The Role of Tissue Expanders in Implant Reconstruction

A mastectomy normally removes a variable amount of breast skin with the nipple. The amount removed depends on tumor size and also on the location of the biopsy scar. The skin circulation and its healing ability are also compromised by mastectomy. Both of these factors prevent the immediate placement of a permanent implant at the time of mastectomy in virtually all patients. Tissue expansion is a process that replaces the missing skin in preparation for placement of a permanent implant later.

A tissue expander is an inflatable plastic bag that is inserted into a pocket under the skin and muscle of the chest (Fig. 14-1). It is similar in construction to a saline implant but the shape is different, it has an adjustable capacity, and it contains a metal port for fluid injection. The expander is usually placed in its collapsed form at the time of mastectomy (immediate reconstruction) or any time after mastectomy (delayed reconstruction). Beginning about 2 weeks after placement, fluid is introduced by needle into the tissue expander to partially inflate it. This is repeated during weekly office visits to gradually expand the skin of the chest. Expansion is completed in approximately 8 weeks. Four weeks are then allowed for the skin to stabilize and loosen. After this time the tissue expander is replaced with an implant as a separate surgical procedure. If needed, an augmentation, a reduction, or a lift of the opposite side is usually performed at the same time.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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