Tissue Expanders Placement

Tissue expander placement surgery

Tissue expander placement Tissue expander placement is a surgical procedure whereby a balloon-like balloon-shaped device (tissue expander) is placed under the skin and muscle surface in order to enlarge the tissue gradually. This grows enough skin that may be used later to replace or reconstruct an area - usually the breast, scale, or face.

Indications

Tissue expanders are applied to:

• Mastectomy Breast reconstruction.
• Burns or scalp trauma reconstruction.
• Plastic surgery to fix birthmark deformities (e.g. microtia, big nevi)
• Reconstruction of post-traumatic scar or post burn scar.

Surgical Procedure

Preoperative Preparation

• Physical examination, testing blood and x-rays.
• Implant size and reconstruction objectives.
• Marking the surgical site

Anaesthesia

• Usually general anaesthesia
• In other instances, skeletal anaesthetic with sedation could be applied to smaller areas.

Incision and Pocket Creation 

• A minor cut is created in the area close to the place of reconstruction.
• Under the skin and / or muscle (usually the pectoralis major in breast reconstruction) a pocket is formed.

Placement of Expander

• The tissue expander is placed in the pocket.
• It will be linked with a fill port (internal or external) where saline will be injected later.

Closure

• The wound is sewn up and sterile dressed.
• Temporary drains can be installed to avoid the build-up of fluid.

Postoperative Care

• Stay in hospital: 1-2 days (or outpatient in the case of minor cases)
• One should expect pain and swelling initially.
• There is the prescription of antibiotics and pain relievers.
• Debridement (where necessary) is completed within 1-2 weeks.

Expansion Phase

• Starts 2-3 weeks after surgery when healed enough.
• Periodical injections (after every 1-2 weeks) into the fill port with saline are carried out to slowly increase the size of the tissue.
• The procedure can last 6-12 weeks with regard to the size of the target.

Tissue expander breast reconstruction India

Tissue expander breast reconstruction involves a 2 step surgery and involves the reconstruction of the shape of the breast following mastectomy (removal of the breast). The temporary tissue expander is inserted in the initial phase to stretch the skin and muscle of the chest gradually. As soon as sufficient space has been made it is substituted with a permanent breast implant or autologous tissue flap. This is a method that offers a natural appearance and offers the ability to be flexible in terms of size and shape.

Indications

• Reconstruction after breast cancer surgery (post-mastectomy).
• Bilateral breast reconstruction (two breasts).
• Delayed rebuilding (following the previous surgeries or radiation)
• Treatment of congenital chest wall defects.

Procedure

Preoperative Preparation

• Extensive consultation with the plastic surgeon.
• Expander type (saline-filled, magnetic port, or remote port) Choice
• Blood work, imaging and pre-incision planning.

Anaesthesia

• The surgery is carried out by general anaesthesia.

Incision and Placement

• The surgeon uses the previously used mastectomy, or makes a new incision.
• One of the pockets is created beneath the pectoralis major muscle.
• The tissue expanter is installed in the pocket.
• A fill port (external or internal) is added which is to be filled with saline at some point.

Closure

• The wound is sewn with sutures and sterile dressings.
• To avoid accumulation of fluid, a surgical drain can be used.

Postoperative Recovery

• Hospital stay: usually 1–2 days
• Minor pain, edema and tightness are normal.
• Within 1-2 weeks drains are discharged.
• Light activities can be resumed after 2 weeks.

Tissue Expansion Phase

• Post-operative time: After healing (usually 2-3 weeks after surgery):
• The surgeon injections are done slowly, 1-2 times every 1-2 weeks, in sterile saline in the expander.
• This is whereby the skin and muscles are stretched to fit in the final implant.
• The growth takes between 6-12 weeks, on the basis of the required breast size.

Second Stage: Expander to Implant Exchange

• When sufficient growth has been secured:
• The second operation involves the removal of the expander with the insertion of the permanent implant (silicone or saline).
• This is a less invasive and shorter process.

Advantages

• Conserves the natural skin covering following mastectomy.
• Adaptable shapes and sizes of the breast.
• Reduced healing compared to flap-based reconstruction.
• May be performed either immediately or delayed following treatment of cancer.

Factors Affecting Tissue expander surgery cost India

The following are just but some of the critical issues that influence the cost of a breast reconstruction surgery using tissues-expanders in India:

Types of reconstruction techniques

• It could be a two-stage process (expander, followed by implant), or single-stage, direct-to-implant. The addition of a tissue expander introduces a step- and hence a cost. 
• The choice to reconstruct with or without implants (saline/silicone) or autologous tissue/flap-based techniques (which are more expensive to use). 
• The necessity of the further procedures: e.g., nipple-areola reconstruction, fat-grafting, revision surgeries. 

Knowledge of the Surgeon and Availability of Facility

• Top-level plastic/reconstructive surgeons (in the best hospitals) are normally costly. 
• Infrastructure in hospital: high-quality hospitals, accredited centres, superior ICU/ward facilities, increased cost. 

Hospital Location & Category

• Any procedural work that is performed in large metros (Delhi/Gurugram/Mumbai/Bengaluru) is generally more expensive than the other smaller cities. 
• Type of hospital room (private room or shared ward), hospital length of stay, ICU care where necessary. 

Complexity of the Case

• Quantity of tissue required to expand, history of treatments (e.g. radiation), extent of reconstruction (single vs. total breast).
• In case of complications, or poor quality of skin/muscle (more time required by the surgeon or special equipment), it increases cost. 

