Doing some research on Breast reconstruction and am curious why tissue expanders are used in this procedure and NOT in sub-muscular Breast augmentation? Thank you.
Why Are Tissue Expanders Used in Breast Reconstruction?
Doctor Answers (6)
Breast reconstruction and tissue expanders
If a mastectomy is performed, often skin is removed and the area needs to be exapnded to handle the implant properly.
Mastectomy removes tissue and skin....
Tissue expanders are used in some breast reconstruction cases to develop coverage for breast implants when tissue removed in mastectomy leaves implant coverage too sparse. This is very common. Usually in breast augmentation, no tissue is removed so skin coverage is adequate and expansion is not useful or necessary.
John Di Saia MD
Let me expand on tissue expanders
It is usually a question of managing the skin. If most the skin of the breast is removed during mastectomy then the skin will need to be expanded over time to produce enough room for a breast implant. If the skin is spared during the mastectomy then it becomes a matter of control of the excess wrinkling of the skin and loosened attachments of the tissue internally from the mastectomy. The expander in this case helps me control the internal pocket more precisely before placement of a permanent implant.
In breast augmentation surgery the skin can stretch enough to accept an implant and internally the pocket size is created just enough to control the implant placement. In rare cases the skin will not stretch (tuberous breast condition) and an expander will be required.
Hope this answers your question.
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Breast Reconstruction with Tissue Expanders
Tissue expanders are used in reconstruction because skin has been removed and there is no breast tissue to protect the implant. Sometimes with the use of AlloDerm, an implant can be placed primarily without the need for a TE, if a relatively small implant is used. Submuscular implants in augmentations are usually not submuscular inferiorly, but here there is protective breast tissue and skin has not been removed.
Some augmentations could use the expander process, especially in small and tight breast that are augmented to relatively large sizes. In breast reconstruction there are a number of other issues. One is the potential shortage of skin due to the mastectomy excision. The expander helps to create more skin. Another is the fear of pushing the size of the implant right after mastectomy because of the thinness of the tissues and the reduction in blood supply to the skin.The expander can then act as a spacer without putting undue stress on the skin. Another is the use of the expander in patients undergoing radiation who desire immediate reconstruction. Here the expander can be used to counteract the potential shrinking effect of radiation on the soft tissue or maintain valuable skin and space for later use with a permanent implant or a flap. In general, when in doubt, place an expander after mastectomy. It is much more difficult to reconstruct a post-mastectomy defect that has shortage of skin.
Could be rarely used in tuberous breast deformity
Expanders are used in breast reconstruction to recruit more skin. When patients have a mastectomy done,some of the skin is removed(depending on the technique). Expanders allow the expansion of existing skin as well an opportunity for a better control on shape and size.
Expanders are replaced with implants in few months. In breat augmentation implants are used immediately. Very rarely in cases of severe constricted breat(tuberous breast deformity) an expander could be used to allow lower pole expansion.