Dr. Mark Yazid Plastic Surgery - Your Partner in Cosmetic Surgery

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Post-operative instructions for two-stage implant-based breast reconstruction

Breast reconstruction is usually performed in two stages. The first stage involves placement of a tissue expander at the time of mastectomy or as a delayed procedure. The second stage — the implant exchange or a microsurgical flap— replaces the expander with a permanent reconstruction once expansion is complete and any additional oncologic treatments (radiation, chemotherapy) have been finished. This page covers the initial tissue expander

Stage 1 — Tissue Expander Placement

What Was Done

A tissue expander is a temporary, adjustable implant placed beneath the chest muscle (pectoralis major) or in a pre-pectoral position (above the muscle, under the skin or ADM layer). Over the following weeks, the expander is gradually filled with saline during clinic visits to stretch the skin and muscle, creating the pocket that will eventually hold your permanent implant.

An acellular dermal matrix (ADM) — a biological mesh — may have been used to help support the lower portion of the expander. This is a common component of modern tissue expander reconstruction.

First 72 Hours After Expander Placement

• Rest with your upper body elevated at 30–45 degrees— a recliner or wedge pillow works well.

• Do not lie flat on your back for the first week — this increases pressure on the expander and can be uncomfortable.

• Expect tightness, pressure, and heaviness across the chest — this is normal and is the most common sensation after expander placement.

• Take prescribed pain medications as directed and stay ahead of the pain, especially in the first 48 hours.

• Keep dressings clean and dry. Do not remove them until instructed at your first post-op visit.

Drain Management

• You will have one or two surgical drains (Jackson-Pratt bulbs) exiting below the chest or axilla.

• Empty drains at least twice daily — morning and night — and record the output volume and color in your drain log.

• Strip the drain tubing before emptying to keep it clear.

• Drains are removed when each drain produces less than 30mL in a 24-hour period — typically 1–3 weeks after surgery.

• Keep drain sites clean and secure the bulbs to your surgical bra or a lanyard. Never let them hang freely.

• Call if drain output suddenly increases, becomes bright red, or has a foul odor.

Surgical Bra & Compression

• Wear your surgical bra 24 hours a day for the first 4–6 weeks, removing it only to shower.

• The surgical bra supports the expander, reduces swelling, and keeps everything positioned correctly.

• Do not wear underwire bras until cleared by Dr. Yazid.

• After 4–6 weeks, a soft, supportive sports bra without underwire may be substituted.

Activity Restrictions — Stage 1

• No lifting over 10 pounds for 6 weeks.

• No reaching overhead or behind your back for 4 weeks.

• No chest exercises, push-ups, or pectoral stretching— the muscle has been released and needs time to heal around the expander.

• Short walks beginning the day after surgery are encouraged to reduce clot risk.

• Return to desk work: typically 2–3 weeks.

• Full activity clearance: discussed at your 6-week visit.

The Expansion Process

Expansion fills begin at   approximately 2–4 weeks after surgery, once your incisions have healed. Each   fill takes only a few minutes in the office. You will feel tightness and   pressure for 24–48 hours after each fill — this is normal.

• Fills are typically scheduled every 1–4 weeksdepending on your skin tolerance, radiation history, and treatment plan.

• The number of fills required varies — most patients require 4–8 sessions to reach their desired volume.

• You may feel a magnetic port just beneath the skin of the expander — this is the fill valve and is normal.

• Mild discomfort, tightness, and a pulling sensationafter fills are expected and resolve within 1–2 days. Tylenol or your prescribed pain medication can help.

• Call if you experience severe pain, sudden deflation of the expander, fever, or skin changes at the expander site after a fill.

• Expansion is paused or delayed if you are receiving chemotherapy or radiation. Dr. Yazid will coordinate your timeline with your oncology team.

Radiation & Expanders

If you require post-mastectomy   radiation, your expansion and exchange timeline will be adjusted. Radiation   significantly affects tissue quality and implant outcomes. Dr. Yazid will   discuss the optimal timing of your exchange surgery based on your radiation   treatment plan. Do not schedule your exchange surgery without confirming the   timing with both Dr. Yazid and your radiation oncologist.

Warning Signs — Stage 1 (Call Immediately)

• Fever over 101.4°F (38.5°C)

• Rapidly spreading redness, warmth, or swelling around the expander

• The expander feels suddenly soft, deflated, or significantly changed in shape

• Skin over the expander appears thin, red, dark, or begins to break down

• Foul-smelling drainage or thick cloudy fluid from incisions or drain sites

• Severe chest pain unrelated to normal post-operative tightness