Not enough breast tissue for expander?

I am scheduled for a mastectomy with immediate reconstruction (saline implant). I met with my plastic surgeon, who expressed concern about having enough skin to fit over the expander. (I had a lumpectomy which removed much of my breast). I do not want to undergo reconstruction if it cannot be done immediately after the mastectomy. Can a skin graft be used to 'make up' for the missing skin?

[CCF-RN,MSN-JS]

Dear zooz,  There are different options for breast reconstruction available and the different options each have pro's and con's related to them.  With a saline implant the expander is placed behind the chest muscle and the skin is sewn together, which gives a bulge.  This type of implant does not give a very large breast because it is behind the muscle pushing everything forward  and everything has to close over the top of it, which limits the size.  Skin grafting is not done for this type of reconstruction.  With the expander, a hollow empty sack is placed behind the muscle and over several months more and more saline is injected into it, which stretches the skin out.  When it becomes the size you want, the sack is removed and replaced with a permanent sack filled with saline.

A nice description of various types of reconstruction and implants can be found in Dr. Susan Love's Breast Book.  There is a chapter dedicated to this topic, descriptions as well as drawings.  It may be a helpful resource for you at this point in your decision making, and discussions with your plastic surgeon.