Tissue Expander Reconstruction

The use of a tissue expander followed by a permanent gel or saline implant is a common procedure used today for breast reconstruction. It can be used when performing a primary or delayed reconstruction. In either case, the tissue expander is placed beneath the chest (pectoralis major) muscle. The muscle and breast skin are closed over it and allowed to heal. Most tissue expanders have a port built into them that can be accessed through a needle inserted in the skin. Saline or salt water is injected through the port usually at 2-3 week intervals. Just as an abdomen stretches during pregnancy, the addition of fluid slowly stretches the skin and recreates a breast mound. Following the completion of chemotherapy or (if chemotherapy is not required), the patient and the surgeon return to the operating room where a small incision is made, the expander is removed, and a permanent saline or gel implant is placed in the cavity.

At the second procedure, a nipple areola reconstruction is usually performed completing the reconstruction. The advantage of a tissue expander/implant reconstruction is that it takes little time to place the expander at the time of surgery and there is not a secondary operative site to deal with.

The disadvantages are that it is often difficult to match a mature woman's breast with just the use of a tissue expander followed by an implant. Most women's breasts have a degree of ptosis or sag, and this is difficult to reproduce with an expander followed by an implant alone. A secondary concern is that without bringing in additional tissue, the skin covering an expander/implant reconstruction can at times become quite thin resulting in visible wrinkles and/or an unnatural feel. In short, the advantages of an expander/implant reconstruction are the relative short duration of surgery and the lack of a secondary operative site. The disadvantages of this procedure are that the surgeon has little flexibility to deal with adverse conditions, and it is difficult to reproduce the appearance and feel of a mature woman's breast with this procedure alone.