Tissue expanders are silicone devices used to stretch and grow the skin. They are temporarily inserted under the skin in a relatively simple surgical procedure. Over subsequent months, they are gradually expanded through regular saline injections. When the skin has been adequately stretched, the tissue expanders are removed.
Breast cancer survivors who have undergone a mastectomy, or breast removal, may consider using a tissue expander. Tissue expanders are most commonly used in breast reconstruction surgery. They may also be used in other patients that require new skin, as an alternative to a skin graft. In these cases, the procedure is ideal for repairing damage to the scalp, because hair will continue to grow on the area.
While this procedure can help patients develop new skin without many scars, it also has a few potential drawbacks. It may take as long as three to four months for the skin to expand. As the tissue expanders grow, it creates a bulge in the skin. This is not often a drawback for those undergoing breast reconstruction, however, those with a tissue expander on the scalp or other area may not desire this appearance. Tissue expanders also require frequent doctor visits for the saline injections.
Not all patients are ideal candidates for tissue expansion. Those undergoing radiation therapy should wait until the treatment is completed. This is to prevent the implant from hardening. In addition, tissue expanders can not generally be used in areas of severe scarring or damage, as healthy tissue is required for expansion. This procedure may also be more difficult in areas of thicker skin, such as the back or torso.
Preparation for the procedure should include a discussion of the patient’s complete medical history, including allergies, medications, and medical conditions. Patients may need to avoid smoking and taking certain medications for a period of time before the surgery. Additionally, they should arrange to have someone drive them home following the procedure. The type of anesthesia used depends on the patient’s preference and the doctor’s recommendations.
If the patient is placed under general anesthesia, or rendered unconscious, she will need to refrain from eating or drinking for a period of time before the procedure. Local anesthesia may be used instead. This simply numbs a specific area of the body.
The procedure itself can often be performed on an outpatient basis, meaning the patient does not stay overnight in a hospital. An exception to this is if the patient has the tissue expander inserted right after a mastectomy is performed. For the procedure, an incision is made and the tissue expander is inserted. A valve and tube leading to the expander are left just below the skin’s surface.
After the incision heals, the patient returns to the doctor about every two to three weeks. The doctor injects a saline solution through the valve, which gradually expands the device. This may cause some discomfort for about an hour afterward. Once the skin has been sufficiently expanded, the tissue expander is removed. If the procedure is for breast reconstruction, a breast implant is then placed into the newly created pocket of skin.
Patients who are considering tissue expansion should discuss the possible risks with their doctor. It is possible for the expanders to leak or break, in which case they will need to be replaced. Patients may also develop an infection, which will necessitate removal of the expander until the infection is treated and gone.