Becker Expander Implant: The Permanent Expander-Implant Explained (No Exchange Surgery?)
A Becker expander implant is a tissue expander and a breast implant in one device. It has a silicone outer shell with an inner chamber that is slowly filled with saline (salt water) through a small port. Once the final volume is reached, the port is removed in a small procedure and the device stays in place as your implant. So the full exchange operation of a standard tissue expander is not needed, but a small procedure to remove the port is.
In this article
What is a Becker expander implant?
The Becker is a special breast implant that can be filled after surgery. The outer shell is made of silicone. Inside there are two parts. One part is filled with silicone gel in the factory. The other part is an empty chamber for saline. A thin tube runs from this chamber to a small port (a valve) that the surgeon places under the skin, often near the armpit.
After the operation, your surgeon or a specialised nurse fills the chamber step by step. Each fill stretches the skin a little more. When the breast has the size you and your surgeon want, the tube and the port are taken out. The Becker then stays as the permanent implant. This is why it is also called a permanent tissue expander or a one-stage expander implant.
Becker vs standard tissue expander and implant: two-stage vs one-stage
In the usual implant-based reconstruction there are two stages. In stage one the surgeon places a temporary tissue expander. In stage two, months later, the expander is removed and swapped for a permanent implant. That second operation is called the exchange surgery. You can read more about it in our article on the tissue expander exchange.
With a Becker the two stages become one. The device that stretches the skin is also the final implant. The exchange operation is skipped. What remains is a small procedure to remove the port. The price for this is less choice at the end. In a standard exchange, the surgeon can pick the best implant shape and size for your chest and can adjust the pocket. With a Becker, the shape is largely fixed once the device is in.
Becker 25, 35 and 50: what the numbers mean
Becker implants come in a few versions, often named Becker 25, Becker 35 and Becker 50. The number describes how the volume is divided between the fixed silicone gel and the adjustable saline chamber. A lower number means a small gel part and a large saline chamber. A higher number means more gel and a smaller saline chamber.
Becker 25: mostly saline. It can be adjusted the most, so it is useful when the final size is still uncertain or a lot of stretching is needed.
Becker 35: a middle version, with a bit more gel and a somewhat smaller saline chamber.
Becker 50: about half gel and half saline. It feels more like a normal silicone implant, but it can be adjusted less.
Your surgeon will choose the version based on your skin, the size of the other breast and how much the size still has to change. Ask which version is planned for you and why.
Who a Becker expander implant may suit
Many surgeons consider a Becker in situations like these:
You want to avoid a second full operation. The exchange surgery is skipped. Only the small port removal remains.
Immediate reconstruction. The Becker can be placed during the mastectomy (breast removal), even when the skin cannot yet hold the full volume. The rest is filled later.
Your final size is still uncertain. The saline chamber can be adjusted over time, so the size can still change a little in the first months.
Delayed reconstruction with tight skin. When placing a full implant straight away is not possible, the Becker can be used as an in-between solution.
Who it may not suit
A Becker is not the best choice for everyone. Many surgeons advise against it, or are careful, in these cases:
Radiotherapy is planned. Radiation makes the skin firmer and less elastic. Filling becomes harder and the risk of problems around the implant rises. Read more in our article on how radiation therapy affects your breast reconstruction options.
Thin or damaged skin. The port and the edges of the device may be easier to see or feel. Rippling (visible waves in the skin) is more likely.
You want the best possible shape. A standard exchange lets the surgeon choose from many implant shapes and sizes and fine-tune the pocket. A Becker gives less control over the final result.
You are unsure about an implant at all. If you may later want reconstruction with your own tissue, a standard expander keeps more options open.
The procedure and the filling visits
The Becker is placed in an operation under general anaesthesia. This can be during the mastectomy or in a later operation. The surgeon makes a pocket, often behind or in front of the chest muscle, and places the device. The tube and the port are placed under the skin, usually near the armpit or on the side of the chest. A drain may be used for a few days.
The filling visits start once the wounds have healed, usually a few weeks after surgery. At each visit the nurse or surgeon finds the port under the skin, cleans the area and adds a small amount of saline with a thin needle. You may feel tightness or pressure for a day or two. This usually eases as the skin adjusts. You return every one to two weeks until the size is right. This often takes a few months.
Some surgeons fill the Becker a little more than the final size and then let some saline out again. This can give a softer, more natural fall of the breast. Your surgeon will explain the plan for you.
Removing the port
When the size is right and the skin has settled, the port and the tube are removed. This is usually a small procedure through a short cut near the port. Many surgeons do this under local anaesthesia, sometimes as day surgery. The valve on the implant closes, and the device stays as your permanent implant. Some surgeons use this same moment for small corrections, such as fat grafting (lipofilling) to soften the edges.
Advantages and disadvantages of the Becker implant
Advantages
Fewer operations: the full exchange surgery is not needed.
The size can still be adjusted during the first months.
Can be used for immediate reconstruction, even when the skin is tight.
A shorter total treatment path for some women.
Disadvantages
Less control over the final shape and implant choice than a standard exchange.
