A tissue expander is a temporary inflatable prosthetic implant that expands the skin lost during mastectomy. It is placed beneath the chest muscles to provide coverage over the implant. Sometimes there is need for additional coverage, which may be achieved by using allograft. An allograft is a skin dermis graft of cadaveric origin that has been processed to remove all the living cells. Eventually living cells from the body replace it.
Two to three weeks after the tissue expander is placed, the expansion begins. Over the next 3-4 months, the patient will have weekly injections of saline into the expander until the desired size is 30% larger than expected. The tissue expander is finally replaced in the operating room with a more permanent implant. The entire process will take about 6 months.
Saline Breast Implant
Saline breast implants consist of a silicone shell filled with saline water. They can be used to replace the lost breast volume following mastectomy. Saline implants have a high safety history as rupture of a implant would release saline water which is simply absorbed by the body. A leak is often identified by the patient as a gradual reduction in breast volume. A ruptured saline implant would require replacement to restore breast symmetry.
Implant reconstruction may be associated with rippling of the skin and contour irregularities related to the implant and thickness of overlying skin.
Silicone Gel Breast Implant
Silicone breast implants consist of a silicone shell filled with silicone gel. It is believed that silicone gel implants have a more natural feel than saline water filled breast implants as they are lighter and less dense. They have equally been deemed safe by the FDA for use in breast reconstruction.
Capsular Contracture: Condition where the scar capsule surrounding the breast implant constricts resulting in a firm implant and possible shape deformity of the breast.
Radiation: High incidence of post radiation capsular contracture
47.5% Capsular contracture after radiation.
Tissue Expander and Implant Reconstruction
Tissue expanders pictured here are placed with minimal volume seen in the expander on the left. An inflow port on the expander allows for additional saline to be injected into the expander during postoperative clinic visits thereby increasing the size of the tissue expander as seen on the right.
- Uses either silicone gel or saline filled breast implants to restore breast volume following mastectomy.
- Implant breast reconstruction often requires the use of tissue expanders to increase the skin envelope of the breast.
Tissue expander is initially placed beneath the skin and pectoralis muscle with minimal volume.
The tissue expander is slowly filled during clinic visits to stretch the overlying skin and increase volume of the reconstructed breast.
- No additional scarring
- Shorter procedure/recovery
- Natural shape in clothing
- Obviates the need to wear a daily external breast prosthesis
- Foreign body causing risk of infection, or scarring around the implant (also known as capsular contracture).
- Risk of rupture requiring exchange or removal
- Possible asymmetry with normal breast
- Implant is never permanent
- Implants generally degrade over time in cosmetic appearance.
- Higher risk of future unanticipated surgery for revision
- High incidence of post-radiation capsular contracture