Tissue Expansion

What is tissue expansion?

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. It is most commonly used for breast reconstruction following breast removal, but it's also used to repair skin damaged by birth defects, accidents or surgery, and in certain cosmetic procedures.

 

If your doctor is recommending tissue expansion, this will give you a basic understanding of the procedure -- when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, however, since much depends on your individual circumstances. Please be sure to ask your surgeon if there is anything you don't understand about the procedure

Tissue Expansion Advantages

Until recently, surgeons were limited to skin flaps and skin grafts to reconstruct damaged tissue. Tissue expansion, however, provides an added technique with several advantages:

• Expansion offers a near-perfect match of color, texture, and hair-bearing qualities
• Because the skin remains connected to the donor area's blood and nerve supply, there is a smaller risk that it will die
• Because the skin doesn't have to be moved from one area to another, scars are often less apparent

Tissue Expansion Disadvantages

On the other hand, skin expansion has one significant drawback - the length of time required to grow additional skin.

Depending on the area to be reconstructed, tissue expansion can take as long as three to four months. During this time, the expander creates what can be an unsightly bulge - which is desirable in breast reconstruction, but can be quite noticeable for someone requiring repair of the scalp or other areas of the body. Furthermore, the procedure requires repeated visits to the surgeon for injection of the salt water that inflates the balloon. For some people, the inconvenience and obvious appearance of an expander are enough for them to consider other options.

Tissue expansion procedure steps

In most cases, the initial operation will take one to two hours, depending on the size and area of skin to be expanded. Your surgeon 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 or she 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.

Expander Enlarges

Once the incision has healed, you'll be asked to return to your surgeon's 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 can causes minor discomfort.

Secondary Operation

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.

Example 1: Scalp

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.
 

Example 2: Breast

A silicone balloon expander is inserted beneath the skin. Once in place, the expander is gradually filled with salt water through a tiny valve. When the tissue has grown to the desired amount, the expander is removed. In breast reconstruction, a permanent implant is then inserted.

Tissue expansion risks and safety information

Skin expansion can produce some remarkable results. As with any operation, though, there are risks associated with surgery and specific complications associated with this procedure.

The most common concern is that the silicone expander used in the procedure will break or leak while it is in the body. While expanders are rigorously tested and placed with care, leaks do occur. If the expander should leak, the salt-water solution (also known as saline) used to fill the expander is harmlessly absorbed by your system and the expander is replaced in a relatively minor surgical procedure.

A small percentage of patients develop an infection around the expander. While this may occur at any time, it's most often seen within a few weeks after the expander is inserted. 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 are left in place for only six to ten weeks, not permanently. Be sure to ask your doctor if you want to know more about the FDA recommendations.