12.  You are doing your first breast reconstruction with an expander as an attending.  How do you order one?  How long does it take to arrive?  What size do you pick?  When do you start expansion?  (Annals 1992; 28:390, PRS 1993; 93:255)

Answer:
Implants for expansion are ordered by contacting the manufacturer which are prepaid and take about 5-7 days to arrive.  The ideal expander should be permanent, elicit minimal capsular response, and tolerate maximal overexpansion with a minimum of technical problems and failures.  While the ideal expander does not yet quite exist, Woods recommends the Becker expander because it does not require exchange for a permanent implant, and he believes that it has a lower incidence of capsular contracture and results in a softer breast.  The largest size expander which can fit into the available pocket should be placed which is usually a 200-cc to 800-cc (recommended capacity) expander.  Expansion is begun 7-14 days postoperatively in increments of 50 cc on a weekly basis, though greater volumes can be used if tolerated by the patient.
 

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