When you are dealing with breast cancer, it may seem like there is a never ending barrage of new terms, techniques, and options that you need to learn about. For example, had you ever even heard of tissue expanders before your breast cancer diagnosis? Perhaps you still haven’t, but as tissue expanders are a very common medical device used during breast reconstruction, now is a good time to become familiar with them.
Tissue expanders are used for women who are undergoing staged or delayed reconstruction. Tissue expanders exist to solve a common problem: what do you do when after all the cancer is removed, the woman no longer has enough room in her skin or chest wall for a reconstructed breast? The answer: tissue expanders.
When women require staged reconstruction (this most frequently occurs when the woman’s skin and chest wall do not have a large enough pocket for an implant), a temporary tissue expander is used to gradually stretch the skin and chest muscle to the proper size for breast reconstruction and maintain that space during any other treatments. The surgeon later removes the tissue expanders and fills the newly created pocket with a breast implant or tissue from another area of the body.
That’s the simplified version. However, there are several more considerations and even a handful of different kinds of tissue expanders. So, let’s delve a bit deeper into what exactly tissue expanders are and what types are available.
What Do Tissue Expanders Do?
Tissue expanders are temporary, “balloon-like” implants that are placed under the chest skin in the area that is going to be reconstructed. Typically, the surgeon places the expanders under both the skin and muscle. However, using newer techniques, the surgeon might place them only under the skin or under the skin and partially under the muscle. Traditional tissue expanders also require the placement of drainage tubes near the surgical site. These tubes remove any unwanted fluid that may build up around the tissue expander.
Once the surgeon places a tissue expander, its size is gradually increased so that the skin and muscle can slowly stretch. Expansion occurs by injecting a liquid solution into the implant or, in the newest technology, inflating it with air. Depending on the desired size of the breast pocket, it may take anywhere from a few weeks to several months before the process is completed. Depending on the type of tissue expander and the amount of expansion required, a woman might experience anything from minimal discomfort to quite significant pain from the filling process.When the expansion is complete, the surgeon will replace the tissue expander with the final implant.
When Is a Tissue Expander Placed?
Technically, tissue expanders can be placed at any time following a mastectomy. However, the surgeon most often places the expanders at the time of the mastectomy in order to save as much of the woman’s original shape as possible. That being said, one of the benefits of tissue expanders is that they allow many women to have breast reconstruction even multiple years after their initial mastectomy.
What Types of Tissue Expanders Are There?
All types of tissue expanders accomplish the same thing: stretching the breast skin and muscle to prepare for final breast reconstruction. Still, there are a few different options that vary in terms of how the end goal is reached. For simplicity, we will divide the types of tissue expanders into traditional and newer inventions.
Traditional Tissue Expanders
Traditional tissue expanders act like silicone balloons which can be filled with salt water. When the surgeon places traditional tissue expanders, they are often partially filled with some liquid. Then, every week or two, women return to their physician to have more saline solution injected into the implant. The surgeon inserts a needle into a small valve in the tissue expanders under the skin to inject the saline solution Women cannot administer salt water injections themselves, so traditional expanders often require regular visits to the physician’s office just at a time when many women are wanting to move on with their lives and put breast cancer behind them. While this type of tissue expander is the most common type of tissue expander, newer options are beginning to be made available
In recent years, newer inventions have begun to make waves. Perhaps most notably is the AeroForm Tissue Expander System, which is already sold in Australia and is going through FDA trials for the US market. Similar to traditional tissue expanders, the surgeon places the AeroForm system beneath the chest muscle with a small amount of filling. However, there’s no saline solution. Instead, the expander holds a small amount of compressed gas, which then the woman or physician decompresses using a wireless remote. Since the woman can control this wireless device safely at home, she does not have to visit her physician for each expansion. This device continues to make significant waves in the Australian market. Time will tell if/when it becomes available in the States.
There are also several other types of tissue expanders available to offer more ability to control shape, improve appearance, and increase control.
- Mentor Worldwide, LLC, launched the MENTOR ARTOURA Breast Tissue Expander in 2015. The device seeks to offer more controlled pocket formation and more predictable outcomes. It also allows surgeons to better align the tissue expander with each woman’s chest thanks to its fixed footprint.
- Sientra offers the Anatomical Controlled Tissue Expansion (ACX) Matrix line. These tissue expanders come in several shapes, including the double chamber tissue expander, which is the only tissue expander that provides women with the option to fill either one or both chambers to achieve their desired results.
What Can I Expect During My Tissue Expansion?
As we briefly mentioned earlier, tissue expansion does not necessarily mean you will experience significant pain or discomfort. For women undergoing traditional tissue expansion, there is often pain associated with the saline injection. However, for newer expanders, the amount of pain or discomfort women experience is largely dependent on the type of tissue expander, the woman’s desired end breast size, and personal pain tolerance. Many women feel fullness or tightness in the breast area immediately following an expansion. Additionally, some women experience some discomfort in their shoulder and back.
Fortunately, there are plenty of ways you can help alleviate some of the discomfort should you experience it. Warm showers, unscented moisturizers, and upper arm stretches are just a few examples. Beyond these methods, you can wear soft bras instead of underwire bras and looser tops. For a few hours following each expansion, limit your physical activity and get approval from your physician before participating in vigorous exercise or lifting heavy objects. Depending on the specific type of tissue expander you receive, there may be several other limitations and precautions such as not soaking in a hot tub or avoiding MRI scans.
For women getting a tissue expander, make sure to discuss any questions and concerns you may have with your physician. While we can provide you with some basic information about tissue expanders, your physician knows best which options will work for your individual situation.