Tissue expander

Tissue expanders are temporary breast implants used to gradually expand and prepare the skin and muscle for a permanent  implant or microvascular flap reconstruction. It is a common procedure for women who have had mastectomies and wish to reshape the breasts.

These temporary implants can be placed underneath the pectoral muscle (sub-pectoral) or over it (pre-pectoral). Sub-pectoral is the most common form of this procedure, but some women may be candidates for pre-pectoral expanding, depending on anatomy.

Tissue expanders are typically implanted during the time of the mastectomy - which is known as immediate reconstruction - but can also be implanted in women who have already had a mastectomy in the past. This is known as delayed reconstruction.

In the past, expansion of the temporary implant was typically performed by injecting saline into a valve in the expander. This method requires regular visits to the plastic surgeon over several weeks.

However, there is now a new method: pumping the expander with air. In this method, your doctor will inject carbon dioxide into the pumps instead of saline, which achieves the same effect while feeling lighter. In some cases, patients can now be sent home with a device called an “Airxpander,” which allows them to inflate the expanders themselves at home by pressing a button.

During your consultation, you and your doctor will discuss all options, as well as timing of the procedure, recovery and your preferred breast size. Our plastic surgeons will work with you to ensure you are informed, comfortable and happy with your results.

In order to expand the implant and gradually stretch the breast, the temporary implant is enlarged over time. This is done by pumping saline solution or air - depending on the type of expander used - into a valve in the expander over the course of a few weeks or months.

Tobacco use and radiation are often associated with increased risk of complications after tissue expander surgery. Your doctor will discuss your unique risk factors with you during your consultation.

There are a number of risks of having this procedure, including:

• Bleeding, infection and scarring
• Asymmetry of the breasts
• Wound disruption
• Numbness and/or pain
• Capsular contracture (hardening of the implants)
• Implant exposure or leakage

If there are complications with your tissue expander placement, you may be at increased risk for complications with a permanent implant and reconstruction.

After the procedure, patients are typically hospitalized overnight. It is common for the breasts to fill with fluids directly after the surgery; to avoid this, the plastic surgeon will insert drains, which will be kept for one to two weeks as the breasts heal. After that period, the drains are removed and expansion can begin. It is recommended that patients avoid stress, heavy lifting, excess physical activity and any friction or abrasion at the incision site during recovery.

There may be some discomfort during tissue expansion. After two to three months, another surgery will be necessary to remove the expanders and exchange them with the permanent implants.

We pride ourselves on our aftercare following mastectomies. Our specialists provide our patients with a supportive bra to improve appearance and comfort during recovery, as well as post-mastectomy exercise and rehabilitation programs. Our expertise goes beyond just the surgery - we work to get you back to your everyday life as quickly and comfortably as possible.