Trying to get my information straight on reconstructive plastic surgery techniques. One I investigated today on a cosmetic surgeons site is called "tissue expansion" which uses a balloon to "recruit more tissue" Can you please explain this in more detail? Thank you so much.
What is Tissue Expansion by Balloon?
Doctor Answers (9)
An expansion by balloon after mastectomy is a tissue expander. It is placed at the time of the mastectomy or later. Then inflated with saline and later replaced with an implant.
Tissue expanders are basicllay balloons that are inflated over a few months period to stretch soft tissue in breat reconstruction.
Tissue expanders are commonly used for breast reconstruction following a mastectomy. These are devices placed under the pectoralis muscle, that are periodically filled with sterile saline in order to stretch the surrounding tissues for a permanent implant. The expansions can be done in the office over multiple visits. After the skin has been slowly stretched, a second surgery is performed in which a permanent, softer implant replaces the more rigid tissue expander.
Neil J. Zemmel, MD
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Breast Reconstruction & Tissue Expansion
Tissue expanders are temporary, adjustable implants (like balloons) that are placed under the pectoralis muscle after mastectomy. The expander is used as a spacer to prevent removal of excess skin and to create the pocket for an implant or flap in the future. After surgery, the expander is injected with saline to stretch skin.
My patients help decide how large they want their breast during the expansion process. The expander is removed in a second stage operation and replaced with either an implant or a flap
I recommend placing the expander at the time of mastectomy if a patient cannot make up her mind about method of reconstruction. Tissue expander preserves all the options of breast Reconstruction and does not burn bridges for the various options of techniques. I see It is as a bridge to the final reconstruction option.
A tissue expander is a device which is increased in size over time by filling it with saline (salt water). Plastic surgeons use these devices for many different reconstructive procedures when they need more tissue than what is available.
In breast reconstruction, after the breast is removed in a mastectomy, a tissue expander is placed underneath the pectoralis muscle and under a product called Alloderm. Thus, the expander is completely isolated from the overlying (and healing) skin. The expander is then filled until the muscle and Alloderm stretch. The skin that remains after the mastectomy drapes over this expander is filled out to a degree (although usually not as much as the original breast). Over the subsequent weeks, the expander is filled to gently expand the muscle and Alloderm and fill out the remaining skin. If expansion is continued beyond the size of the original breast, you can "create" more skin with expansion. What this allows for is a controlled creation of a "pocket" underneath the muscle which allows for placement of an implant at a future time. In essence, what the expander is truly creating is a space for a future implant by expanding the overlying muscle and preserving the amount of skin remaining from the mastectomy.
Breast reconstruction with tissue expander
Breast reconstruction with tissue expander is a method where a deflated permanent implant is placed beneath the chest muscle. Alloderm (dermis) can be added to completely cover the device. The reconstruction is allowed about two weeks of healing and after that point the implant is inflated with saline in the office. This is usually accomplished once a week until the final volume is reached. The expander is allowed to sit without expansion for at least 4 weeks and anytime after that point the expander can be exchanged for a permanent implant (usually silicone). With this type of reconstruction the patient can decide how quickly or slowly the expander is inflated to its final volume.
Tissue expanders in breast reconstruction
Tissue expanders are temporary, inflatable implants that are placed on the chest, usually under the pectoralis muscle after mastectomy, and then injected with saline through a port to place the overlying soft tissue on stretch. As the expanders gets larger and larger, the skin stretches and provides more skin to allow shaping of the breast. This usually requires removing the expander at a second stage and replacing it with a permanent implant.
The expander can also be used as a mere spacer to prevent removal of excess skin and to occupy the pocket where an implant or flap can later be placed. Most surgeons who do breast reconstruction will suggest placing the expander as a spacer as the least one should do at the time of mastectomy if a patient cannot make up her mind about method of reconstruction. The use of the expander provides options to the surgeon and does not burn bridges for the various options of techniques.
Different applications for tissue expansion
Tissue expansion is a technique that involves the placement of an expander below the skin or the deeper tissues in order to recruit and expand these tissues. Different types of expanders are used in different body parts. One of the commonest applications is the use of tissue expanders in breast reconstruction and burn reconstruction.
Tissue expanders are inflatable balloon-like devices that can stretch tissue to assist in the reconstruction of wounds and defects typically resulting from injury or cancer surgery. The principles are similar to what happens to a woman's abdomen during pregnancy. When stretching forces (inflating the expander) are applied to healthy skin, it will increase in volume and can then be used in reconstruction. The most common use of expansion is in the reconstruction of a mastectomy with implants.