Cost of devices/Implants and consumables

• The kind of tissue-expand implant used (brand, type, remote port vs simple port) and the quality of the implants.
• Consumables, anaesthesia, operating theatre (OT) time, special instruments.
• Pre-operative research and post-operative treatment (medications, dressing, follow-up visits). 

Timing Immediate vs Delayed Reconstruction

• Figures given above might be possible to minimize hospital days and total expenses by performing immediate reconstruction (at same time as mastectomy). 
• Delayed reconstruction also implies more operations, which increases the expense.

Best hospital for tissue expander placement India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Tissue expander complications and risks

Tissue expander surgery is considered to be generally safe and is commonly used in reconstructive plastic surgery surgery. But, as it means inserting a foreign device under the skin or the muscle, there are complications that may arise (especially in the expansion phase or in patients who have undergone radiation therapy, which have diabetes or poor wound healing).

Postoperative Complications during the Early Days (The First Few Weeks):

Infection

• Description: Most frequent complication.
• Etiology: Perioperative contamination, wound healing failure or stagnation of fluid.
• Symptoms: The symptom of the area around the surgical site may be redness, warmth, fever, pus, or pain.

Management:

• Mild cases → antibiotics.
• Severe cases: Surgical drainage or remove expander.

Hematoma or Seroma

• Description The build-up of blood (hematoma) or fluid (seroma) around the expander.
• Symptoms: Asymmetry, swelling, pain.
• Treatment: Surgical surgery or draining with a syringe.

Wound Dehiscence/Skin necrosis

• Definition: Rupture of skin or incision as a result of tension or insufficiency of blood circulation.
• Risk factors: Flap skin gets thin following mastectomy, radiation therapy, and infection.
• Treatment: Local wound care or surgical revision; extremes, expender removal.

Difficulties throughout the Expansion Phase:

Pain or Tightness

• Description: Each saline fill is commonly followed by the stretching of tissues.
• Treatment: NSAIDs, reduced rate of growth, hot packs.

Expander Exposure

• Description: Skin above expander gets thin resulting in the exposure of the device.
• Causes: Over-expansion, infection, or poor healing.
• Management: Immediate assessment — usually necessitates taking out or changing.

Leakage or Rupture

• Description: The leak of saline as a result of the break on the expander shell or port.
• Findings: Volume and asymmetry loss.
• Management: Surgical replacement.

Port Problems

• Condition: Problems with accessing / locating the injection port (internal or remote).
• Reasons: Port migration, blockage or flipping beneath the skin.
• Treatment Imaging-guided saline fills or surgical repositioning.

Long-Term or Late Complications:

Capsular Contracture

• Description: Geographical development of narrow tight, fibrous scar tissue around the expander or implant.
• Symptoms: Hardness, deformity, or pain of the reconstructed breast.
• Treatment: Capsulotomy (scar release) or implant replacement.

Asymmetry or Unsatisfactory Form

• Description: Asymmetrical growth or shape abnormalities on the breasts.
• Management: Further growth, re-excision or lipo-fat grafting to enhance contour.

Expander Malposition or Migration

• Description: The expander moves out of position, deforming.
• Treatment: plastic surgery or revision surgery.

Delayed Cosmetic Recovery or Surgical Disfigurement

• Description: This is particularly seen in patients who have received radiation therapy previously, are smokers or have poor skin quality.
• Treatment: Wound Care, Wound Delay, or Tissue Flap Reconstruction.

Systemic or Uncommon Complications

• Allergy to implant material (extremely rare)
• Surgical risks (e.g., nausea, dizziness) associated with general anaesthesia.
• Incision site pigment or scarring.
• Mental suffering or unhappiness with the cosmetic outcome.

Conclusion

Tissue expander breast reconstruction is a simple, reliable, and popular way of the restoration of the breast shape in case of mastectomy or loss of a good part of the tissue. It enables surgeons to produce a natural contour by stretching the skin and muscle beneath it thereby maintaining integrity of tissue. Though the process consists of two phases, which include the placement of the expander and the replacement of the implants, it provides customizability in terms of size and symmetry, and thus, it is a favorite choice among most patients. Altogether, the tissue expander breast reconstruction may offer great cosmetically outcomes, great patient satisfaction, and better quality of life when properly planned and followed.

Tissue Expanders Placement in India with GetWellGo

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• Complete transparency
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• Expert plastic surgeon/cosmetic surgeon with a strong track record of success
• Assistance during and after the course of treatment.
• Language Support
• Travel and Accommodation Services
• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
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FAQ

What is the duration of stay of the tissue expander in the body?

• Generally, 3-6 months, which relies on the rate of tissue growth, and the size of the breast one wants. Once this is removed, the procedure is preceded with a permanent implant or tissue flap.

Is the process of expansion painful?

• Each saline fill should be followed by mild to moderate tightness or pressure. The pain typically resolves in a day and could be treated using prescribed pain killers.

Is it possible to do tissue expansion following radiation therapy?

• Yes, however, it can grow at a slower pace and is associated with an increased risk of complications including skin thinning or slow healing. The schedule will be adjusted to meet your surgeon.

Does the tissue expander show under the skin?

• The expander can be minimally felt during expansion phase. The contour of the breast looks like a natural one after exchange of the implants.

Is it possible to resume normal activities during expansion?

• Daily activities are generally permitted and vigorous exercise or straining the chest area should be avoided until complete healing can be done.

Can it reconstruct the nipple?

• Yes, nipple-areola reconstruction is generally done when the last implant is placed.

How long do the results last?

• Careful and subsequent attention can lead to successful final breast reconstruction with lasting and natural appearance, which may last many years.