EXPANDERS AND SILICONE

Breast reconstructions with expanders

Formerly, cancerologists always conducted very extensive and radical amputations.

Today mastologists (cancer specialists working only in breast diseases) already carry out more economical removals in certain cases due to the precision of diagnoses and earlier diagnosis of the disease. In these cases, in spite of the mastologist removing the entire breast, the plastic surgeon can opt for an immediate or late reconstruction with an expander when good skin coverage and fat remains on the area treated.

What is an expander?

It is a small “plastic pouch” (of silicone), hollow, linked by a fine tube to a valve (the size of a large coin). This assemblage is placed into the area where the skin needs to be “stretched” (expanded).

Once placed under the skin and fat of the area of the reconstruction and the scars are consolidated, expansion begins: a needle injects saline solution inside the valve (that is under the skin and is palpable) until the skin is tense.

These sessions are repeated every 3 or 4 days, a time necessary for the skin to relax (already slightly expanded), until the expander is completely filled and maximum expansion is reached.

At each injection the expander gradually stretches the skin and it has been confirmed that the “stretched” skin multiplies itself at a cellular level.

We find an example of this in nature itself, when mothers, after pregnancies, have their abdominal skin “stretched out” to the point of being flaccid and redundant.

Reconstruction of the aortic-nipple complex: The areola can be reconstructed using the donor area – the inner skin of the thighs, and the nipple part of the contralateral nipple.

 

Well then: we induce a “pregnancy” under the skin we wish to expand, stretch it out, in short, “gain” tissue.

After removing the expander when the ideal filling is reached (60 to 90 days after starting the expansion), the skin of the area will be definitively stretched and flaccid.

At this time the expander is substituted by a definitive silicone implant.

The skin, that before was tight and tense and would not hold any implant under it, can now support a 300, 400, 600 ml implant or more, depending of each case.

The second operative session for complex treatment of the areolo-mammilary (CAM) follows the same pattern previously explained in other reconstruction techniques.