What Is a Breast Tissue Expander Rupture?

In preparation for breast implant placement after a mastectomy, a breast tissue expander may be used. A breast tissue expander is an implantable, balloon-like device used to stretch breast skin and chest wall muscles. Over the course of two to six months, the expander will create a pocket so that a permanent saline or silicone implant can be inserted as part of breast reconstruction surgery. Though usually a safe procedure, the tissue expander has the potential of rupturing.

Although a rupture is not a medical emergency, it may require quick intervention and, often, surgical replacement or removal of the device.

This article will review the signs of tissue expander rupture and its causes. It also addresses prevention and treatment.

How Do You Know if Your Breast Tissue Expander Has Ruptured?

The rupture of a breast tissue expander may not be all that noticeable at first. If the tissue expander leaks, you may experience a gradual decrease in your breast size or notice that the shape of your breast gradually changed.

A traumatic injury or excessive compression may cause the implant to burst or pop, which can cause an immediate change in breast size or shape.

For instance, if the rupture occurs at the top of the device, the top part of the breast may suddenly flatten. If the rupture occurs near the bottom, you will likely experience an overall deflation of your chest cavity. Because the device is filled with a saline (saltwater) solution, the body will gradually absorb the fluid.

The rupture itself may not cause pain unless it was caused by a blunt force or a puncture wound. However, a traumatic injury may cause bleeding, especially if the external port (where the saline fluid is injected) is disrupted.

Causes of Breast Tissue Expander Rupture

A breast tissue expander will often be placed during a mastectomy, either under the pectoralis (chest) muscle or over it. If other cancer treatments are planned, a separate surgical procedure may be scheduled after additional therapies are completed.

The implants themselves are quite sturdy and designed to be left in place for months. However, they can rupture.

Some of the causes of tissue expander rupture include:

• Surgical puncture, during the initial implant procedure or another breast surgery
• Mammogram compression, in which too much pressure is applied during the imaging procedure
• Traumatic injuries, including sports injuries, falls, or vehicle accidents
• Overfilling the expander, often in an effort to accelerate the procedure (this can also be very painful)
• Valve leakage is usually caused by a needle puncture or junction disruption between the expander and external port
• Product defects (rare, but possible)

Risk Factors

Some factors may increase the risk of tissue expander ruptures. but, surprisingly, they are not what many people imagine them to be.

A large breast increases the risk of rupture simply because the implant has more room for flexure. Smooth implants are more vulnerable than textured ones because they are prone to twisting and slippage. However, this increased risk may be offset by risks related to textured implants and should not be the primary reason for avoiding a smooth implant.

Capsular contraction, the hardening of the breast cavity tissues, can also reduce the available space within the breast cavity, increasing the risk of overfilling.

Obesity, older age, diabetes, smoking, or radiation therapy may slow postoperative healing and/or increase vulnerability to infection. but these factors do not increase the risk of a tissue expander rupture.

Diagnosis of a Breast Tissue Expander Rupture

Even if a rupture is apparent, your healthcare provider will order an imaging study (such as an ultrasound or breast MRI) to check for bleeding, infection, or other internal abnormalities.

It is important not to rush into treatment without first completing these imaging tests. Your insurance company may deny your claim for a replacement if you have not provided them with evidence of the rupture.

Treatment for Breast Tissue Expander Rupture

A breast tissue expander will almost always be removed if a leak or rupture has occurred. The only exceptions may be if the leakage occurred somewhere near the external port or if you are near the end of your expansion procedure.

The surgery would ideally be performed by a plastic surgeon, who might use the same incision site to minimize scarring and avoid complications prior to the final reconstructive procedures.

If a rupture occurs near the end of the expansion process, the surgeon may recommend removing the expander and moving straight to the permanent breast implant if the cosmetic results are deemed acceptable. This might mean opting for a permanent implant that is slightly smaller than you had originally planned.

Preventing Breast Tissue Expander Rupture

Breast tissue expanders can rupture for any number of reasons. While there is no way to predict if and when a rupture might occur, there are several things you can do to reduce your risk:

• Choose the right surgeon: Although many plastic surgeons are qualified to perform breast augmentation, you need to find one skilled in breast reconstruction. These specialists are trained to deal with complications caused by radiation therapy and other cancer-related treatments. When choosing a surgeon, you can ask what procedures they perform. The larger cancer centers, especially those that are considered National Cancer Institute-designated centers, are more likely to have plastic surgeons on staff who have experience treating cancer patients.
• Understand your treatment options: There are smooth and textured expanders. There are also surgical mesh and dermal matrix products used to stabilize the expander and help tissues grow. Ask your surgeon why certain products have been chosen, and seek a second opinion if you are concerned about the recommendation.
• Know your limitations: As much as you may want symmetrical breasts, skin can only expand so much and may not be the same in all cases. This is especially true if there is encapsulation or the expander is placed in front of the pectoralis muscle. Overfilling can lead to the abnormal thinning of breast skin.
• Avoid risky physical activities: During the two to six months you're undergoing tissue expansion, avoid sports or any activity that places direct pressure on the breasts and may cause you to fall. This includes using specific gym machines or even yoga poses requiring lying flat on your chest.
• Listen to your pain: When the implant is filled with saline, let your healthcare provider know if you have excessive pain. While it is normal to feel some discomfort after an expansion, it shouldn't be severe enough to keep you up at night or hurt excessively with movement. Overt pain may be a sign that the implant has been overfilled. If your skin feels very tight (taut) or uncomfortable, this is also a sign that the implant may be overfilled.

Always speak with your health insurance company to know which costs are covered and which are not. Remember that "more expensive" doesn't always mean "better." Listen to your healthcare provider and do your homework to ensure the optimal appropriate care.

Coping With Breast Tissue Expander Rupture

The rupture of a breast tissue expander can be emotionally draining as it adds yet another procedure to an already extensive roster of treatments. There is no minimizing the emotions you may feel. The setback can raise doubts and fears about your mortality and/or appearance or exacerbate feelings of loss and depression.

As much as people may tell you to "hang in there," don't bury your emotions or put on a good face. Share your feelings with friends, family, and your medical team. If you are feeling isolated, find a support group or ask your oncologist for a referral to a therapist or psychiatrist who can help. Don't face these or other setbacks alone. There is help.

Summary

Breast tissue expanders are used to improve outcomes for breast implants following mastectomy. Though this procedure is often done safely and without complication, there is a risk of expander rupture. If the expander ruptures, it deflates and the body absorbs the saline inside.

A rupture can be caused by a traumatic injury to the chest, overfilling the expander, or a defect in the expander itself.

The expander will then need to be surgically removed. Then, a new expander may need to be placed or possibly replaced with the final implant.