Higher chance of rippling, because a large part of the device is saline.
Port problems: the port can turn, be felt, become painful or leak, and sometimes needs an earlier small procedure.
The device itself is usually not the softest or most natural-feeling implant.
A small extra procedure is still needed to remove the port.
Risks of a Becker expander implant
The risks are largely the same as with any implant-based reconstruction. Your surgeon will discuss them with you before surgery:
Infection or wound problems, especially in the first weeks. Sometimes the device has to be removed for a while.
Capsule formation (capsular contracture): hard scar tissue around the implant that can make the breast firm or change its shape.
Rippling: visible or palpable waves in the skin, more common with thin skin and with saline-filled devices.
Port or tube problems: turning, leaking, discomfort, or the port being visible under the skin.
Deflation or leak of the saline chamber, which makes the breast smaller and needs a new operation.
A later operation to replace, adjust or remove the implant. No implant lasts a lifetime.
Recovery after a Becker expander implant
Recovery after placement is similar to recovery after a standard tissue expander. You may feel tightness and pressure in the chest for the first days. Most women can do light activities within a few weeks. Your surgeon will tell you when you can lift, drive and exercise again. Recovery after the port removal is much lighter: a small wound, usually a few days of mild discomfort, and a quick return to daily life. During the filling months you can usually live normally between visits.
Becker vs standard expander vs direct-to-implant
Three implant-based paths are common. None is better for everyone; each fits different situations.
Standard tissue expander and implant (two-stage). Two operations. The most control over the final implant and shape. Suitable for most situations, also when the plan is still open. See our complete guide to tissue expander and implant-based reconstruction.
Becker expander implant (one-stage with port removal). One main operation plus a small port removal. Adjustable size. Less control over the final shape and a higher chance of rippling.
Direct-to-implant. One operation. The final implant is placed straight away. Works best with good skin quality, enough skin and no planned radiotherapy. No adjustment afterwards.
Which path suits you depends on your skin, your treatment, your body and your wishes. Your surgeon will help you weigh these together.
Frequently asked questions
What is a Becker expander breast implant?
A Becker expander breast implant is a combined tissue expander and breast implant in one device. It has a silicone gel outer part and an inner chamber that is filled with saline (salt water) through a small port. After the filling, the port is removed and the device stays in place as the final implant.
Does a Becker implant need a second surgery?
Not a full second operation. The exchange surgery of a standard tissue expander is not needed, because the Becker stays as the implant. A small procedure is still needed to remove the port and its tube, and this is often done under local anaesthesia.
What is a Becker 25 expander breast implant?
Becker 25 is one of the versions of the Becker device. The number shows how the volume is divided between the fixed silicone gel and the adjustable saline chamber. In the Becker 25 the gel part is small and most of the volume comes from saline, so it can be adjusted a lot. Becker 35 and Becker 50 have more gel and a smaller saline chamber.
Is a Becker implant a permanent tissue expander?
Yes, you can see it that way. It stretches the skin like a tissue expander, but it is made to stay in the body as the permanent implant. That is why it is also called a permanent expander-implant or a one-stage expander implant.
Tissue expander vs Becker: what is the difference?
A standard tissue expander is temporary. It is always swapped for a permanent implant in a second operation. A Becker is both expander and implant, so the exchange operation is skipped. In return, the surgeon has less control over the final shape and implant choice than with a standard exchange.
How long does the filling take with a Becker expander?
The filling usually starts a few weeks after surgery, once the wounds have healed. You then visit the clinic every one to two weeks for a small fill. Most women reach their final size within a few months. Your surgeon may then wait a while before the port is removed, so the skin and shape can settle.
Can I have a Becker expander implant if I need radiotherapy?
Many surgeons are careful with a Becker when radiotherapy is planned. Radiation makes the skin firmer and less elastic, which makes filling harder and raises the risk of problems around any implant. Your team will often suggest another plan, such as a standard expander, delayed reconstruction or your own tissue. Discuss this early with your surgeon.
Does a Becker implant last forever?
No. Like every breast implant, a Becker is not a lifelong device. It may need to be replaced or adjusted years later, for example because of capsule formation, rippling, a change in shape or a leak. Your surgeon will explain how the implant is checked over time.
Questions to ask your surgeon
Why do you suggest a Becker for me, and what would be the alternative?
Which version (Becker 25, 35 or 50) do you plan, and why?
How many filling visits do you expect, and when will the port be removed?
What is the chance of rippling or port problems in my case?
What happens if I need radiotherapy after all?
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Written by Dr. Mahyar Foumani, plastic and reconstructive surgeon specializing in breast reconstruction. Based on the book 'Breast Reconstruction Explained.'
This article is education, not medical advice
This article explains in plain words how breast reconstruction works. It is meant to help you understand what is possible, so that you and your doctor can make a good decision together. It does not replace personal medical advice.
Every situation is different. What is best for you depends on your body, your illness, your treatment and your own wishes. So always follow the advice of your own doctor or care team. Do you have symptoms, or are you unsure about something? Please contact your doctor or GP. In an emergency, call your local emergency number.
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