ABOUT 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. A silicone balloon expander is inserted under the skin near the area to be repaired and then gradually filled with salt water over time, causing the skin to stretch. Tissue expansion generally produces excellent results when reconstructing some areas of the face and neck, the hands, arms, and legs. Expansion may be more difficult on the back, torso, or other areas where skin is thick.
Until recently, surgeons were limited to skin flaps and skin grafts to reconstruct damaged tissue. Tissue expansion, however, provides an added technique with several advantages.First, expansion offers a near-perfect match of color, texture, and hair-bearing qualities. Second, because the skin remains connected to the donor area’s blood and nerve supply, there is a smaller risk that it will die. In addition, because the skin doesn’t have to be moved from one area to another, scars are often less apparent.
On the other hand, skin expansion has one significant drawback – the length of time required to expand additional skin. Depending on the area to be reconstructed, tissue expansion can take as long as 3 – 4 months. During this time, the expander creates what can be an unsightly bulge – which is desirable in breast reconstruction, but can be quite noticeable for someone requiring repair of the scalp or other areas of the body. Furthermore, the procedure requires repeated visits to the surgeon for injection of the saline that inflates the balloon.
Anaesthesia & Stay
We prefer the use of a general anesthesia, in which case you’ll sleep through the entire operation.The operative time varies from procedure to procedure depending on the size and area of skin to be expanded. In most cases, the initial operation will take 1 -2 hours. Most tissue expansion is done in an outpatient surgical facility, the size and location of the expansion, will dictate where the surgery takes place and wether overnight stay is required.
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Almost anyone in need of additional skin can benefit from tissue expansion-from infants to elderly men and women. 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. The skin is expanded as shown to make place for an implant.
- To repair skin damaged by birth defects, accidents or surgery, and in certain cosmetic procedures. However, if the affected area is severely damaged or scarred, expansion is probably not an option, since healthy skin is the first requirement.
- Hair loss following Burns / Trauma large areas of the scalp with hair loss makes it difficult to replace and restore, lost tissue with skin from other areas of the body which do not grow hair. Tissue Expansion is ideal for scalp repair because the local stretched skin on the scalp retains normal hair growth and restores a more natural appearance.
We will begin by making a small inconspicuous incision next to the area of skin to be repaired.The silicone balloon expander is inserted into a pocket created beneath the skin. The expander includes a tiny tube and a self-sealing valve that allows the surgeon to gradually fill the expander with saline solution. The valve is usually left just beneath the surface of the skin. Depending on your skin condition & the site of placement, filling of the expander may commence immediately or after the wound has healed Once the incision has healed, you’ll be asked to return to our office periodically so that the expander can be injected with additional saline. 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.
Post Op Recovery
The initial surgery to insert the expander causes most patients only temporary discomfort which can be controlled with medication prescribed by us. 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. Usually, normal activity can resume in 2 – 4 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.
The most common concern is rupture/ leak of the silicone expander Though rigorously tested and placed with care, leaks do occur. If the expander should leak, the saline solution, used to fill the expander is harmlessly absorbed by your system and the expander can be replaced in a relatively minor surgical procedure.
A small percentage of patients develop an infection around the expander. While this may occur at any time, it’s most often seen within a few weeks after the expander is inserted. The expander may need to be removed for several months until the infection clears. A new expander can then be inserted.
Sameer Karkhanis, MD
Board-Certified Mumbai Plastic Surgeon
Chief Plastic Surgeon & the Director at CCRS is a qualified Aesthetic Plastic and Reconstructive Surgeon. He is Board Certified, with the qualification of DNB Plastic Surgery (Diplomate of National Board). He is an active member of the International Society of Aesthetic Plastic Surgery.