bloody things out and I am so glad I could help in any way, no matter how small. xoxoxoxo

  4. Thank you for this blog. I have so many questions of how my hair will look, how my boobs will look in the end, etc. I just finished chemo Friday. I have my right side expander swapped for implant September 1st, the other side not until 6 - 9 months after radiation (so next summer). Your information was very calming to my worry about my hair and my boobs and how they will look in the end. As if worrying about cancer returning isn't enough. lol.

    1. Amen. So true! They will all look amazing when all is said and done. Sending lots of <3 your way. xoxo

  5. Your reconstruction looks amazing!! Mind if I ask what type of implant you have? I had a bi-lateral mastectomy with final implants put in 6 weeks ago. They look terrible. Very uneven and flat, not natural at all. Now I have to wait 6 months to get them fixed. So much for the "silver lining" to breast cancer... thx

  6. I'm so sorry to hear that! I have a round silicone implant on the mastectomy side - the symmetry surgery on the other side lifted the breast and then they added a small implant to match the roundness of the mastectomies side. Stay strong and make them fix it!!

  7. Thank you for putting this out there in a way that is so understandable and relatable. I'm about to go through a double mastectomy and am comforted by reading your posts ��

  8. Your breasts look amazing. I was just wondering if you have to position just right for the pictures in order for them to look like that or do they look that good all the time? I had two reconstructions and I think my skin is just really thin and elastic so I still have a lot of rippling since there is no tissue to hide the implant. Do you have this issue at all and you just hide it well or were they able to avoid that issue with yours?

    1. I definitely have rippling also - especially when I lie down and the implant slips weirdly to the sides or in bras that try to push me up to much. My doc told me It's just the absence of fat, but since it was removed it's not like you can gain weight when it goes away. I have noticed it's lessened since I started using this Retin A body oil from The Chemistry Brand - it's also faded my scars and helped with the residual stretch marks.

      I've also thought about asking if an injection of something like restylane or another filler might help. Possibly something to ask your doctor about!!!


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