Full boarded in Plastic and Reconstructive Surgery
Tissue expansion is a method that exploits skin elasticity in order to obtain the required quantity of tissue to reconstruct the area involved. It is done by inserting under the skin a balloon with a valve, which is gradually and periodically inflated with water (saline solution), stretching the overlaying skin.
It is often used in breast reconstruction, but can also be used to correct any kind of defect. This method has many advantages. First and foremost, the possibility to use tissue with identical features to that to be corrected (thickness, colour, hair density, etc.).
The disadvantages arise from the need to undergo two operations and from the difficulties to camouflage the device during the refilling phase. In fact, if in breast reconstruction the priority is the need of the patient, in other types of treatment it could become an important problem in managing everyday personal relations.
All surgical operations carry a minimum of unpredictability and risk
Tissue expansion, like all surgical procedures carries the risk of complications. The most common is that the device can break and the valve could leak the injected fluid. However, this does not carry any danger for the patient's health.
Infection is another complication and may also result in the temporary removal of the expander.
Beginning from the week before the operation, it is advisable not to take any form of aspirin so as to avoid any problems of coagulation, and for smokers to stop smoking for at least 4 weeks (2 before and 2 after the operation).
If the patient suffers from an infection or illness it is advisable to postpone the operation.
The operation is generally carried out in a day-surgery and it is essential that the patient is accompanied by a person who can later take them home and be with them in the first 24-48 hours.
The procedure varies depending on where the expander is localized and can be carried out either in a hospital or outpatients. It can last 1 or 2 hours depending on the expander size and the area to be treated. A small incision is made in the area creating a pocket where the expander is fitted. It can be subcutaneous or submuscular. During the operation, an initial quantity of liquid is injected into the expander through a valve which can be incorporated or connected (by a small tube) to it. After the incision has healed, in the following weeks, in outpatients, the expander is gradually filled until the skin has stretched to its ideal size. The second surgical operation involves the removal of the expander through the original incision and the new skin is redistributed replacing the damaged area of skin.
Instead, in breast reconstruction, the expander is removed after the implanting of a prosthesis.
Either a local or general anaesthesia may be used. The choice depends on the operation to be carried out and is decided case by case.
Post-operation pain obviously depends on the operation carried out, and is kept under control by drug therapy. Where filling is concerned, a temporary and slight discomfort is always present.