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Tissue Expanders And Breast Reconstruction

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Updated January 12, 2011

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Tissue expanders are implantable, expandable balloon-like devices used in breast reconstruction surgery.   After a mastectomy, a tissue expander can be used during immediate or delayed breast reconstruction to stretch breast skin and chest wall muscles in order to make way for a permanent breast implant.

About Breast Implant Reconstruction

Silicone Breast Implant
Linda Bartlett, National Cancer Institute

Most breast reconstructions are done using permanent breast implants, but unlike breast augmentation, breast reconstruction is a multi-step process.  A mastectomy for breast cancer removes all your breast tissue and affects your symmetry instantly.  Some women opt for external breast prosthesis and a post-mastectomy pocket bra.  Many women choose immediate or delayed breast reconstruction with implants, depending on their treatment options.  Getting a tissue expander is the first step for breast reconstruction with an implant.

Tissue Expanders And Breast Implants

Tissue Expander, Round with Internal Port
Round Tissue Expander - Art © Pam Stephan

Tissue expanders have silicone outer shells and either an internal valve or external port to allow for saline fluid injections. You will be offered a variety of shapes and sizes of tissue expanders if you choose breast implants as your breast reconstruction method. 

Your tissue expander should match the shape of the permanent breast implant that you are going to use.  Both devices come in round, oval, and anatomical shapes.  These balloon-like devices have smooth or textured surfaces.  Tissue expanders are not intended to be permanent implants – most will be removed in a second surgery and replaced with a permanent breast implant.  Expanders with an external port may remain in place after the port has been sealed and removed.

Tissue Expander Placement

Breast Implants - Expansion
Expansion of Tissue - Art © Pam Stephan

After a mastectomy, a tissue expander is inserted beneath chest wall muscles, where it is positioned within a pocket of tissue.  Because your expander and your implant are surrounded by muscle, instead of being on top of muscle or only partly under muscle, the weight of the device will be well-supported.  This muscular support prevents "bottoming out." When an implant is not supported by muscle, it can eventually slide down as gravity takes effect and tissues relax with age.

In some cases, a tissue expander will leak or break.  Saline solution that leaks out won't harm you.  Be sure to get help for a tissue expander rupture.

Tissue Expansion Treatments

Tissue Expander Teardrop
Tissue Expander Teardrop - Art © Pam Stephan

When your mastectomy incision has healed, saline will gradually be injected into your tissue expander to stretch the surrounding tissues and create space for a permanent breast implant.  This may be done over a series of appointments.

Tissue  Expansion

If your expander has an internal valve, your surgeon will locate the port and add saline will through a needle that is inserted through your skin to the port.  For expanders with external ports, saline is added directly into the port.  You will feel some stretching and perhaps discomfort during fills.  Discomfort should quickly fade.  Some women experience pain during saline fills and for a day or so after an expansion treatment.  But if pain persists, contact your surgeon for help.

Temporary Disadvantages of Tissue Expanders

Tissue Expander with External Port
Tissue Expander, External Port - Art © Pam Stephan
  • Airport security scanners and metal detectors can sometimes find the metal valves of tissue expanders. Prepare before your flight by getting a doctor's letter or note on a prescription pad, stating that you have an implanted metal object. Show this letter to security agents.
  • Tissue expanders will be overfilled, so your skin can stretch and drape when your permanent breast implant is placed. If you have only one expander, you will be asymmetrical until your expander is replaced.
  • An implant with an external port has a low risk of infection, but these can be salvaged with proper surgical care and antibiotics.
  • Tissue expanders may ripple and their edges may show through or be easily felt. Permanent implants should feel more comfortable.

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Sources:

Breast Cancer Treatment (PDQ®). Reconstruction. National Cancer Institute. Last Modified: 11/19/2010.

Exteriorization of Buried Port to Salvage Infected Tissue Expander. Ahmed Elshahat, MD. Eplasty. 2009; 9: e37. Published online 2009 September 8.

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