Some people have enough skin left that an implant can be placed directly.) This can be placed over the muscle or under the muscle. While many believe under the muscle gives better cosmetic results (especially for those who are being reconstructed without real breast tissue to hide behind), it really is typically up to surgeon preference. If going under the muscle, the surgeon will cut through the pectoral muscle, attach a mesh-like sling to hold the expander in place, and then insert an empty (or only very partially filled) expander before sewing you back up.
So “immediate” is kind of a misnomer, because you still have the expansion part before it even remotely resembles a breast. Your incision must be completely healed before any expansion can take place, so the first expansion is typically about one month after surgery (although can vary depending on how you heal). The expander has a metal port in it, which receives the needle so that saline can be injected to fill up the expander (kind of like blowing up a balloon). Because when they are filling the expander, the muscle and skin is also stretching, this is a super weird sensation. Nifty magnet device that helps them locate the port for the needle I mentioned before I have no feeling over my breasts, so I can’t feel the needle going through my skin (a total blessing because it’s kind of a big needle!), but you can definitely feel the tightening and stretching as the expander is filled. In my case, they usually only filled 60-100 cc at a time and then I would have to wait a week to come back and do it again to give my skin time to stretch in between fills.
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