3- Expanders

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The anterior thoracic region allows an efficient use of the skin expanders thanks to the rigid support surface, formed by the rib cage. The constant force applied to the skin through an expander supported on the ribs is extremely effective.

Tissue expanders are prostheses with a silicone elastomer wrap that are gradually filled with saline solution. They are classified according to their shape in semilunar, round or anatomical. The texture can be smooth or textured, and the valve remote, or included in the prosthesis itself.

In principle, tissue expansion is indicated for all mastectomized patients who have adequate muscle coverage and an insufficient amount of skin to accommodate a definitive implant. It is usually wrapped with a Vicryl matrix.  or acellular dermal. These matrices can be of animal origin or even human tissue, fortunately the technology has advanced to the point that acellular dermal matrices (ADM) are applied during surgical procedures in areas where tissue loss has occurred, allowing a regeneration of the remaining tissue, its revascularization and also supporting the region, with low risk of eventual complications. Over the months, due to the coverage of the desired region, the ADM has a biological behavior and function similar to the recovered tissues.

Reconstructions with expanders require two surgical steps. In the first stage, the expander is inserted into the submuscular pocket, which can be total, when formed by the pectoralis major and serratus muscles, or partial, when covered only by the pectoralis major muscle. When partial, the mastectomy flap must be thick enough to ensure good coverage in the lateral region of the prosthesis and, consequently, reduce the chances of extrusion.

The valve, when remote, must remain in the subcutaneous tissue of the axillary region, thoracic lateral wall or over the sternum, in order to facilitate the puncture and expansion in the postoperative period. In the included valves, there is a magnet system, which facilitates the identification and correct puncture of the valve.

In the second stage, the expander is exchanged for a definitive implant and any asymmetries are corrected. Capsulectomy (capsule removal), fat grafts (lipophiling) and contralateral breast symmetrization can be performed together at this stage.

  In breast reconstructions, the expanders usually used are anatomically shaped and the expander base corresponds to the original breast base. An overexpansion of 15-20% in the final volume of the expander must be taken into account, for a more significant gain in tissue, especially in the lower pole.

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                                          Expander with valve included

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                                       Lipofilling or fat grafting