Tissue Expanders and Implants
Tissue expanders and implants are very popular methods of breast reconstruction. They require the shortest surgical time for the first surgery and do not require special, further training to perform past that received in a plastic surgery residency.
Multiple visits are required between the first and second stages of the reconstruction for filling of the implant. This is usually performed in the office by injecting saline solution through a needle through the skin to progressively fill the expander. When the proper volume has been achieved the patient is scheduled for the second stage where the tissue expander is exchanged for a permanent implant.
The advantages of a quicker and technically less demanding initial procedure must be weighed versus the disadvantages of later complications including capsular contracture, or hardening of the implant which occurs more frequently than with breast implants performed for aesthetic breast augmentation. These advantages and disadvantages must be weighed carefully for each individual patient.
The look and feel an implant reconstruction will be different than those of a reconstruction using the patient’s own tissue.
A tissue expander may also be placed at the time of the initial mastectomy (breast removal surgery) as a temporary spacer in the chest if radiation therapy will be required. The tissue expanded may be removed and replaced with a breast reconstruction flap at a later date. This allows for the preservation of the maximum amount of chest wall skin while sparing the flap the potentially damaging effects of the radiation therapy.
Tissue Expander / Implant
A tissue expander is inserted following the mastectomy to prepare for reconstruction.
The expander is gradually filled with saline over multiple office visits in the weeks following the initial surgery through an integrated or separate tube to stretch the skin enough to accept an implant beneath the chest muscle.
After surgery, the breast mound is restored. Scars are permanent, but will fade with time. The nipple and areola are reconstructed at a later date.
A soft tissue allograft material may be used during the tissue expander / implant reconstruction process. This material provides a "hammock" to better shape and protect the implant reconstruction.
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