Tissue Expanders in Breast Reconstruction

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When a patient has a mastectomy and desires reconstruction, the breast reconstruction is often done in stages. After the breast surgeon removes the breast tissue (called a mastectomy), the breast surgeon or plastic surgeon performing the reconstruction will often put a tissue expander underneath the pectoral muscle. This tissue expander will create a space for the permanent implant to be placed. This temporary expander is initially smaller than the permanent implant.

The tissue expander will be expanded in multiple sessions to allow a gradual stretching of the patient’s muscle and skin. This expansion process is performed so that the patient will not have the pain associated with a completely stretched out muscle and to allow the patient’s skin to remain healthy. If an implant is placed at the time of the initial mastectomy, the patient may experience severe pain. If skin is stretched too tightly at the time of mastectomy the skin may die, and the patient will not have a good cosmetic result. Placement of a tissue expander will also allow the patient to choose the size of her permanent implants.

The original tissue expanders had a port where saline (salt water) could be injected into the implant via a connecting tube. This port was separate from the tissue expander. Modern tissue expanders now have a “fill valve” built in to the expander. These “fill valves” have magnetic finders, which allow the reconstructive surgeon a way to find the valve for saline injections. A needle connected to a syringe of saline is inserted into the skin and through the fill valve into the expander to deliver the saline fill. Patients will undergo “fills” where the tissue expanders have saline added to their expanders in their physician’s office. The “fills” continue until the expander is the desired size. This “fill” process typically occurs over several months.

A new expander is now available which contains a built-in expansion device using wireless technology that is controlled by the patient. This patient controlled expander releases a specific amount of carbon dioxide into the expander at the press of a hand held control device. This patient controlled expansion process allows the patient to determine the pace of their expansion. Unlike the saline fill methods, expansion occurs outside a physician’s office and without needles. This new technology has been well received by many patients.

Whichever expansion process is used, the expander will be removed and replaced by a permanent implant during an additional operation. If patients have had their nipples removed at the time of their mastectomies, new nipples can be reconstructed or tattooed, based on patient preference. Tissue expanders help patients achieve their goal of breast reconstruction following mastectomy.