Tissue expansion is a relatively straightforward procedure that 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. Although tissue expansion is most commonly used for breast reconstruction, it also may be used to repair skin damaged by birth defects, accidents or surgery, and in certain cosmetic procedures.
The Best Candidates for Tissue Expansion
Almost anyone in need of additional skin can benefit from tissue expansion, from infants to elderly men and women. 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.
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.
How Tissue Expansion Works
During your initial consultation, Dr. Lee B. Daniel will evaluate your condition. Your age, skin condition, medical history and other factors will help your surgeon determine if you will benefit from tissue expansion. Your flexibility and tolerance for the inconvenience associated with this procedure will help you determine if you want to pursue it. Before proceeding with tissue expansion, discuss your expectations and your understanding of it with your surgeon.
Dr. Daniel will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain medications. You should arrange for someone to drive you home after your surgery, and to help you out for a day or two.
In most cases, the initial operation will take 1-2 hours, depending on the size and area of skin to be expanded. Dr. Daniel will begin by making a small incision next to the area of skin to be repaired, and will do everything possible to make the incision as inconspicuous as possible. He will then insert the silicone balloon expander in a pocket created beneath the skin. The expander includes a tiny tube and a self-sealing valve that allows the surgeon to gradually fill the expander with saline solution. The valve is usually left just beneath the surface of the skin.
Once the incision has healed, you'll be asked to return to our office periodically so that the expander can be injected with additional saline. As the expander enlarges, your skin will stretch. In some people, this procedure causes some minor discomfort.
When the skin has stretched enough to cover the affected area, you'll have a second operation to remove the expander and reposition the new tissue. In breast reconstruction, the surgery required to remove the expander and insert the permanent implant is relatively brief. More complex surgery to repair skin on the face or scalp will take longer, and may require more than one expansion sequence to complete.
After Tissue Expansion: What to Expect
How you feel after surgery depends on the extent and complexity of the procedure. The initial surgery to insert the expander causes most patients only temporary discomfort which can be controlled with medication.
For breast reconstruction patients, if tissue expansion is separate from breast removal, normal activity can resume in 2-4 days.
Most tissue expansion patients find they can keep up with their normal routine while the expander is in place. Following the second surgery, most patients are up and about within a week.
You may feel some minor discomfort each time saline is injected into the expander, but this usually lasts only an hour or two. The follow-up procedure to remove the expander and put the new tissue in place may create some temporary discomfort, but this, too, can be controlled with medication.