Tissue Expansion Surgery

Tissue expansion is a procedure that enables the body to produce extra skin for reconstructive surgery procedures. A silicone balloon expander is inserted under the skin near the area to be repaired and then gradually filled with saline over time, causing the skin to stretch and grow. Although tissue expansion is most commonly used for breast reconstruction, it also may be used to repair skin damaged by birth defects, accidents or surgery, and in certain cosmetic procedures.

Who Should Consider Tissue Expansion?

Almost anyone in need of additional skin can benefit from tissue expansion. Tissue expansion is often used for:

• Breast reconstruction when there is not enough skin to accommodate a permanent breast implant to restore a woman’s natural appearance.
• 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.
• Reconstructing several areas of the face and neck, the hands, arms, and legs

The Surgery: How Tissue Expansion Works

While most tissue expansion is done in an outpatient surgical facility, the size and location of the expansion, as well as the preference of the patient and surgeon, will dictate where the surgery takes place. Your surgeon may begin tissue expansion immediately at the time of breast removal. If you’ve had an injury, on the other hand, your surgeon will probably recommend that tissue expansion be performed in an outpatient surgical facility after the wound has healed.

The surgeon may use local anesthesia, combined with a sedative to make you drowsy. You’ll be awake but relaxed, and should feel little discomfort. General anesthesia is also an option, in which case you would sleep through the surgery.

The initial operation typically requires 1–2 hours, depending on the size and area of skin to be expanded. The 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 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.

Once the incision has healed, you’ll return periodically so that the expander can be injected with additional saline. As the expander enlarges, your skin will stretch. In some people, this procedure causes some minor discomfort. 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.

After Tissue Expansion: What to Expect

How you feel after surgery depends on the extent and complexity of the procedure. The initial surgery to insert the expander causes most patients only temporary discomfort which can be controlled with medication prescribed by your physician.

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. 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.