Having tissue expanders for breast reconstruction: Abby Goetcheus

Middle-school physical education teacher Abby Goetcheus, of Glen Mills, Pennsylvania, was certain about the type of breast reconstruction she wanted after a bilateral mastectomy, surgery to remove both breasts, in June 2018.

Abby, who was 44 when diagnosed with stage I breast cancer, talked with her breast surgeon and read about her reconstruction options online. She decided to rebuild her breasts through DIEP flap surgery, which would use her own tissue and muscles taken from elsewhere in her body. It was, in her words, “the natural way.”

She liked that the DIEP flap procedure would let her avoid implant reconstruction. In the implant method, tissue expanders are inserted after surgery and filled to gradually stretch the breast skin to fit breast implants.

When she met with her plastic surgeon, however, Abby’s plan for a “natural” approach was dashed. He said that she didn’t have enough belly fat to use for a DIEP flap. The unexpected news rattled her. “I kind of panicked,” Abby recalls. She wasn’t ready to skip reconstruction entirely and go flat, so she agreed to having implant reconstruction. That meant first getting tissue expanders.

Yet she felt uneasy about that choice. Abby participated in several online breast cancer support groups and had read about problems with expanders and implants. She asked people in those groups about their decisions. Some urged her to go flat while others said that reconstructing with expanders and implants was fine.

“You have to go with your gut feeling and see what happens,” she says. “I knew that if I tried the expanders and there were any problems at all, I would say, ‘Take ‘em out, I’m done.’”

Filling expanders

The tissue expanders were placed during Abby’s breast cancer surgery. Expanders look something like an inflatable breast implant. There’s a port for adding in saline solution to increase size and stretch the skin to fit an implant later.

“You can feel the edges of the expander,” Abby says. “You feel like it’s popping out of your skin sometimes.”

After the bilateral mastectomy, most of Abby’s pain was due to the surgery and to drains that had been inserted to keep fluid out of the surgical area. The drains were removed 9 days later. The expanders hadn’t yet been filled and didn’t bother her much.

While Abby was healing, her pathology report came back showing that she needed radiation treatment. Radiation can affect expanders and cause difficulties, so some doctors advise waiting to fill them until after radiation. Abby’s plastic surgeon felt that filling the expanders before radiation was right for her.

Her first fill happened about 8 weeks after surgery. A nurse practitioner added the saline.

“I could feel it expand. You could feel the pressure,” says Abby. Afterwards, she had a lot of achiness and pain. “You could feel it pulling on your breastbone in two different directions. It’s very uncomfortable and your muscles are going crazy because it’s stretching your skin.”

She received diazepam (Valium) to ease the muscle spasms and took acetaminophen for pain. After each fill, she came home and rested. She slowly resumed activities after a day or so.

“It was hard to sleep at night. You need to get comfortable and you can’t lay down, you can’t lay on your chest. You have to sit up,” Abby says. “I’m a stomach sleeper so that was horrible. I mostly slept downstairs on the sofa, sitting up with pillows.”

The diazepam made her “loopy,” she says. She didn’t take it during the day when she wanted to be mentally alert for her children, then ages 10 and 6. Her wife took care of her then and throughout her breast cancer treatment. “She is my rock,” Abby says, “but I still wanted to be there and reassure my kids that I wasn’t totally out of it.”

The third expander fill was the worst, she says. The pressure and pain in her breastbone “put me over the edge.” It hurt so much that Abby considered stopping the reconstruction process. She decided that she was too invested to stop at that point, so she persevered.

Less saline was added during her fourth and final fill. She had less pain with that one than with the previous fills.

Gaining perspective

Abby has high praise for her doctors and health care team, although they never directly talked about the pain and discomforts she might have with expanders. “I felt like I was thrown into it because I couldn’t get the DIEP surgery and at the last minute had to make a decision. I didn’t know what to expect at first,” she says.

Her team told her that she could stop the expanding when she wanted to, which she did. They also warned that skin problems or infections could mean that the expanders would need to be removed, which didn’t happen for her.

“They can’t tell you how you will feel with the expanders because everyone is different,” she says. “From my perspective now, I think it was a better experience than some people had.”

Abby shares her story online with others who are looking for encouragement about the expander process.

“I go on and say, ‘It was tough, not a piece of cake by any means, but it wasn’t that bad,’” she says. “Looking back, I made it through.