tissue expanders

[dammie]

I have written before and have truly appreciated your responses which have helped guide me in the past.
     I had a bilateral mastectomy on 3/17 with tissue expanders placed during the same surgery.  I have seen comments before that expanders were placed under the skin.  However, mine have been placed under the muscle.  Are there advantages or disadvantages regarding this placement?  Also, I have been instructed not to do any heavy lifting or driving during these next six weeks but was told lifting was not an issue after that.  I will be undergoing weekly expansion for approx 6-8weeks.  I then will maintain the last expansion for approx 4 weeks for the skin to stretch and then have the exchange with the implants.  My concern is working during this 4 week "stretching" period prior to the exchange.  I have been on sick leave and do have time available.   My job consists of some lifting and pushing.  I am concerned of damaging  the reconstruction during this period.  What requirements are necessary to not ruin the reconstruction process?
  One last question.  I had completed 8 cylces of ACT prior to mastectomy.  Prior to the surgery, I had been complaing of right sided headaches.  A MRI of the brain was done.  No "convincing evidence" of metastasis was found however, there might be something "vascular in nature"  in the right parietal lobe.  My oncologist is setting me up with a neuro consultation for evaluation.  Any advice?  I know that I cannot have any additional MRIs at this time due to the metal in the expanders.
Thank you for your responses and this wonderful site.

[maryg]

I am having a mastectomy within a week-2 weeks, and can't decide between implants or a tram flap.  I already have a silicone implant in left breast (for 27 years), it is my right breast that is being removed.  My P.S. "thinks" I would be happier with a tram flap, but the scars and length of operation scare me.  He said that the implants will feel very hard and it will set higher than the other breast.  Comments please from those who have just had one removed.  Thanks

[pitcrew]

I had my expander put in Mar 3, under the muscle. I returned to work part on mar 8 and full time on the 15th. My doctor told me to use my head, don't overdue and do not lift pretty much anything over about 5lbs for about 4 to 6 weeks to insure healing. Other then being alittle sore I am healing really good and am already half way done. Already I no longer have to stuff my bra, I am thrilled with the results so far. I can't wait to get my hair long and breasts back and feel half way normal again!  Good Luck to you.

[dammie]

Thank you all for your responses.  I will be taking one day at a time and following up with the neurologist.  Christie, your success is very encouraging.  I hope to have the same success.

[nurse12hr]

I had the same type of tissue expanders.  I went back to work on my  10th post op day (I'm an RN) and worked the whole time while being expanded.

Of course I was a bit sore and had others do what lifting was required in my job.  But overall had no problems with the reconstruction.  I have a very active lifestyle and this didn't slow me down at all!

(was on a horse on my 7th post op day)

[CCF-RN,MSN-rf]

Dear dammie:  Placing expanders under the muscle is actually the more common approach. I suspect much of the "under the skin" talk you hear or see is actually mis-speak.  Placing the expanders under the muscle makes the reconstruction appear more natural.  Regarding your activity level it is difficult to make specific recommendations as each surgeon will have his/her own protocol for what he/she believes is appropriate level of activity.  You may want to present your specific situation to your plastic surgeon to see if your activity falls within the standard protocol for recovery.  

It seems appropriate to have you see a neurologist for the brain issue.  Once the MRI is reviewed, a plan can be made that can coordinate with your reconstruction.  It may be that a neurologist's eye will help offer more explanation.

[surgeon]

By far the most common (and best) location for expanders is under the muscle, as you have had done. As to specific restrictions, since there are variations in anatomy and in surgeon preference, you really need to ask your plastic surgeon and let him/her know your particular concerns. As to your other issue, the neurological question, seeing a neurologist seems like a good plan; I'd guess that person will be able to anwer your questions. As you know, you'll be getting an "official" answer as well from the Cleveland Clinic.