This week, Richard M. Kline Jr. M.D., of The Center for Natural Breast Reconstruction, answers your question.Question: Why do expanders have to be used when breast are removed and the pocket is empty and ready to be filled with an implant?Answer:  It is not always necessary to place expanders at the time of mastectomies, but in many situations, it is a safer choice than immediately putting in an implant. Even if the breast surgeon leaves the nipples and removes no skin at all, the skin is not always healthy, as the blood flow is invariably at least somewhat compromised after mastectomy. Placing an implant under very poorly perfused skin would put additional pressure on the skin from within, and quite possibly cause the skin to die that otherwise would have lived. With an expander, we have the option of placing no fill at all at the initial surgery, thus minimizing additional pressure on the skin. In actual practice, sometimes the skin’s blood supply is so poor we don’t even put in an expander right away, but rather return to the operating room several weeks or months later to begin reconstruction.Having said the above, I do agree it is nice if the final implant can be placed under healthy skin flaps immediately. However, it should only be done under ideal circumstances.Have a question about breast reconstruction or post-surgical you’d like answered by our surgical team? Just ask!