Tissue Expansion

Tissue Expansion is a procedure performed to promote the growth of healthy supplementary skin used for the replacement of damaged skin. This reconstructive procedure is an option for almost any area of the body, allowing plastic surgeons to repair skin damaged by both congenital and acquired defects.

Who are Good Candidates for Tissue Expansion:

Almost anyone in need of additional skin can benefit from tissue expansion — from infants to elderly men and women.

• The procedure is used widely in breast reconstruction when there is not enough skin to accommodate a permanent implant to restore a woman’s natural appearance.
• It is also an option for repairing or replacing areas of the scalp, where hair growth makes it difficult to replace lost tissue with skin from other areas of the body.
• Tissue expansion generally produces excellent results when reconstructing some areas of the face and neck, the hands, arms and legs.
• Expansion may be more difficult on the back, torso, or other areas where skin is thick. If the affected area is severely damaged or scarred, expansion is probably not an option since healthy skin is the first requirement.

Consultation

You and your surgeon will reach an understanding about what you can expect from this procedure and the long-term benefits you will experience. Every patient is different, and your surgeon will choose the surgical technique and treatment plan that is right for you. During the initial consultation, you should expect to provide a complete medical history and have measurements and photographs taken for your medical record. Your surgeon will conduct a complete physical examination and discuss possible risks and complications of the procedure.

Procedure

Tissue expansion is a way to stretch skin, so that the body’s own tissue can be used to fix or replace skin that is going to be removed. It takes place in three main steps:

1. Placement: To help the skin stretch, a small incision is made, and the expander—a little balloon attached to a tube and “port”—is inserted under an area of healthy skin, usually near the section of skin that is going to eventually be removed. Children are placed under anesthesia during placement.
2. Filling and Stretching: After the initial cut heal, you must come to the office about once a week to have saline (a sterile liquid that is safe for the body if it leaks) added to the pouch through the port. The port may be under the skin, meaning the area has to be numbed and held still to inject saline into the expander. Week by week, the bag will be filled with more liquid during clinic visits, which will slowly stretch the skin.
3. Removal: Once there is enough new skin, the expander will be taken out and the new skin can be pulled over to replace the damaged skin.

The expander may need to be in for several months before the skin is ready for surgery. The exact amount of time it will take to stretch the skin depends on where on the body the expander is placed, how much damaged skin needs to be replaced, and how well your child tolerates the expansion process.

Tissue Expansion : Risks and Safety

Is it safe?

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.

Other Risks Include:

• Hematoma
• Infection
• Wound dehiscence
• Skin necrosis
• Capsular contracture
• Implant rupture, is tissue expansion is done in the place where the surgery was done, and implant was inserted

Is Tissue Expansion Painful?

You may have had a tissue expander, or an implant placed during the surgery. If an expander was placed, salt water (saline) or air was added to it to start stretching your skin. Right after the surgery, you will probably feel weak, and you may feel pain for 2 to 3 weeks. The pain might be due to stretching, however it can be easily dealt with by using suitable painkiller medicine.

Recovery

You may feel some minor discomfort each time saline is injected into the expander, but this usually lasts only an hour or two. The follow-up procedure to remove the expander and put the new tissue in place may create some temporary discomfort, but this too can be controlled with medication. Most tissue expansion patients find they can keep up with their normal routine while the expander is in place. Following the second surgery, most patients are up and about within a week. If tissue expansion was done on breast area you will need to wear special bra, after 14 days you may remove the Surgical Bra and wear a “sports” type bra that will provide support and maintain the placement of the tissue expander. Please do not wear an underwire bra. Please wear a “sports” bra for 24 hours a day for 21 days. You may remove the bra to shower.

Tissue Expansion Results

The growth of tissue is permanent but will retract to some degree when the expander is removed. Topically applied tissue expansion devices also exist. These have the benefit of being inexpensive and do not require a surgical procedure to implant them under the skin. The swelling may affect your breast, chest wall, shoulder and arm. It’s a normal part of the healing process and should lessen six to eight weeks after your surgery. Generally, the results of tissue expansion are superior to other methods used to reconstruct or repair damaged skin. But keep in mind, the goal is improvement, not perfection. For most tissue expansion patients, the procedure dramatically improves their appearance and quality of life following surgery.

If you’re physically healthy, psychologically stable and realistic in your expectations, you’ll probably be quite pleased with your new look.

Things to keep in mind:

Tissue 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.