A tissue expander is an empty implant that a surgeon places under the skin in a procedure called tissue expansion. Over time, a healthcare professional gradually fills it with saline or carbon dioxide through a self-sealing valve to stretch the skin and cause it to grow.

Healthcare professionals commonly use tissue expanders as a tool in breast reconstruction surgery. However, depending on a person’s need, a surgeon can place the implant or implants in other parts of the body.

This article discusses what a tissue expander is, how it works, and the risks. It also looks at the procedure in more detail, including preparation and recovery.

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Tissue expanders are temporary, empty implants. A surgeon will place these implants under the skin and fill them slowly over time with saline or carbon dioxide.

The expander has a self-sealing valve, making it possible to fill it gradually.

A person will need to make appointments every 1–2 weeks for a few months. The total duration of the treatment will vary depending on the part of the body in which a surgeon has placed the tissue expander.

However, it can take 2–6 months to stretch the skin enough for breast reconstruction surgery.

The surface of tissue expanders can be textured or smooth. People using them for breast reconstruction purposes may wish to talk with a surgeon about opting for a smooth surface tissue expander.

The reason for this is that the use of a textured surface tissue expander can very slightly increase a person’s risk of developing breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).

BIA-ALCL is a rare type of lymphoma that develops in the scar tissue and fluid that surrounds a breast implant. It is curable in most cases if a person receives an early diagnosis.

Research from 2020 also notes that textured surface tissue expanders can increase the chance of bacterial contamination. The researchers found that smooth surface tissue expanders are a safe alternative to textured surface tissue expanders.

The American Society of Plastic Surgeons (ASPS) explains that people may require tissue expanders to grow extra skin, most commonly for breast reconstruction surgery following a mastectomy.

Surgeons can also use tissue expansion for repairing skin that has sustained damage as a result of:

  • accidents
  • surgery
  • congenital anomalies
  • cosmetic procedures

The reason for needing a tissue expander will determine where a surgeon places it. For instance, if skin cancer or a wound has produced a bald area on the head, the surgeon may use a tissue expander to stretch the hair-bearing skin on the scalp.

In other cases, a surgeon may place tissue expanders on the limbs or torso to reconstruct a wound or repair an abnormality.

A surgeon will provide specific instructions on how to prepare for the procedure. They will provide guidance on what a person can eat or drink and what medications they should take or avoid.

If a person smokes, they may need to quit for at least 2 weeks before and after the surgery because this habit can impair wound healing.

The instructions will vary based on:

  • the purpose of the procedure
  • when a surgeon will perform the procedure in relation to other procedures a person requires, such as a mastectomy
  • whether the surgery will take place in an outpatient center or a hospital
  • the type of anesthesia a person requires

A person should also organize for someone to drive them home afterward.

The process of inserting a tissue expander will vary among individuals based on the need for tissue expansion. It will also depend on when it takes place in relation to other procedures.

If a person is undergoing immediate breast reconstruction, a surgeon may put the tissue expanders in place at the same time as performing the mastectomy.

If the procedure is occurring separately from the mastectomy, the surgery will usually last 1–2 hours.

During this time, a surgeon will create a pocket beneath the skin or the muscle and insert the silicone balloon expander into it.

The individual will need a follow-up appointment to remove the bandages from the incisions and, in some cases, the sutures. Some people may also require a drainage tube after the surgery, which the healthcare team will explain how to care for and drain.

Once the initial incision heals, a person will visit the surgeon’s office periodically. During these visits, the surgeon will partially fill the expanders by inserting saline or carbon dioxide into the valve.

As the expanders fill, they will stretch the skin and cause new skin to grow. During this time, a person may experience some discomfort and pain.

The recovery time will vary from person to person based on the extensiveness of the procedure.

If a person undergoes separate breast removal and tissue expansion procedures, they can expect to return to their normal activities within a few weeks of getting the expanders. However, it might be 4–6 weeks before they can perform more strenuous activities.

Following the removal of the expanders, most people can expect to begin light activity within a week of the surgery.

A person should discuss with their doctor what to expect while recovering from the surgery. They should follow the doctor’s instructions on how to manage pain following both surgeries.

According to the ASPS, a person can expect to experience temporary discomfort each time the surgeon fills the expander. The discomfort should lessen within 2 hours.

Between fills, a person may experience soreness similar to the type of soreness that can occur after working out. They can lessen the discomfort by:

  • taking warm showers
  • using over-the-counter pain medication, such as ibuprofen or acetaminophen
  • wearing a soft, supportive bra
  • doing any stretches or exercises that a doctor recommends
  • using a gentle moisturizer on the area without applying it directly to the incision

A person should speak with a doctor about what to expect between fills and how to manage any discomfort.

After the expanders reach the predetermined size, a person will need a second procedure to remove them.

For breast reconstruction, this surgery is generally relatively straightforward and involves replacing the expanders with implants. In other cases, such as repairing the skin on the face or scalp, the second surgery may be more complex.

As with any other medical procedure, there are benefits and risks.

The advantages of tissue expansion include the following:

  • It offers a near-perfect skin color match.
  • There is less chance of the tissue dying, as it remains connected to the person’s blood and nerve supply.
  • The scars are less apparent, as the surgeon does not have to remove the skin from one part of the body and attach it to another.

The main concern regarding using a tissue expander is that it may leak while it is inside the body. However, if this does occur, the body will absorb the saline, which is harmless. A surgeon will then replace the tissue expander.

There is also a chance of infection, particularly a few weeks after the initial surgery. In these cases, a surgeon may remove the tissue expander and replace it once the infection clears.

There are also other disadvantages that a person may wish to consider. Firstly, the entire process can take 3–4 months, and it requires multiple trips to get saline or carbon dioxide injections.

Secondly, during this time, the tissue expander causes a bulge. Although this may be less of a concern in relation to breast reconstruction surgery, it can be very noticeable on other areas of the body.

A person should contact a doctor if they notice any signs of infection or they think their expanders may have leaked.

Signs of infection include:

  • fever
  • a foul or strong smell from the incision site
  • warmth or discoloration near the expansion site
  • swelling
  • severe bruising

A surgeon inserts tissue expanders to help the skin stretch and cause new skin to grow. The procedure is very common in breast reconstructive surgery. However, a surgeon can also use expanders to grow tissue to repair damage to the skin in other parts of the body.

During the initial procedure, a doctor will insert a tissue expander. Once the skin has healed, a person will then visit a doctor, who will inject saline or carbon dioxide into the expanders over several months.

As the expanders fill, new skin will grow, and the existing skin will stretch. When the skin covers a large enough area, a surgeon will remove the expanders through a second surgery.

If a person is undergoing breast reconstruction surgery, a surgeon will insert permanent breast implants at this point.