Tissue Expansion
- Tissue Expansion
- Are You A Good Candidate
- Meeting With The Doctor
- How The Procedure Is Performed
- What To Expect After Surgery
- Possible Side Effects And Risks
- How Long Will The Results Last
- Questions You May Have
Tissue Expansion
Tissue expansion is a method of allowing the body to "grow" more skin so that a plastic surgeon can use the new skin to reconstruct or repair a part of the body that is injured or disfigured. A special balloon called a tissue expander is placed under the skin near the area of the body to be reconstructed. The tissue expander is gradually filled with sterile salt water over several weeks or months. The time involved in tissue expansion depends on the individual case and the size of the area to be repaired.
Tissue expansion is most commonly used for breast reconstruction, but it is also used to repair skin damaged by birth defects, accidents, or surgery, and in certain cosmetic procedures. It is especially useful in repairing or replacing areas of the scalp since the expanded tissue is able to continue to grow hair. Tissue expansion offers many advantages over other procedures such as skin graft and flap surgery. It offers a near-perfect match of color, texture, and hair-growing qualities. And because the skin remains connected to the donor area's blood and nerve supply, there is a smaller risk that it will die. Lastly, because the skin doesn't have to be moved from one area to another, there is often less scarring than with other procedures.
The surgeons at The Metropolitan Institute for Plastic Surgery have successfully used tissue expansion to aid in the reconstruction of injured or disfigured body parts for numerous patients. They will guide you in determining the type of procedure that is best for you and will use their skill and experience to ensure a safe and pleasing outcome.
Are You A Good Candidate for Tissue Expansion?
Almost anyone in need of additional skin can benefit from tissue expansion. In fact, the procedure has been performed on patients from infants to the elderly. Tissue expansion generally produces excellent results when reconstructing areas of the face and neck, the hand, arms, and legs. Expansion may be more difficult on the back, torso, or other areas where skin is thick. If the affected area is severely damaged or scarred, tissue expansion is probably not an option since healthy skin is the primary requirement.
Because tissue expansion often requires weeks or months to grow the necessary skin and can entail repeated visits to the doctor, you must feel comfortable with the time investment required. In addition, depending on the area of the body being expanded, tissue expansion can create a temporary unsightly bulge that can be quite noticeable in areas such as the scalp, face, hands, arms, or legs. Therefore, the inconvenience and obvious appearance of an expander are factors that you must consider when deciding to move forward with the procedure. The doctors at The Metropolitan Institute for Plastic Surgery will work with you to determine if tissue expansion is the right choice for your situation.
Meeting With The Doctor
The first, and perhaps most important, step in tissue expansion is meeting at length with the doctors and staff at The Metropolitan Institute for Plastic Surgery to discuss the options available and determine the best way to perform the procedure to meet your goals. During this meeting, the doctor will examine and evaluate your injury or disfigurement and explain in detail the possible tissue expansion procedures and their risks and results.
The doctors and staff at The Metropolitan Institute for Plastic Surgery will:- Explain which type of anesthesia will be used, where the surgery will be performed, and if a hospital stay is required
- Outline in detail how the surgery is performed and what you can expect before, during, and after the procedure
- Discuss with you the current FDA regulations governing the use of implants, if appropriate
- Provide detailed cost and payment information
- Answer all your questions
How The Procedure Is Performed
Depending on the extent of your tissue expansion surgery, it will either be performed at one of the region's premiere accredited outpatient-based surgical facilities: the Center for Ambulatory Surgery, Inc. (CASI) or the Washington Hospital Center or at an area hospital if an overnight stay is required. The size and location of the expansion determines the type of anesthesia that will be used. Both where your surgery will be performed and the type of anesthesia to be used will be discussed with you during your initial consultation.
In most cases, the initial tissue expansion surgery takes between one to two hours to complete. The doctor makes a small incision next to the area of skin to be repaired. The doctor does everything possible to make the incision in the least visible location possible. The doctor then inserts the silicone balloon expander in a pocket created beneath the skin. The expander includes a tiny tube and a self-sealing valve that allows the doctor to gradually fill the expander with sterile saline solution. The valve is usually left just beneath the surface of the skin. Drains may be put in place to help drain fluid from the surgical area. The doctor then closes the incision with stitches and places a gauze dressing over the area.
Once your incision is healed, you will return to the doctor's office periodically so that the expander can be injected with saline solution. As the expander enlarges with saline solution, your skin stretches to accommodate the growing expander. When the skin has stretched enough to cover the affected area, you will have a second operation to remove the expander and reposition new tissue or an implant.
