evolution laser and rejuvenation centre
Dr Tim Sproule

Plastic Surgery - Tissue Expansion Surgery

You may remember reading or hearing about a little Texas girl who suffered multiple injuries when she was trapped in a well for more than three days. An injury to her forehead occurred when her foot wedged against her skin during her fall and remained there the entire time she was in the well.
When she was rescued and hospitalized for treatment, plastic surgery teams were called to the scene to perform a relatively simple procedure to repair the damaged skin. Using tissue expansion, the surgeons created more skin to cover the defect.
In the not-too-distant past, the girl's doctors would have transplanted healthy skin from another part of her body to the damaged area. Unfortunately, that procedure sometimes left unsightly scars in both donor and recipient areas.

In addition, there was often a visible difference in colour, texture and thickness between the transplanted and surrounding skin. Tissue expansion solves those problems by allowing plastic surgeons to "grow" new skin from an area nearby, or to stretch adjacent, healthy skin. Tissue expansion was first used to reconstruct breasts following mastectomy. Today, its use has expanded to include repair of skin damaged by birth defects, trauma or tumor removal. Sometimes, it is used for aesthetic purposes such as breast enlargement or hair replacement.

When larger defects are involved, tissue expansion is a multi-step process. A silicone balloon is implanted beneath the skin, usually adjacent to the area to be repaired. The balloon is gradually filled with saline solution over a period of weeks or months, during which the body responds in several ways. First, some evidence indicates the outermost layer of skin thickens as the cells multiply in reaction to the pressure. At the same time, the underlying layer of connective tissue thins as it is squeezed between the outer layer of skin and the expanding balloon. The body forms a membrane of scar tissue around the expander, adding to the look of fullness.

When the skin is expanded to the desired degree, the balloon is removed, along with any deformed tissue. Then, the new skin is positioned and sutured into place, covering both the defect and the area from which the tissue is generated so that both look normal. Finally, about five months after the expander is removed, the outer layer of skin thins, the layer beneath it thickens, and the capsule of scar tissue dissolves, returning the body to its previous state, but with additional healthy skin. A quicker, more immediate form of tissue expansion may be used when the area of skin to be replaced is relatively small. In this case, healthy tissue can be expanded immediately, while the patient is still in the operating room. This intra-operative method stretches existing skin instead of creating new tissue, as is possible with the longer, gradual process described above. However, the result is the same: enough healthy tissue to cover the defective area. Dr. Sproule will determine which procedure is appropriate for you.

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