Tissue Expansion, Staged Breast Reconstruction
Tissue expansion is a process whereby existing tissue overlying the breast is slowly stretched by a balloon type devise to create sufficient tissue with which one can create a breast.
A temporary breast tissue expander is placed in the chest. The tissue expander can be placed at the time of breast cancer surgery (mastectomy) or at a later stage. Over a period of weeks the reconstructive surgeon gradually fills the expander with saline solution. During this process, your skin will gradually stretch and grow to make room for a new breast as it expands. Your body will slowly adjust to the growth of the implant in the same manner a women’s body adjusts to the gradual growth of her abdomen when she is pregnant.
Eventually when the desired size have been achieved the newly created space can be filled with an appropriate reconstruction. The second stage reconstruction is done at approximately three to six months after the desired expanded size have been achieved. The delay allows the tissue to soften and permanently acquire the expanded shape.
Thus one procedure in theatre to place the expander and a drain. One week later the drain is removed. Wait one month before commencing expansion allowing the scar to mature and not rupture, open up when stretched. Expansion can be done daily, weekly, biweekly or whenever you feel up to it. The expansion process continues until the desired size is reached. Once the desired size is reached we wait 3 months before removing the expander and performing the definitive reconstruction at a second surgical procedure.
The reconstructive options range from prosthetic or implant reconstruction to any type of flap reconstruction. Often we place a silicone implant alone or in combination with a latissimus dorsi flap from the back to provide additional coverage over the implant. The latissimus dorsi flap lends itself well to gradual expansion and allows for added coverage. Free flap reconstruction with your own tissue could also be used to fill the cavity so created for the breast.
This type of reconstruction requires a minimum of two operations. Should you develop complications, wish to delay your nipple and areola reconstruction or wish to have alteration in the shape of your breasts, you would need additional surgery.
The initial procedure involves the placement of the expander. Gradually the desired size will be reached during the expansion process. The seconds or definitive reconstruction will depend on the type of reconstruction decided upon. Please see appropriate informative note. The nipple and areola may be reconstructed at the second stage or at a delayed third stage. Delaying the nipple areola reconstruction allows the breast to settle in the correct shape and allow for a more correct positioning of the nipple areola.