What To Expect After Your Surgery
| Activity | When |
| Drains Removed | One to Two Days After Surgery |
| Shower or Bath | Once Drains Are Removed |
| Back to Work | One Week After Surgery |
| Driving | Usually Within Two Weeks After Surgery |
| Stitches Removed | Ten to Fourteen Days After Surgery |
| Strenuous Activity | Three to Six Weeks After Surgery |
| Fading of Scars | Several Months to One Year |
Immediately After Your Surgery
How you feel after surgery depends on the extent and complexity of your tissue expansion surgery. Most patients experience only mild discomfort after the procedure and this can be controlled with prescribed pain medication. You may also have some bruising, swelling, and numbness in the area of your surgery. In most cases, the procedure is performed on an outpatient basis and you are ready to go home shortly after your surgery. It is wise to have someone drive you home and to have someone stay with you for a few days.
The First 24 to 48 Hours After Your Surgery
Any discomfort you experience will improve rapidly during the first 24 to 48 hours after your procedure. The doctor will prescribe pain medication to alleviate much of the discomfort. You may feel a bit tired from the anesthesia and have some soreness in the area of your incision.
You may also experience some minor bleeding or oozing in the area of your incision. This bleeding or oozing usually results in a slight staining of the gauze dressing placed over the surgical area. If more than a slight staining of the gauze occurs, call the staff at The Metropolitan Institute for Plastic Surgery. If surgical drains were put in place during your surgery, they will most likely be removed within the first few days. Once they are removed, you can shower or bathe.
The First Two Weeks After Surgery
You will notice a marked improvement in your discomfort and activity level during the first few weeks after your surgery. You should be able to return to work during this time and will, in most cases, have your stitches removed. Once your incision has healed, you will begin regular visits to the doctor's office to have saline solution injected into your expander. You may feel some minor discomfort each time the saline solution is injected into the expander. The discomfort generally lasts only a few hours and can usually be managed with over the counter pain medication.
Resuming Your Normal Routine
Everyone heals at different rates and you are the best judge of when you are ready for certain activities, but the following are general guidelines:
- You can most likely return to work in about a week following your surgery to remove the expander and reposition the tissue or insert an implant.
- Most patients feel comfortable with their normal routine while the expander is in place. The only consideration is to be careful about bumping the area that holds the expander.
- Strenuous exercise can begin in about three to six weeks after surgery; the doctor will give you specific instructions on when to return to your exercise program and any post-surgery restrictions.
- The scars from your surgery should be protected from sunlight for at least a year after surgery.
- Most scars will fade substantially over time; though it may take one or two years for them to become much less visible.
What Are Possible Side Effects or Risks?
Like all surgical procedures, there are risks associated with tissue expansion surgery. During your pre-surgery consultation with your doctor, your individual risks will be assessed and discussed in detail. As with any surgery, you can help reduce the risks associated with your surgery by closely following the instructions provided to you by the staff of The Metropolitan Institute for Plastic Surgery. And, the doctors and staff at the Institute will be with you every step of the way to ensure a safe and pleasing outcome.
Possible side effects include:- Infection
- Leaking of the balloon expander
- Scarring
How Long Will the Results of Your Tissue Expansion Surgery Last?
Tissue expansion surgery can begin the process of restoring and repairing injured or disfigured parts of the body. The results can be remarkable and are considered permanent.
Questions You May Have
Is there any risk that the balloon expander will leak or rupture?
While expanders are rigorously tested and placed with care, leaks do occur. If the expander should leak, the sterile salt-water solution, also known as saline, will be harmlessly absorbed by the body. It is also worth noting that the tissue expander is filled with salt water and not with silicone, the type of fluid used for some breast implants.
Will my insurance coverage pay for my Tissue Expansion?
Generally, tissue expansion surgery is covered by insurance. The staff at The Metropolitan Institute for Plastic Surgery will work with you to obtain pre-approval from your insurance company.
Are there alternatives to Tissue Expansion surgery?
Many women choose not to have Tissue Expansion immediately following breast removal, electing to wait until they are ready for another surgery or to wear some form of a prosthetic breast. This is a personal decision and differs from woman to woman.
Are there ways to correct the look of my remaining breast if it is not symmetrical to my newly created breast?
In cases where the wound or disfigurement does not require extensive tissue or muscle, skin grafting may be suitable to correct the injury or disfigurement. Flap surgery is also an alternative. During your initial consultation, the doctor will go over any possible alternatives and their risks and benefits with you.
