What Is Tissue Expansion:
Tissue expansion is a reconstructive surgical technique which allows the body to "grow" extra skin where there has been tissue loss due to trauma or disease. The most common application is in post-mastectomy breast reconstruction, but tissue expansion can be used in almost any part of the body following most types of injury. It is also quite advantageous for reconstruction of the scalp, because the “new” skin created contains matching hair follicles (as opposed to using skin grafts or flaps from other parts of the body, which may leave bald spots on the scalp).
How Does Tissue Expansion Work:
A balloon-like expander with a silicone shell is inserted under the skin near the area which is in need of repair. Over time, the shell is gradually filled with saline (saltwater), causing the skin to stretch and grow. Once sufficiently stretched, the new skin is then placed over the defect and sutured in place.
Who Is a Good Candidate:
Tissue expansion can be performed on people of all ages and all skin types, but is generally most successful when performed on thin-skinned areas, such as the face, neck, scalp, hands, arms, and legs. The technique can be more difficult when working with thick-skinned areas like the back and parts of the torso, and may not be possible on areas where the skin is severely damaged or scarred.
Tissue Expansion Pros and Cons:
- offers a near-perfect match of skin color, texture, and sensation
- less risk of tissue loss because the skin remains connected to its blood and nerve supply
- scars are less noticeable than with skin flaps or skin grafts
- expansion can take as long as 3 to 4 months
- expander creates what may be considered an unsightly bulge while in place (fine for breast reconstruction, but undesirable in facial reconstruction)
- requires repeated trips to your surgeon for saline injections to further inflate the expander
Tissue Expansion Risks and Complications:
Risks and complications include:
- unfavorable scarring and/or skin discoloration
- excessive bleeding or hematoma
- skin or fat necrosis (tissue death)
- poor wound healing or wound separation
- blood clots
- anesthesia risks
- deep vein thrombosis
- cardiac and pulmonary complications
- persistent edema (swelling) or fluid accumulation
- persistent pain
- temporary or permanent change/loss of skin sensation
- unsatisfactory aesthetic results requiring revisional surgery
- breakage or leaking of the expander
Call your surgeon immediately if have chest pain, shortness of breath, unusual heartbeats, or excessive bleeding.
Tissue Expansion Recovery and Downtime:
The majority of patients are able to resume their normal routine within 2 to 4 days of surgery, and maintain their normal activities while the expander is in place. Following the second surgery (to remove the expander and reposition the new tissue), most patients are back to work within a week.
Reconstructive procedures vary greatly from patient to patient, and thus, recovery time can vary greatly as well according to your general health and the length and complexity of your procedure. Any severe pain during recovery should be reported to your doctor.
Tissue Expansion Costs:
Tissue expansion is reconstructive in nature, and therefore will usually be covered by your health insurance plan. Even if your health plan covers the procedure, make sure you check with your surgeon’s billing office to determine whether or not your plan is accepted by the practice.
For the uninsured, costs vary greatly, depending on the type and amount of reconstruction needed. Only your surgeon can give you an idea of the costs for your unique procedure.
When speaking to your surgeon, be sure to ask about costs not only for his surgical fee, but for anesthesia, medications, facility fees, and lab work.
Tissue Expansion - Other Considerations:
If you are having tissue expansion after traumatic injury, your surgeon will most likely want to wait to perform the initial surgery until after your wound has healed. For breast reconstruction patients, however, your surgeon may begin tissue expansion at the time of breast removal.
Though tissue expansion generally produces superior cosmetic results when compared with other reconstruction methods, you should keep in mind that the goal of any plastic surgery is improvement, not perfection.
Tissue Expansion - How It’s Done:
- Anesthesia Is Administered
Medications are given for your comfort during the surgical procedure. Often, general anesthesia is given so that you will be asleep throughout the procedure. However, tissue expansion may also be performed using a combination of local anesthesia and intravenous sedation. Your surgeon will recommend the best choice for you.
- Incisions Are Made
Your surgeon makes a small incision next to the defect, taking care to make the incision as inconspicuous as possible.
- Expander Is Inserted (and Partially Filled)
Your surgeon inserts the silicone-shelled expander (also called a balloon) into a pocket he or she has created under the skin. Left just beneath the surface of the skin is a tiny tube and a self-sealing valve through which a small amount of saline is injected to begin the expansion process.
- Incisions Are Closed
Incisions are closed with sutures, leaving just enough of an opening to allow for future saline injections. Incisions are usually given additional support with surgical tape and skin adhesive (tissue glue).
- Expansion Process Continues
After the incision is healed, you will return periodically to your surgeon's office for additional saline injections to enlarge the expander, further stretching the skin. This procedure (and the resultant stretching of the skin) can cause minor discomfort for some patients.
- Expander is Removed and Skin is Repositioned
When there is sufficient expanded skin to cover the defect, your surgeon will perform a second surgery to remove the expander and complete your reconstruction. The new tissue created by the expansion process will be repositioned over the area needing repair and sutured in place. This procedure is relatively brief in breast reconstruction. Facial and scalp reconstruction are usually more complex and time-consuming, and may require multiple procedures to complete (possibly including a repeat of the expansion process).
Tissue Expansion, Consumer Information Sheet, American Society of Plastic Surgeons.