A few women opt to have immediate breast reconstructive surgery, which combines the breast removal and reconstruction into a single procedure. The rest—a majority of reconstructive patients—opt for a delayed breast reconstruction procedure, which essentially involves two operations. If a woman wants to preserve the skin of her removed breast (or breasts) intact, for a later, more natural looking breast reconstruction this is where tissue expanders come in useful.
Tissue expansion is a technique used by plastic and restorative surgeons to help the body grow additional, skin, bone and other tissues. Tissue expansion is achieved by implanting a tissue expander under the healthy skin, which is inflated gradually over time with saline injections to achieve the desired enhanced volume. Tissue expansion works by taking advantage of the natural elasticity of the skin. This technique is useful in breast reconstruction as well as in reconstructive procedures on the lips and the eyelids. Tissue expanders can also be used in other situations, such as repairing damaged skin caused by birth defects, accidents or previous surgery.
“A breast tissue expander is an inflatable breast implant designed to stretch the skin and muscle to make room for a future, more permanent implant,” says the Johns Hopkins Medicine Breast Center web.
Once implanted underneath the skin and the pectoral muscle, the tissue expander is gradually inflated over time with saline injections, made via a small valve in the expander. This occurs over a period of several weeks—with an average of around three months—until the expander has reached the desired size or volume.
Your surgeon will also look at, among other factors, the quality of the overlying skin of the breast, the condition of the pectoral and serratus muscles, in determining whether you are a good candidate for the issue expansion technique.
Using tissue expanders and preserving the natural skin towards reconstruction with a breast implant is ideal for women who want to have more natural looking breasts following a mastectomy.
Implanting the tissue expander
Immediately after the mastectomy operation removes the breast tissue in its entirety, the tissue expander is placed under the pectoral muscle. Sometimes, the tissue expander may be expanded with saline at the time of insertion.
It is always better to consult with a surgeon before a mastectomy so that all options can be explored, explained and understood. When other supporting therapies such as chemotherapy and radiotherapy are necessary, it becomes even more important to plan the reconstruction before the mastectomy.
For those patients who need to undergo radiotherapy it is important to have the expander placed at the time of mastectomy to preserve the skin. Undergoing radiotherapy without placing an expander can lead to skin and tissue damage during the therapy. Such damage rules out any possibility of future tissue expansions, making that person only eligible for an autologous-flap reconstruction.
If the patient does not require radiotherapy as part of her cancer treatment the placement of the tissue expander may be delayed.
During the expansion stage, you will need to visit your surgeon’s office at regular intervals for expansion of the tissue expander with saline. Your surgeon will measure and monitor the amount of saline that is injected into the expander. Doing so ensures that when the appropriate size is reached, it becomes possible to make a direct swap with a similar sized silicone implant.
Expansion rates and volumes are dependent on each patient’s level of comfort and the progress of wound healing, among other factors.
Your surgeon will monitor your progress carefully at each post operational visit. It may take up to 6 months for full expansion and settling time before the expander is ready for replacement.
Replacing an implant for the expander is considered the second stage of breast reconstruction using a tissue expander. In Australia, surgeons usually replace the expander with an anatomical or tear drop shaped permanent silicone breast implant.
Completing the reconstruction
Tissue expanders are a breast reconstructive option for women who have undergone a surgical breast removal (mastectomy). As with any other procedure, breast reconstruction with tissue expansion and implants have their limitations.
If you decide to have a breast reconstruction with tissue expanders immediately following a breast removal you’ll see your surgeon for your first post-op visit about two weeks following the removal. This first visit is the best time to ask all your questions about the procedure.
On your next visit, saline will be added to the expander. Your surgeon will also examine the incision to make sure your breast is healing properly. If the sutures are not the dissolvable kind, your surgeon will decide when to take them out.
Every week, for one to two months, you will have to return to your surgeon’s office to insert more saline solution inserted into the tissue expanders. Prior to each expansion, your surgeon will examine the incision line and breast mound. This process takes anywhere from 20 to 30 minutes. During the procedure and immediately afterwards, you may feel tightness in the area of your breast. You may also develop a slight soreness in your back and shoulders. The discomfort usually subsides after a day or two.
If pain or discomfort does not subside after three days, contact your surgeon immediately.
After each expansion you can continue regular activities. You may also return to work and perform light-duty housekeeping a couple of hours after your expansion. Once you regain a full range of motion in your shoulder and have stopped taking pain medications, you can resume driving a car.
Your surgeon may show you a few stretching exercises to perform after every expansion. Expect your surgeon to ask about your progress with these exercises when you have check-up appointments.
Once your expansion is nearly complete, you may notice that your new breast mound looks significantly larger than your natural breast. This is completely normal. Loose tops or sweaters can help to camouflage this imbalance.
If your job involves lifting 5 or more kilograms, you may need to discuss temporary light-duty options with your employer.
As the advice goes, be careful around kids, men and pets, especially dogs.
If you have any questions, your surgeon should be happy to answer them.
The possible risks and complications vary according to the type of tissue expanders used. It can also vary by individual.
Surgeon, anaesthetist and hospital costs will vary. Since tissue expanders are considered to be part of reconstructive surgery (as opposed to cosmetic surgery), Medicare and private health insurance usually cover their expense as well as hospital costs. Patients with private health insurance will also be eligible for a rebate for the expander/implant and surgical fee.
You should expect the costs to be higher if you are having combined procedures at the same time.
This information is correct as of 2017.