Tissue expansion, stretching of the skin

Tissue expansion is a method used in plastic surgery. This allows scar tissue, an old tattoo, skin defects and very hairy skin to be treated. Tissue expansion is also used after a mastectomy. In this case we call it a breast reconstruction. A tissue stretcher or tissue expander is used. This is a balloon that is placed under the skin. The balloon is then frequently filled with a saline solution. This stretches the skin over a period of several weeks to several months.

What is a tissue expansion?

During tissue expansion, the skin is stretched to allow a skin defect to close properly. In this way, a scar is prevented or scars are moved so that they are not visible. Tissue expansion is also used to create a breast when a breast has been amputated. Sometimes tissue expansion is used to remove tattoos. The skin can also be stretched to create extra skin, with the aim of a skin transplant. Scar tissue after amputation can also be treated well with tissue expansion. In addition, tissue expansion can be used to treat heavily hairy areas such as Tierfell nevus (a heavily hairy birthmark) or werewolf syndrome. Tissue expansion falls under plastic surgery.

Tissue stretcher, tissue expander

A tissue stretcher or tissue expander is used to stretch the skin. This consists of a plastic balloon that can be filled with liquid through a valve. This causes the balloon to expand and stretches the skin. Of course, the balloon is not filled in one go, as this would cause the skin to tear. Filling is done step by step, often once or twice a week. The balloon is filled with saline solution. We also call this physiological salt.

Operation

The balloon is often applied under anesthesia, but sometimes a local anesthetic is possible. This depends on where the balloon will be placed. An incision is made in the skin, under which the balloon is placed. The balloon is placed right next to the skin defect, so that the overlying skin is sufficiently stretched. The doctor will allow the wounds to heal before starting to fill the balloon, otherwise the wounds will reopen. After the wounds have healed, the balloon is filled with a saline solution. This is done via a needle that is inserted into the filling opening. The filling opening is located under the skin. The valve can also be connected to a tube that is above the skin. Admission to the balloon often requires hospitalization. This lasts from several days to a week, depending on the area to be treated and the wound healing.

How long does it take?

Inflating the balloon is not possible in one go: this would cause the skin to stretch too quickly and tear. On average, the balloon is refilled once or twice a week. Sometimes the frequency is even less. In total, replenishing and stretching the skin takes several weeks, often two to four months. The skin is then sufficiently stretched and the balloon is surgically removed. In certain cases the balloon remains present, such as with breast reconstruction.

Side effects and results

Significant swelling may be present for several hours after refilling the balloon. This swelling gradually decreases. There may also be some irritation or discomfort to the skin. In general, tissue expansion is well tolerated by most people. However, it may happen that the balloon is no longer well tolerated. The tissue expansion must then be stopped prematurely. In some cases the balloon will leak. It is then necessary to remove the balloon. This one can’t stay put! In these cases the entire treatment will have to be performed again.

The result is often satisfactory. But as with all other treatments, the results can be disappointing or take an unexpected turn. The skin can tear, bleeding can occur or tissue can die. An infection can also develop. Sometimes it is necessary to start a second treatment. In other cases, additional scars will form. There will also always be scars left behind that cannot be treated.

Reimbursement by the health insurer

In cases where there is a medical necessity, tissue expansion is reimbursed by the health insurer. In the case of tattoo removal, there is often no medical necessity. The costs for tissue expansion can therefore be fully or partially borne by the patient himself. Please inquire in advance about the costs and reimbursements. In the case of breast reconstruction, scar treatment or medical skin transplantation, the costs will be fully reimbursed.