Following a mastectomy, breast reconstruction often uses a staged approach. Tissue expanders are temporary devices that prepare the chest for permanent breast implants, helping individuals achieve a natural-looking breast mound and regain confidence.
What Are Tissue Expanders?
Tissue expanders are medical devices designed to gradually stretch the skin and surrounding tissues to create space for a permanent breast implant. They are typically constructed from a silicone elastomer shell, similar to a deflated balloon. Inside or connected to the shell, there is usually a small, self-sealing port, which allows for the controlled injection of sterile saline solution to inflate the expander over time. This stretching process harnesses the body’s natural ability to grow new skin when subjected to gentle, continuous tension.
The primary function of a tissue expander is to ensure there is enough skin and soft tissue available to cover a permanent breast implant, especially when a significant amount of tissue was removed during the mastectomy. Without sufficient tissue, placing an implant directly might lead to an undesirable aesthetic outcome or complications. Expanders come in various shapes, such as round or anatomical (tear-drop shaped), and can have smooth or textured surfaces, with the choice depending on the individual’s needs and the surgeon’s preference. Some expanders even use carbon dioxide and are patient-controlled via a remote device, allowing for home expansion.
The Expansion Process
Tissue expanders are surgically placed, often during the mastectomy or in a separate procedure after initial healing. The surgeon creates a pocket, typically beneath the pectoralis chest muscle, where the deflated expander is inserted. This initial surgery usually lasts one to two hours, depending on complexity.
After the surgical site has healed, which generally takes a few weeks, the “filling” or expansion phase begins. During regular office visits, typically weekly or bi-weekly, the surgeon or nurse uses a small needle to inject sterile saline solution into the expander’s port. Each injection usually adds 50 to 100 cubic centimeters of saline, gradually increasing the expander’s volume and stretching the overlying skin and muscle. The port may be located internally, requiring a magnetic locator to pinpoint it under the skin, or externally in some designs.
Patients commonly experience sensations of pressure, tightness, or mild discomfort as the skin stretches with each fill. This discomfort typically subsides within 24 to 48 hours and can often be managed with pain medication. The expansion phase continues until the desired volume and skin laxity are achieved, which can take anywhere from several weeks to several months, depending on the individual’s tissue response and the target breast size.
Transitioning to Final Reconstruction
Once tissue expansion is complete, the next step is an “exchange surgery.” This second surgical procedure involves removing the temporary expander and inserting the permanent breast implant into the newly created pocket. Exchange surgery is generally smaller than the initial placement, often performed on an outpatient basis, allowing patients to return home the same day.
During this procedure, the surgeon may also make adjustments to the implant pocket, such as scar tissue removal or inframammary fold improvements, to optimize the aesthetic outcome. Patients, in consultation with their plastic surgeon, select the final implant type, choosing between saline or silicone-filled implants based on factors like desired feel, shape, and overall appearance. Silicone implants often offer a more natural feel, while saline implants provide adjustable volume. This surgery concludes the expander’s role, transitioning to the final, permanent breast form.
Important Considerations
Living with tissue expanders involves a period of adaptation and specific care. Patients may experience various sensations, including a feeling of tightness, pressure, or temporary asymmetry, especially if only one breast is being reconstructed. Numbness in the breast area is common due to nerve disruption during surgery, though some sensation may return over time. Temporary swelling and bruising are also expected after the initial placement.
While tissue expanders are generally safe, potential complications can occur. These may include infection, sometimes necessitating expander removal, or a seroma (fluid collection). Expander deflation or rupture is also a rare possibility; the saline contents are safely absorbed, but the expander would need replacement. Clear communication with the surgical team is important to address any concerns, especially if signs of infection like fever, redness, or unusual swelling arise.
Post-operative care involves adhering to specific activity restrictions, such as avoiding strenuous upper body exercise and heavy lifting, typically for several weeks after surgery and during the expansion phase. Wearing a supportive, non-underwire bra is often recommended. Individual experiences with expanders can vary, so following personalized guidance from the healthcare team is important. The process requires patience and consistent follow-up appointments.