Patient-controlled expansion: applying a new technique to breast reconstruction.

Tissue expansion has been used as a technique to increase the amount of skin (and/or soft tissues) available for closing a defect or reconstructing an anatomic unit. Although the technique has undergone many modifications, the basic principles have remained more or less constant. The shortcomings of tissue expansion have remained unsolved for many years, namely, long periods of expansion with concomitant abnormal appearance with increased risk of complications over this extended period. Decreasing the expansion period would significantly contribute to patient convenience, decreased costs, and improved acceptance of the technique. This would need to be done within a background of safety without compromise to the reconstructive effort. With minor modification to the existing tissue expanders and their attachments together with modified patient-controlled infusion devices, a new method has been devised for tissue expansion in which the patient can control and expedite the entire process. As "proof of concept," 10 patients were selected for this trial. All had undergone mastectomies without concomitant radiotherapy. Successful full expansion, beginning the day after surgery, was achieved in all cases in approximately 3 weeks with minimal complications. Patent pending design modifications have been made that expedite the process, making it easier, more efficient, and cheaper to achieve full expansion. Although the numbers in this series were small, proof of concept was achieved, and trials are ongoing with increasing numbers expected. The concept is applicable to all forms of tissue expansion, including aesthetic indications such as hair restoration, tubular breast correction, and the like.