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Prophylactic Mastectomy with Primary Expander Implants


Bilateral skin-sparing mastectomy

  • The surgery is initiated on one side.
  • A boat-shaped incision is made including normally the areola, but it can be preserved when the patient wants it.
  • After suturing, the scar should be horizontal and not askew into the axilla.
  • The skin is spared as much as possible.
  • The breast with surrounding tissue is removed down to the pectoralis muscle, sparing the fascia.
  • The same procedure is carried out on the contralateral side.

Reconstruction with expander prosthesis

A plastic surgeon performs the reconstructive part of the operation.

  • A sub-muscular pocket is made in the midline deep to the pectoral muscle and the serratus fascia.
  • Thorough hemostasis is performed.
  • One or two vacuum drains are positioned and fixed.
  • The expander prosthesis is inserted.
  • The muscle is sutured.
  • The skin is closed in two layers.
  • The procedure is repeated on the remaining side.
  • Both expanders are filled with saline (the volume depends on skin circulation).
  • Dry bandages are applied.
  • The drains are activated.

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