Plastic Surgery & Reconstructive Procedures

Tissue Expansion

Reconstruction

Tissue expansion is a process whereby existing tissue overlying the breast is slowly stretched by a balloon-type device to create sufficient tissue with which one can create a breast.

Placement of a temporary breast tissue expander in the chest. The tissue expander can be placed at the time of breast cancer surgery (Mastectomy) or a later stage. Over weeks, the reconstructive surgeon gradually fills the expander with saline solution. During this process, your skin will gradually stretch and grow to make room for a new breast as it expands. Your body will slowly adjust to the growth of the implant in the same manner a woman’s body adjusts to the gradual change of her abdomen when she is pregnant.

Eventually, when the desired size has been achieved, the newly created space can be filled with an appropriate reconstruction. The second stage reconstruction is done at approximately 3-6 months after the desired expanded size has been achieved. The delay allows the tissue to soften and permanently acquire the expanded shape.

The reconstructive options range from prosthetic or implant reconstruction to any type of flap reconstruction. Often we place a silicone implant alone or in combination with a latissimus dorsi flap from the back to provide additional coverage over the implant. The latissimus dorsi flap lends itself well to gradual expansion and allows for added coverage.

Free flap reconstruction with your tissue could also be used to fill the cavity so created for the breast. This type of reconstruction requires a minimum of two operations.

Should you develop complications, wish to delay your nipple and areola reconstruction or want to have alteration in the shape of your breasts, you would need additional surgery.

The initial procedure involves the placement of the expander. Gradually the desired size will be reached during the expansion process. The second or definitive reconstruction will depend on the type of reconstruction decided upon by you and your doctor.

The nipple and areola may be reconstructed at the second stage or a delayed third stage. Delaying the nipple-areola reconstruction allows the breast to settle in the correct shape and allows for a correct positioning of the nipple-areola.

  • About

    You will receive a general anaesthetic. The reconstructive surgeon draws the appropriate access incisions on your breast either before or during the procedure.

    Firstly the oncological surgeon removes the breast tissue and necessary lymph nodes via the predetermined access incisions.

    The expander is placed under the existing breast tissue and muscle.

    A drain is placed at the surgical site. These drains will remain until the drainage is less than 30ml in 2 consecutive days. The wound is closed in layers, and appropriate dressings applied.

    You would have to stay in the hospital for 1-2 days during the healing process. You will be taught to empty the surgical drain and to keep a record of the drainage. Antibiotics and pain medication will be given to take home. The drains will be removed once it drains less than 30ml in 2 consecutive days. You need to follow up with both the reconstructive as well as the oncological surgeon on the dates given at discharge.

    Pain, bruising and swelling will gradually disappear over the next few weeks. The first expansion will occur in the surgeon’s rooms approximately two weeks after the initial expander placement. The patient and surgeon will proceed with weekly increase until the desired size is reached, and as the patient tolerates the development.

    Should any complications arise, the surgeon may attempt salvage of the expander. Still, in the case of infection, the expander would have to be removed and the reconstruction delayed to a period of 6-12 months.

  • Complications

    Below follows a list of some of the more frequent complications associated with tissue expansion. (Please note that the complications below have an increased incidence in patients who have previously received radiation therapy or in those who are smokers.):

    • Local Complications (Around The Breast):
      • Haematoma formation
      • Seroma formation
      • Delayed wound healing
      • Wound sepsis
      • Wound breakdown
      • Sensory changes in the breast
      • Pain
    • Expander Complications
      • Expander deflation
      • Expander rupture
      • Expander extrusion
      • Capsular contracture (hardening of the expander)
    • Systemic Complication (Your Body):
      • Fluid and electrolyte abnormalities
      • Deep vein thrombosis
      • Postoperative lung complications
    • Long Term And Cosmetic Complications (The Way It Looks):
      • Reconstruction malposition
      • Breast Asymmetries
      • Poor scarring
      • Secondary procedures to improve the appearance, e.g. fat fills.