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Types of Reconstruction Surgery – Expander Implants

Types of Reconstruction Surgery Expander Implants
Photo courtesy of Johns Hopkins Medicine

Following on my series of articles about the different types of reconstruction surgery, today I’m discussing expander implants after mastectomy.

What Is Tissue Expansion?

A tissue expander is used widely in breast reconstruction when there is not enough skin to accommodate a permanent implant to restore a woman’s natural appearance.

A tissue expander is a temporary device that is placed on the chest wall under the pectoralis major muscle. This may be done immediately following a mastectomy, or it can be done later. The tissue expander’s purpose is to create a soft pocket to contain a permanent implant.  Tissue expanders come in a variety of shapes and sizes.

According to PlasticSurgery.org tissue expansion is a “relatively straightforward procedure that enables the body to ‘grow’ extra skin for use in reconstructing almost any part of the body.  A silicone balloon expander is inserted under the skin near the area to be repaired and then gradually filled with salt water over time, causing the skin to stretch and grow.”  It is a staged approach.

Most expanders have a fill port that is built into the front of the device, and this is accessed with a needle through the skin.  Expansion only takes about a minute, and the amount of fluid that is placed in it is limited by the tightness of the patient’s skin. A typical volume for each expansion procedure is 50 cc’s of saline (about 10 teaspoons).

Once Tissue Expansion Is Achieved…

Once expansion of your tissue is completed and you are cleared for another operation (about one month after finishing chemotherapy), the second stage of reconstruction is performed.  This is an outpatient procedure that involves exchanging the expander for an implant, and creating a more refined breast shape. The initial tissue expander placement, and subsequent exchange for an implant, each take about 1 hour in the operating room.

Advantages and Disadvantages of Tissue Expanders

The good part about the procedure is that tissue expansion offers a very good to near-perfect match of color, texture, and hair-bearing qualities, also because the skin remains connected to the donor area’s blood and nerve supply, there is a smaller risk that it will die. In addition, because the skin doesn’t have to be moved from one area to another, as it does with the various flap surgeries I’ve written about lately, scars are often less apparent.

The disadvantage of the procedure is that it takes rather a long time to grow additional skin. Depending on the area to be reconstructed, tissue expansion can take as long as three to four months.

Also, the procedure requires repeated visits to the surgeon for injection of the salt water that inflates the balloon.  And from what I’ve learned from those enduring this procedure, IT’S DAMNED UNCOMFORTABLE, I don’t care what the surgeons say.  I’ve heard the complaints – they discuss the discomfort of having these foreign objects in their chests that are regularly inflated so that it feels like their breasts are going to explode, the necessity for sleeping in a recliner chair because they can’t roll onto their sides or stomachs for at least two months, the drains going from the surgical sites drive them nuts, healing sometimes takes a long time…

I’m not saying don’t have this – just be aware of the pitfalls.  Make sure you discuss this procedure thoroughly with your surgeon and ensure it’s the best one for you and your particular needs before you proceed.

Reference Articles:

http://www.breastreconstruction.org/TypesOfReconstruction/ExpanderImplant.html

breastcancer.org discussion forums

http://plasticsurgery.org

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