In this article, Dr. Leena Jain, among the leading Plastic Surgeons in Borivali, explains what a tissue expander is, how it works, and the risks associated with using one.

She also delves deeper into the procedure, including preparation and recovery.

An empty implant that a specialist positions under the skin during a tissue expansion procedure is known as a tissue expander.

To stretch the skin and cause it to grow, a surgeon slowly fills it with saline or carbon dioxide using a self-sealing device.

Tissue expanders are commonly used in breast reconstruction surgery by healthcare professionals.

However, a surgeon can place the implant or implants in other parts of the body depending on the patient’s needs.

What exactly are they?

Tissue expanders are empty implants that are used for a short period.

Breast cancer surgeons place these implants under the skin and gradually fill them with saline or carbon dioxide over time.

The expander has a self-sealing valve that allows for gradual filling.

For a few months, a person will need to schedule appointments every 1–2 weeks.

The total treatment time will vary depending on the part of the body where a surgeon implanted the tissue expander.

However, stretching the skin enough for breast reconstruction surgery can take 2–6 months.

Tissue expanders can have a textured or smooth surface.

People who want to use them for breast reconstruction should talk to a surgeon about using a soft surface tissue expander.

The reason for this is that using a textured exterior tissue expander can increase a person’s risk of breast implant-associated anaplastic large cell lymphoma by a small amount (BIA-ALCL).

BIA-ALCL is a rare type of lymphoma that develops around a breast implant in the scar tissue and fluid. In most cases, if a person is diagnosed early enough, it can be cured.

According to Dr. Leena Jain, textured surface tissue expanders can increase the risk of bacterial contamination.

She says smooth surface tissue expanders are a safe alternative to textured surface tissue expanders.

What are their functions?

According to Dr. Leena Jain, tissue expanders are used to grow extra skin, most commonly for breast reconstruction surgery after a mastectomy. 

Surgeons can also use tissue expansion to repair skin that has been damaged as a result of accidents surgery:

• accidents
• surgery
• congenital anomalies
• cosmetic procedures

If a bald spot on the head is caused by skin cancer or a wound, the surgeon may use a tissue expander to stretch the hair-bearing skin on the scalp.

In other cases, a surgeon may use tissue expanders to repair a scar or fix an anomaly on the limbs or torso.

Getting ready for the procedure

A surgeon will give you detailed instructions on how to get ready for the procedure.

They’ll tell you what you can eat and drink, as well as what medications you should take or avoid.

If a person smokes, they may need to give up the habit for at least two weeks before and after surgery because it can slow wound healing.

The instructions will vary based on:

• the purpose of the procedure
• when a surgeon will perform the function about other procedures a person requires, such as a mastectomy
• whether the surgery will take place in an outpatient center or a hospital
• the type of anesthesia a person requires

Procedure 

The procedure for inserting a tissue expander varies from person to person, depending on the need for tissue expansion.

The timing of other procedures will also determine it.

If the patient is having immediate breast reconstruction, the tissue expanders may be implanted simultaneously as the mastectomy.

The surgery will usually take 1–2 hours if it is done separately from the mastectomy.

A specialist will form a pocket under the skin or muscle and inject the silicone balloon expander into it throughout this time.

A follow-up appointment will be required to remove the bandages from the incisions and, in some cases, the sutures.

After the surgery, some people may need a drainage tube, which the healthcare team will explain how to care for and drain.

After the initial incision has healed, a person will return to the surgeon’s office regularly.

The specialist will partly fulfill the expanders during these visits by injecting carbon dioxide or saline into the valve.

The expanders will stretch the skin as they fill, causing new skin to grow. A person may feel some discomfort and pain during this time.

Recovery

The length of recovery time varies from person to person, depending on the extent of the procedure.

Individuals who have separate breast removal and tissue expansion procedures can expect to resume normal activities within a few weeks of receiving the expanders.

It may take 4–6 weeks for them to be able to perform more strenuous activities.

Most people can expect to resume light activity within a week of the surgery after the expanders have been removed.

A person should discuss what to expect while recovering from surgery with their doctor.

They should follow the doctor’s pain management instructions after both surgeries.

Keeping yourself at ease in between fills

According to Dr. Leena Jain, the patient should expect some temporary discomfort each time the surgeon fills the expander. Within two hours, the pain should subside.

A person may experience soreness between fills, similar to the soreness that can occur after working out. They can alleviate the discomfort by doing the following:

showering in hot water, wearing a soft, supportive bra taking over-the-counter pain relievers like ibuprofen or acetaminophen.

using a gentle moisturizer on the area without applying it directly to the incision doing any stretches or exercises that a doctor recommends using a mild moisturizer on the site without applying it directly to the incision

A person should consult a doctor about what to expect in between fills and how to cope with any discomfort.

Taking out and re-inserting a tissue expander

A second procedure will be required to remove the expanders once they have reached the predetermined size.

This surgery, which involves replacing the expanders with implants for breast reconstruction, is usually relatively straightforward.

The second surgery may be more complicated in some cases, such as when the skin on the face or scalp needs to be repaired.

Risks and benefits

There are advantages and disadvantages to any medical procedure.

The following are some of the benefits of tissue expansion:

It comes close to matching the color of your skin.

The tissue has a lower chance of dying because it is still connected to its blood and nerve supply.

The scars are less noticeable because the surgeon does not have to remove the skin from one part of the body and reattach it to another.

The most serious concern with using a tissue expander is that it may leak inside the body.

If this happens, the saline will be absorbed by the body and will be harmless. A surgeon will then replace the tissue expander.

Infection is also a possibility, especially in the weeks following the initial surgery.

In these cases, the tissue expander may be removed and replaced once the infection has cleared.

There are also some disadvantages that a person should think about.

To begin with, the procedure can take 3–4 months to complete, and it necessitates multiple trips to obtain saline or carbon dioxide injections.

Second, the tissue expander causes a bulge during this time.

Although this is less of a concern for breast reconstruction, it can be very noticeable in other areas of the body.

When should you see a doctor?

If you notice any signs of infection or suspect your expanders have leaked, you should see a doctor.

Infection symptoms include:

• fever
• warmth or discoloration near the expansion site
• swelling
• a foul or pungent smell from the incision site
• severe bruising

Summary

A specialist injects tissue expanders to assist the skin in stretching and growing new skin. The procedure is commonly used in breast reconstruction.

On the other hand, expanders can be used by a surgeon to grow tissue to repair skin damage in other parts of the body.

A tissue expander will be inserted during the initial procedure. After the skin has healed, the patient will go to the doctor and have saline or carbon dioxide injected into the expanders over months.

New skin will grow as the expanders fill, and the existing skin will stretch. When the skin has increased to cover a large enough area, the expanders will be removed in a second surgery.

A specialist will inject lasting breast implants at this position if a person is having breast reconstruction surgery.