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What is 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 and grow. Although tissue expansion is most commonly used for breast reconstruction, craniofacial surgeons use tissue expansion to repair skin damaged by congenital anomalies, accidents or surgery.

Almost anyone in need of additional skin can benefit from tissue expansion, from infants to elderly men and women. It is an option for repairing or replacing areas of the scalp, where hair growth makes it difficult to replace lost tissue with skin from other areas of the body. Tissue expansion generally produces excellent results when reconstructing some areas of the face and neck. If the affected area is severely damaged or scarred, expansion is probably not an option, since healthy skin is the first requirement.

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 does not 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 grow 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 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 salt water that inflates the balloon. For some people, the inconvenience and obvious appearance of an expander are enough for them to consider other options.

Risks and complications Skin expansion can produce some remarkable results. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure. The most common concern is that the silicone expander used in the procedure will break or leak while it is in the body. While expanders are rigorously tested and placed with care, leaks do occur. If the expander should leak, the salt-water solution, also known as saline, used to fill the expander is harmlessly absorbed by your system and the expander is 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. In some cases, the expander may need to be removed for several months until the infection clears. A new expander can then be inserted.

Treatment TREATMENT & MANAGEMENT

During your initial consultation, your surgeon will evaluate your condition. Your age, skin condition, medical history and other factors will help determine if you will benefit from tissue expansion. Your flexibility and tolerance for the inconvenience associated with this procedure will help you determine if you want to pursue it.

In most cases, the initial operation will take one to two hours, depending on the size and area of skin to be expanded. The surgeon will begin by making a small incision next to the area of skin to be repaired, and will do everything possible to make the incision as inconspicuous as possible. She will then insert the silicone balloon expander in a pocket created beneath the skin. The expander includes a tiny tube and a self-sealing valve that allows her to gradually fill the expander with saline solution. The valve is usually left just beneath the surface of the skin.

Once the incision has healed, you will be asked to return to the office periodically so that the expander can be injected with additional saline. As the expander enlarges, your skin will stretch. In some people, this procedure causes some minor discomfort.

When the skin has stretched enough to cover the affected area, you will have a second operation to remove the expander and reposition the new tissue. More complex surgery to repair skin on the face or scalp will take longer, and may require more than one expansion sequence to complete.

How you feel after surgery depends on the extent and complexity of the procedure. The initial surgery to insert the expander causes most patients only temporary discomfort which can be controlled with medication.

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.

While most tissue expansion is done in an outpatient surgical facility, the size and location of the expansion, as well as the preference of the patient and surgeon, will dictate where the surgery takes place.

How soon you resume your normal routine depends on the length, complexity and type of surgery you have had. 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.