CONSULTANT PLASTIC SURGEON
TISSUE EXPANSION
What is tissue expansion?
Tissue expansion is a relatively straightforward procedure that enables the body to "grow" extra skin for use in reconstructing almost any part of the body.
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A silicone balloon expander is inserted under the skin near the area to be repaired and then gradually filled with saline or carbon dioxide over time, causing the skin to stretch and grow. It is most commonly used for breast reconstruction following breast removal, but it's also used to repair skin damaged by birth defects, accidents, surgery and in certain cosmetic procedures.
"Surgeons who have the necessary training, expertise, and experience in reconstructive surgery are fit to perform cosmetic surgeries with excellent outcomes. Those surgeons only trained in aesthetic procedures will have much more difficulty doing the same. The more tools and training in plastic surgery the surgeons have, the more qualified they are! "
Who is a good candidate for tissue expansion?
Almost anyone in need of additional skin can benefit from tissue expansion -- from infants to elderly men and women. Tissue expansion generally produces excellent results when reconstructing some areas of the face and neck, the hands, arms, and legs.
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The procedure is used widely in breast reconstruction when there is not enough skin to accommodate a permanent implant to restore a woman's natural appearance. It is also an option for repairing or replacing areas of the scalp, where hair growth makes it difficult to replace lost tissue with skin from other areas of the body.
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Expansion may be more difficult on the back, torso, or other areas where the skin is thick. If the affected area is severely damaged or scarred, expansion is probably not an option since healthy skin is the first requirement.
What should I expect during a consultation for tissue expansion?
In preparing for tissue expansion, you may be asked to get lab testing or a medical evaluation, take certain medications or adjust your current medications, stop smoking in advance of surgery and avoid taking aspirin, anti-inflammatory drugs, and herbal supplements as they can increase bleeding.
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The surgery will be performed in an accredited hospital and requires you to stay overnight for observation unless you and Dr Ricardo have made other plans for your immediate postoperative recovery. You must arrange for a friend or family member to drive you to and from surgery and to stay with you the first night following the hospital’s discharge.
Dr Ricardo and the entire staff will provide thorough preoperative instructions and answer any questions you may have. The goal is to make your surgical experience as easy, comfortable, and safe as possible.​
What are the steps of a tissue expansion procedure?
Step 1 – Anaesthesia
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Dr Ricardo may use local anaesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed and should feel a little discomfort. He may recommend the use of general anaesthesia instead, in which case you'll sleep through the entire operation.
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Step 2 – Surgical procedure
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In most cases, the initial operation will take one to two hours, depending on the size and area of the skin to be expanded. Dr Ricardo will insert the silicone balloon expander in a pocket created beneath the skin. The expander includes a self-sealing valve or gas cylinder that allows him to gradually fill the expander with saline or carbon dioxide.
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Once the incision has healed, you'll be asked to return to his office periodically so that the expander can be filled. As the expander enlarges, your skin will stretch. In some people, this procedure can cause minor discomfort. The expander is filled by inserting a needle into the self-sealing valve, which may be under the skin, or by using a remote dosage controller to fill the expander with carbon dioxide.
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When the skin has stretched enough to cover the affected area, you'll have a second operation to remove the expander and reposition the new tissue. In breast reconstruction, the surgery required to remove the expander and insert the permanent implant is relatively brief. More complex surgery to repair skin on the face or scalp will take longer and may require more than one expansion sequence to complete.
What should I expect during my tissue expansion recovery?
How you feel after surgery depends on the extent and complexity of the procedure. The initial surgery to insert the expander causes most patients only temporary discomfort which can be controlled with medication. You may feel some minor discomfort each time saline is injected into the expander, but this usually lasts only an hour or two. The follow-up procedure to remove the expander and put the new tissue in place may create some temporary discomfort, but this too can be controlled with medication.
How soon you resume your normal routine depends on the length, complexity, and type of surgery you've had. For breast reconstruction patients, if tissue expansion is separate from breast removal, normal activity can resume in two to four days. Most tissue expansion patients find they can keep up with their normal routine while the expander is in place. Following the second surgery, most patients are up and about within a week.​
What results should I expect after my tissue expansion?
Generally, the results of tissue expansion are superior to other methods used to reconstruct or repair damaged skin. But keep in mind, that the goal is an improvement, not perfection. For most tissue expansion patients, the procedure dramatically improves their appearance and quality of life following surgery. If you're physically healthy, psychologically stable, and realistic in your expectations, you'll probably be quite pleased with your new look.