What is Tissue Expansion?

Tissue expansion is a technique used to encourage the body to grow new skin for use in reconstructive surgery. There are a number of advantages to tissue expansion, including reduced risk of graft rejection, along with better color and hair growth matching. The primary disadvantage is that the procedure requires the creation of a visible bulge and the patient may have to wait several months before the reconstructive surgery can be performed. This procedure is performed by a plastic surgeon and will require an initial surgery, follow-up appointments, and a reconstructive surgery.

In the original tissue expansion procedure, the surgeon inserts an inflatable balloon under the skin. The balloon is positioned at or near the area being targeted for reconstructive surgery, such as under a mastectomy for a breast cancer patient, or in the scalp for a patient who has lost part of the scalp to burn injuries. The patient may be given local or general anesthesia for the procedure.

During a series of follow up appointments, water will be injected into the balloon. As the balloon swells, it puts pressure on the skin, promoting the growth of new skin cells. Essentially, the patient is growing a skin graft. Once enough skin has been grown, the surgeon can schedule a reconstructive surgery. The balloon will be removed and the skin will be used to replace damaged or missing skin. In the case of a surgery like breast reconstruction after mastectomy, the expanded skin will be used to create a new breast with a permanent breast implant to help the breast hold its shape.

All surgeries carry some risks. With tissue expansion, it is possible to experience inflammation or infection around the balloon, especially in the first few weeks. In some cases, the balloon ruptures. The sterile saline inside will be absorbed by the body, but another surgery will be needed to remove the balloon and insert a new one.

Using skin grown with a tissue expansion technique can result in better reconstructive surgery outcomes. The skin grown on the patient's body will more closely match the skin around the surgical site, making the reconstruction less visible after healing. In addition, the newly grown skin will be able to produce hair to match the surrounding skin, allowing to blend in more naturally. The ability to grow hair can be especially important for reconstructive surgery on the scalp.

The main drawback to tissue expansion is that the patient will have to walk around for several months with a silicone balloon full of water under the skin. For a mastectomy patient, this may not be a problem, as the balloon will mimic the natural shape of the breast and make the mastectomy less visible. For someone undergoing tissue expansion on a location like the face or arm, the balloon can attract negative attention.