Introduction
Tissue expansion surgery is one of the most commonly preferred surgeries performed in case of breast reconstruction. This procedure aims to enable new and healthy tissue growth by not using supplementary grafts but rather aiming for cell generation. Before the invasion of tissue expansion surgery, surgeries were performed by harvesting tissue flaps from a donor site and replacing them on the damaged site. But tissue expansion surgery aims at a slow progressive tissue culture or growth. This procedure is chosen for all parts of the body, giving the surgeons the space to repair both the defects that occurred due to trauma as well as those during birth.
However, tissue expansion surgery is most commonly preferred in cases of breast reconstruction, which is done as a follow-up after removing the damaged breasts due to cancers or damage of the breasts due to trauma defects or burn injuries. Earlier, tissue expansion surgery was performed in the year 1905, followed by 1908, and later in the year 1921, where sustained tissue traction and regrowth were achieved up to eight to ten centimeters. Later, this procedure became a very innovative surgical technique in the field of reconstructive surgery and has been in practice until today.
However, although tissue reconstruction surgery is a highly beneficial surgery, the completion of the surgery, along with its entire outcome, often requires a period of three to six months. Because the reconstruction aims at the natural healing process of the body, which occurs in the form of secondary healing, it takes its own time for the cells to form, multiply, mature, and fill in, making the affected area look aesthetically appealing for the person seeking it.
How Is Tissue Reconstruction Surgery Performed?
Tissue reconstruction surgery is done by preparing the surgery site initially. This is followed by placing a balloon-shaped expander beneath the skin that is damaged, which, over the period, gets filled and expanded with saline, causing the skin to stretch, elongate, and grow to the desired level and site. The balloon expands and then is removed once the desired size is achieved. This is also characterized by the replacement of the new skin, redistributed over the surface of the damaged skin surface area.
Whereas here, tissue expansion of the breast post-mastectomy is done in two stages, namely, immediate and delayed surgery. During all these procedures, the surgery is done by expanding the affected area using expanders and slowly placing the breast implants (saline implants) to accommodate the desired surface area, recreating the structure of the breast.
When Is Tissue Reconstruction Surgery Indicated?
Tissue expansion surgery is recommended in places of reconstruction with greater damage affecting esthetically or functionally. The sites that show a greater response to tissue reconstruction surgery are the neck, face, arms, legs, and hands, where the outcome is considered excellent. Because tissue reconstruction mainly aims at the replacement and evolution of new healthy tissues, it does not aim at expansion alone, especially in acres with severe damage or scarring. This procedure is also considered an adjunct to other rehabilitative procedures like the placement of skin grafts or flaps. As the damaged skin portion is still in contact with the skin, unlike grafting or flap surgery, there is an unaltered blood and nerve supply, which gives superior outcomes.
Tissue expansion surgery also minimizes surgical complications like graft rejection or skin necrosis (skin death). The new skin that is growing seems to be healthy and is a replica of the lost tissue, resembling its shape, form, texture, and color. Any scar formed while performing the surgery is scarcely visible and aesthetically manageable. However, it is crucial to discuss the importance of the surgery with the patients and let them know the approximation of the surgery, its benefits, postoperative complications, and care before performing the surgery.
What Are the Indications for the Expanders Used?
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Although the expanders are easy to use, certain specifications have to be met.
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The areas of insertion of the expanders and the incision site should be planned before the surgery.
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The level of incision and its size depends on the instrument to be placed, and the approximated incision levels are generally around three to five centimeters.
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The expanders are left for up to two weeks and then later removed once the stretch level is achieved.
What Are the Complications After a Tissue Reconstruction Surgery?
Although tissue reconstruction and expansion surgery is a very favorable one, like every other surgery, it has its potential complications, and they are:
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Cellulitis - Cellulitis is a clinical condition characterized by the accumulation of fluid in between the intestinal tissues of the skin.
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Skin infections - Due to any infection-causing bacteria.
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Disclosure of the balloon expander placed beneath the skin.
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Deflation of the expander balloon placed in the surgical site.
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Necrosis of the skin in the site of desired expansion.
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Ischemia of the skin overlying the defective surface.
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Hematoma - Hematoma is a clinical condition characterized by the formation of blood clots in the tissue or at the vessels supplying the surgical site. This may be seen as an acute reaction, which, over some time, gradually settles down.
Conclusion
Loss of tissue post-breast surgery can greatly affect the confidence of a woman. In order to overcome this scenario, reconstruction of the breast post-mastectomy (breast removal surgery) is highly crucial, as it helps in reducing the post-surgical trauma, mentally providing them with both esthetic and psychosocial wellness. This being said, it also indicates reconstruction of the breast is considered a necessary procedure and not just an esthetic correction. Almost sixty-five percent of the women prefer choosing breast reconstruction surgery, and tissue expansion has greatly helped them. Although various methods are available, like implant placement and graft, this particular surgical procedure greatly helps and benefits the patient with a more natural-looking breast with very minimal complications. This tissue expansion surgery of the breast, on the other hand, is considered to be very safe and reliable with its surgical techniques and is also highly cost-effective. Tissue expansion surgery can also be performed in women with associated comorbidities, helping them along with short working or surgical time and quick recovery, and does not indicate the need for a donor when compared to other breast reconstruction surgeries.
