A tissue expander is similar to a deflated breast implant but it has port that allows the expander to be gradually filled with fluid. Tissue expanders are typically needed if the areola, nipple, and/or skin are removed during a mastectomy. A tissue expander is also a safety option used in breast reconstruction if there is any concern for decreased blood supply to your skin, nipple, or areola. The tissue expander can be thought of as a “babysitter” device to maintain your breast shape while your body heals from the mastectomy, until the skin can accommodate a breast implant. A tissue expander is typically placed partially of fully deflated.
Tissue expanders are placed as part of a staged breast reconstruction. In the first stage, a tissue expander is placed allowing the mastectomy skin time to heal. The tissue expander is then filled to the desired breast volume. In the second stage of the reconstruction, the tissue expander is removed and a breast implant is placed. The second stage procedure may be combined with fat grafting to smooth out any mastectomy skin irregularities and camouflage the implant.
You may be a candidate for tissue expander placement if:
- You are scheduled to have a mastectomy due to a new breast cancer diagnosis
- You require a skin sparing mastectomy with the removal of your nipple/areola
- You desire a larger breast size for your final reconstruction compared to your current breast size
- You have a complex health history that requires a simpler procedure with shorter time under general anesthesia
- Simple procedure with little downtime
- Tissue expander reconstruction is an outpatient procedure that does not require a hospital stay. Most patients can return to light daily activity four weeks after surgery
- Reduced complications
- A scan is performed after the mastectomy to evaluate if areas of your skin have decreased blood supply. If a decrease in blood supply is found, a tissue expander is placed and allows your skin time to heal without stress or tension, reducing your risk of skin loss or infection.
- Maintain breast shape during radiation therapy
- Tissue expander reconstruction maintains the shape and contour of the breast during radiation therapy, if required for your cancer treatment
Tissue expanders are FDA approved devices and are an important option for breast reconstruction. Like all implantable devices tissue expanders carry risk of infection, seroma (fluid developing around the tissue expander), and delayed wound healing. These risks are reduced by surgical technique, the placement of breast drains, intraoperative antibiotics, patient activity restrictions, and postsurgical oral antibiotics
Tissue expander reconstruction is typically an outpatient procedure, so you will go home the same day as your surgery. You will be sent home with drains. Two drains are placed to each operated breast. Drains are typically removed within 2-3 weeks, depending on the drain output.
The expansion process takes place in the clinic and is a simple procedure with minimal discomfort. The amount of expansions you will require will be determined during your post operative follow up appointments. If you require radiation therapy, you will complete your expansion process prior to starting radiation.
Once you have healed from your expansions, or following radiation therapy, the tissue expander will be exchanged for an implant. Fat grafting is commonly performed when the implant is placed to smooth out any mastectomy irregularities and camouflage the implant. If you require radiation therapy, you must wait at least 6 months after radiation before proceeding with your next surgery.