Tissue expanders are medical devices often included in the process of implant-based and autologous tissue-based breast reconstruction. These devices gradually create a breast pocket in the skin and tissue of the chest wall. To schedule a consultation to discuss your options for reconstructive surgery, please call our experienced team at 303-706-1100.
Tissue Expansion Following Mastectomy
After mastectomy, the skin and muscle on the chest often must be expanded before implants or tissue flaps can be used to reconstruct breasts. For some women, an immediate implant reconstruction – at the same time as mastectomy – without expansion may be an option. But for others, tissue expansion is an effective way to stretch the skin and muscle, creating a space in which the breast implant or tissue flap is placed.
Tissue expanders can be placed at the time of your mastectomy or after. Some women choose to begin breast reconstruction years after their mastectomy, and tissue expanders can be placed even if your mastectomy was performed a long time ago.
What to Expect From Tissue Expanders
A tissue expander looks a lot like a breast implant, although it has a thicker outer shell than breast implants. There is a port on the front of the expander. Your plastic surgeon fills the expander with saline fluid through this port, which is how the volume is gradually increased over time, which in turn gradually expands the tissue.
Here are some things that accompany a typical tissue expansion:
- The expanders are placed beneath the pectoralis major muscle after mastectomy
- The upper portion of the expanders are covered by the muscle itself, while the lower portion is covered by a product called AlloDerm®
- AlloDerm offers a hammock-like support below the expanders, which means our plastic surgeons do not have to stretch the muscle across the entire implant
- AlloDerm expedites the expansion process and creates a breast pocket resembling that of natural breasts
Usually, during surgery, a pain catheter and two drainage tubes are placed in each breast — the catheter helps control pain by infusing numbing medication into the pocket and the drains collect fluid into small bulbs. Based on the output of fluids after the initial 24 hours after surgery, the tubes will be removed by your surgeon.
The tissue expander contains a port built into the front through which saline is added to the expander, usually weekly. We start the expansion usually 7-10 days after the expanders are placed, and our patients visit The Breast Center Park Meadows Cosmetic Surgery each week as the expansion process continues.
The Tissue Expansion Process
After each expansion, you can expect mild discomfort, mostly related to the tightness and muscle soreness as saline is added to the expander to stretch the skin and muscle. Your surgeon will continue to expand the tissue until the breast pocket is large enough for an implant — an advantage of the tissue expander is that the patient is able to choose her own implant size based on the size of the breast pocket. The volume of the expander will be similar to that of the implant, but the implant will look and feel much more natural than the expander.
After the skin and tissue have been expanded enough to create a pocket which will hold the implant, patients are ready for the second stage of reconstruction. This is an outpatient operation completed at our affiliated, state-licensed, The Joint Commission-accredited Park Meadows Outpatient Surgery. The tissue expanders are removed, scar tissue is removed from the pocket, and new saline or silicone implants are placed in each breast pocket. The implant will settle for the following months until the patient is ready for steps including:
- Breast shaping surgery, also known as fat grafting, to improve the breast contour and to even out any irregularities
- Nipple reconstruction
- Areola pigmentation
In specific and unique situations, this first stage of tissue expansion can be skipped and a permanent saline or silicone implant can be placed immediately after the mastectomy. This is known as direct-to-implant or single-stage breast reconstruction. Our surgeons can help determine if you are a candidate for this technique and talk with you about details related to this surgery.
There are, of course, advantages and disadvantages — while these patients skip the weeks of tissue expansion and move directly to the implant placement, the implant size is dictated by the size of the pocket left after the mastectomy. Even by skipping the first stage, the overall reconstruction process does not usually result in fewer total surgeries — there is usually at least one surgery to make modifications to the implant after it is placed and before the nipple and areola are reconstructed.
To learn more about breast reconstruction and to discuss your options, please call The Breast Center Park Meadows Cosmetic Surgery at 303-706-1100 to arrange a consultation. The board-certified plastic surgeons at our practice are proud to bring advanced, effective reconstruction techniques to women from Denver, Lone Tree and across the state of Colorado.