What is Tissue Expansion?

Tissue expansion enables the body to “grow” extra skin for use in reconstructing almost any part of the body. A silicone balloon expander is inserted under the skin near the area to be repaired and then gradually filled with salt water over time, causing the skin to stretch and grow. It is most commonly used for breast reconstruction following breast removal–but it’s also used to repair skin damaged by birth defects, scars due to burns and other accidents or surgery, and in certain reconstructive procedures such as skin cancers or hair loss.

The Best Candidate for Tissue Expansion

Almost anyone in need of additional skin can benefit from tissue expansion.

The procedure is used widely in breast reconstruction when there is not enough skin to accommodate a permanent implant to restore a woman’s natural appearance. It is also an option for repairing or replacing areas of the scalp, where hair growth makes it difficult to replace lost tissue with skin from other areas of the body. Tissue expansion generally produces excellent results when reconstructing some areas of the face and neck, the hands, arms, and legs.

Tissue expansion is ideal for scalp repair because the stretched skin on the scalp retains normal hair growth. Most other body tissue does not grow hair to the same degree.

Following tissue expansion, the repaired scalp looks very natural. Expansion may be more difficult on the back, torso, or other areas where skin is thick. If the affected area is severely damaged or scarred, expansion is probably not an option, since healthy skin is the first requirement.

Advantages and Disadvantages

Until recently, surgeons were limited to local skin flaps and skin grafts to reconstruct damaged tissue. Tissue expansion, however, provides an added technique with several advantages. First, expansion offers a near-perfect match of color, texture, and hair-bearing qualities. Second, because the skin remains connected to the donor area’s blood and nerve supply, there is a smaller risk of circulatory problems or loss of sensation after the reconstruction. In addition, because the skin doesn’t have to be moved from one area to another, scars are often less apparent.

On the other hand, skin expansion has one significant drawback–the length of time required to grow additional skin. The process usually takes 3-4 months total, in which time there will be a visible bulge due to the tissue expander itself. In addition, the procedure requires repeated visits to the surgeon for injection of the saline solution that inflates the expander.

Despite the drawbacks, tissue expansion can produce very pleasing results, and is a superior technique for selected reconstructive cases where the available local skin is inadequate.

Possible complications

Although expanders are thoroughly tested and carefully inserted, leaks can occur. If the expander leaks, the saline solution will be harmlessly absorbed by your body. Minor surgery is required to replace the expander. Rarely, an infection may develop around the expander. In some cases, the expander may need to be removed for several months until the infection clears. A new expander can then be inserted.

You may have concerns about the use of a silicone tissue expander in this procedure because of the Food & Drug Administration’s (FDA) limitations on silicone breast implants. At this time, the FDA ruling does not affect tissue expanders because they are filled with salt water, not silicone gel, and because they are not permanent implants.

Before Surgery

During your initial consultation, Dr. Cambre will evaluate your condition. Your age, skin condition, medical history and other factors will help him to determine if you will benefit from tissue expansion. Your flexibility and tolerance for the inconvenience associated with this procedure will help you decide whether it is right for you.

Dr. Cambre will give you specific instructions on how to prepare for surgery. Whether your surgery is done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two, if

The Surgery

The tissue expander insertion is generally performed in a hospital or outpatient setting under general anesthesia or intravenous sedation. The initial operation will most likely take 1-2 hours, depending on the size and area of skin being expanded. A small, discreet incision is made next to the area of skin beneath which the expander will be placed.

The pre-selected tissue expander is inserted in a pocket created beneath the skin at the chosen location where the skin will be stretched. The expander includes a self-sealing valve that allows the surgeon to gradually fill the expander with saline solution. This valve may be located either on the expander itself (integrated valve), or it may be located distant from the expander, connected to the expander by a small tube (remote valve). The valve is usually placed just beneath the surface of the skin in a location where it can be easily identified.

Once in place, the expander is gradually filled over the course of several weeks with saline solution, which is injected through the valve. This will require some follow up office visits. As the expander enlarges, your skin will stretch. This may cause minor discomfort for a couple of hours after the injection. Any discomfort you experience may be controlled with pain medication. When the expander has been inflated to its’ final volume, it will be left in place for several weeks or months, to prevent shrinkage of the new skin.

In the second stage operation, after sufficient new skin has been recruited by the stretching process, the expander is removed. In breast reconstruction, a permanent implant is then inserted beneath the now larger skin envelope. In the case of tissue expansion for other reconstructive purposes, after removal of the expander, the expanded skin will be repositioned over the original defect or area for which the new skin was intended.

After the Surgery

The speed of your recovery depends on the extent of the surgery. For breast reconstruction patients, normal activity can usually resume in 2-4 days. Most patients can resume normal activity within a week following the second surgery. Minor scar revision surgeries may be required subsequently, in order to achieve the optimal final result.