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Reconstruction with Tissue Expanders and Silicone Prosthesis

Reconstruction with tissue expander and prosthesis is a technique commonly used to restore the breast. In this method, after an oncological surgeon completes mastectomy, a tissue expander- an inflatable balloon- is implanted under the pectoralis muscle (the large muscle under the breast). Since mastectomy reduces the circulation of the breast skin and removes a significant amount of the breast skin and nipple, it would not be possible to implant a permanent prosthesis during mastectomy. Therefore, tissue expansion and skin enlargement should be performed to replace the missing skin, so that this space caused by this can then be replaced with a permanent prosthesis. Although this method is usually performed simultaneously with mastectomy, it can also be performed for patients who have previously undergone mastectomy and have not undergone reconstruction.

 

The tissue expander is implanted under the pectoralis muscle and inflated.

The surgery is performed under general anaesthesia and takes about 1 hour. The inflation of the tissue expander is started 2 weeks after surgery (to give it time to heal) under operating room conditions and takes 6-10 weeks depending on the expansion ratio of your skin. In general, the tissue expander is inflated with a 30% larger volume to compensate for the normal reduction seen on the skin after the permanent prosthesis of the suitable size is implanted. The implantation of permanent silicone prosthesis is usually performed after the completion of chemotherapy and radiotherapy. If no add-on-therapy will be given, the permanent prosthesis is implanted 2-3 months after the last inflation. Operations for equalization with the other breast (for example, breast lift or breast reduction) can be performed at this stage. Finally, reconstruction of the nipple and areola is performed under local anaesthesia to complete the process. In other words, reconstruction with tissue expander and prosthesis requires a total of 3 separated operations.

The ideal patient for reconstruction with tissue expander and prosthesis is a weak female patient who does not have too much sag in the other breast and who does not need postoperative radiotherapy. For patients with a history of radiotherapy to the breast, tissue expanders and prosthetic applications are a relative contraindication since irradiated skin and muscle may not expand in sufficient amount.

In this technique, there are risks such as infection and migration of tissue expander out of the skin.