A tissue expander is a device which is placed under the chest muscle to create a pocket or hold the skin envelope in place after a skin sparing mastectomy. Breast reconstruction by expander is a staged procedure. It is used in both immediate and delayed reconstruction.
How does it work in delayed breast reconstruction?
The device is inserted through the original mastectomy scar on the chest wall and placed under the chest muscle. Once the wound has healed, typically 2 -3 weeks later, the expansion can be started in an outpatient setting. The process of expansion involves injection of saline either directly in to the impant or via a port sitting away from the expander. The procedure takes just a few minutes. The expansion procedure is done every few weeks and in total, can take up to several months.
What are the risks of the expansion?
Infection of the implant is the most important risk, which can happen at any stage. Also, pain can become an issue with increasing size of the expander.
What happens once the expansion is finished?
Depending on the type of expander placed and the shape achieved, either the expander is exchanged or replaced with an implant.
What kind of final result can be expected?
Delayed breast reconstruction using expander and implant gives a breast shape which typically sits rather high on the chest with a signifcant projection in the upper pole. Hence it very rarely leads to a natural looking breast, which matches the other. Even if a breast lift procedure is perfomed on the other healthy breast, there will still be a marked asymmetry. However, it is the most simple type of breast reconstruction.
When can this technique not be done?
If the chest wall has been irradiated beforehand, then expansion is contraindicated. The reason being that it can lead to a high risk of wound breakdown, infection and capsular contracture.
How does it work in immediate breast reconstruction?
The expander is placed under the chest wall. The muscle is partially detached in order to facilitate the expander to sit in a central position. The skin is than draped over the chest muscle.
What are the risk of this procedure?
The main risk of this procedure is infection. In a small breast the expander can be placed completely under the chest muscle, whereby in a medium to large sized breast the muscle needs to be detached. This leaves the expander directly exposed to the thin skin of the mastectomy.
What kind of result can be expected?
The result is better than in a delayed expander reconstruction. But depending on the size, a rather high sitting breast with little amount of natural droop is to be expected.
What happens once the expansion is finished?
Depending on the type of expander placed and the shape achieved, either the expander is exchanged or replaced with an implant.
click here for before/after images of the surgical procedure