Tissue expansion is a relatively simple procedure that allows the body to “grow” extra skin for use in reconstruction on almost all parts of the body. A silicone expander balloon is inserted under the skin near the area to be repaired and then gradually filled with saline water over time, causing the skin to stretch and grow. It is most commonly used for breast reconstruction after removal, but it is also used to repair skin damaged by birth defects, accidents, surgery and in some aesthetic procedures.

Virtually anyone who needs additional skin can benefit from tissue expansion, from children to elderly men and women.

The procedure is often used in breast reconstruction when there is not enough skin to accommodate a permanent implant to restore a woman's natural appearance. It is also an option for repairing or replacing areas of the scalp where hair growth makes it difficult to replace lost tissue with skin from other parts of the body. Tissue expansion generally produces excellent results when reconstructing certain areas of the face and neck, hands, arms and legs. Expansion may be more difficult on the back, trunk, or other areas where the skin is thick. If the affected area is severely damaged or scarred, expansion is probably not an option as the first requirement is that the skin is healthy.

Until recently, surgeons were limited to flaps and skin grafts to reconstruct damaged tissue. Tissue expansion, however, offers an additional technique with several advantages. Firstly, the expansion offers an almost perfect combination of color and texture. Secondly, because the skin remains attached to the blood and nerve donor area, there is less risk of necrosis. Furthermore, because it does not have to be moved from one area to another, scars are often less apparent. On the other hand, skin expansion has a significant drawback − the length of time required to grow additional skin. Depending on the area to be reconstructed, tissue expansion can take three to four months. During this time, the expander creates what can be an unsightly bulge − which is desirable in breast reconstruction, but can be quite noticeable to a person needing repair of the scalp or other areas of the body. Furthermore, the procedure requires several visits to the surgeon to inject the saline water that inflates the balloon. For some people, the inconvenient appearance of an expander is enough for them to consider other options.

During your first consultation, the surgeon will evaluate your condition. Your age, skin condition, medical history and other factors will help the surgeon determine whether you will benefit from tissue expansion. Your flexibility and tolerance for the inconvenience associated with this procedure will help you determine whether you want to undergo this procedure. Before proceeding with tissue expansion, discuss your expectations and your understanding of the subject with your surgeon.

Skin expansion can produce some significant results. As with any surgery, however, there are risks associated with the surgery and specific complications associated with this procedure.

The most common concern is that the silicone expander used in the procedure will rupture or leak while it is in the body. The expanders are rigorously tested and placed with great care and safety, however, they may leak. If the expander ruptures, the saline solution used to fill the expander is harmlessly absorbed into the system and the expander is replaced with a relatively minor surgical procedure. A small percentage of patients develop infection around the expander. This situation can occur at any time, but most often it happens a few weeks after insertion of the expander. In some cases, the expander may need to be removed for several months until the infection disappears. A new expander can then be inserted.

Your surgeon will give you specific instructions on how to prepare for surgery, including guidance on eating and drinking, smoking, and taking or avoiding certain medications. If you smoke, your surgeon will probably ask you to stop smoking for at least two weeks before and after surgery, as smoking reduces blood circulation to the skin and prevents healing.

Be sure to ask someone to accompany you to surgery and help you at home if necessary.

The procedure must be carried out in a safe and comfortable place for the doctor and the patient, in a surgical center authorized by the Health Surveillance, with equipment and trained staff for any complications.

The surgeon can begin tissue expansion immediately at the time of breast removal.

The surgeon may use local anesthesia, combined with a sedative to make you drowsy. You will be awake but relaxed, and may feel a little uncomfortable. Your surgeon may recommend using general anesthesia if you prefer to sleep throughout the procedure.

In most cases, the initial surgery takes 1-2 hours, depending on the size and area of ​​skin to be expanded. Your 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 discreet as possible. The surgeon will then insert the silicone expander balloon into a space created under the skin. The expander contains a small tube and a self-sealing valve that allows the surgeon to gradually fill the expander with saline. The valve is usually left just below the surface of the skin.

Once the incision has healed, you will need to return to the surgeon's office periodically so that saline can be injected into the expander. As the expander expands, your skin will stretch. In some people, this procedure may cause discomfort.

When the skin has stretched enough to cover the affected area, you will undergo a second procedure to remove the expander and reposition the new tissue. In breast reconstruction, the surgery required to remove the expander and insert the permanent implant is relatively brief. More complex surgery to repair facial skin and scalp takes more time, and may require more than one expansion sequence to complete.

Tissue expansion is ideal for scalp repair because the stretched skin over the scalp maintains normal hair growth. Most other body tissues do not grow hair at the same rate.

A silicone expander balloon is inserted under the skin. Once installed, the expander is gradually inflated with saline water through a small valve. When the tissue has expanded to the desired size, it is removed. In breast reconstruction, a permanent implant is then placed.

Expansion is also used to repair the skin of the head and neck, hands, arms and legs.

How you feel after surgery will depend on the extent and complexity of the procedure. The initial surgery to insert the expander causes, in most patients, temporary discomfort that can be controlled with medication prescribed by the doctor. There may also be some discomfort when the saline solution is injected into the expander, however, it only lasts 1-2 hours. The procedure to remove the expander and place the new tissue in place may cause temporary discomfort, but is also controlled with medication.

Again, the time it will take for you to return to your normal routine will depend on the extent, complexity and type of surgery you have undergone. For patients who have undergone breast reconstruction, if tissue expansion is separated from breast removal, normal activity can resume in 2-4 days.

Most patients who undergo tissue expansion report that it is possible to return to their normal routine while the expander is still in place. After the second surgery, most patients recover within a week.

In general, the results obtained by tissue expansion are better than the results of other methods used to reconstruct or repair damaged skin. But remember, the goal is to improve, not to achieve perfection. For most patients who undergo tissue expansion, the procedure dramatically improves appearance and quality of life after surgery. If you are physically healthy, psychologically stable, and realistic in your expectations, you will probably be quite pleased with your new appearance.