The permanent tissue expander.

The permanent tissue expander has many advantages over a fixed-volume implant. Chest-wall skin can be expanded, enabling safe reconstruction of an aesthetically pleasing breast without the use of flaps. Excessive pressure on compromised skin flaps is avoided, and larger breasts can be achieved postoperatively by staged expansion. It appears that early capsular contracture can be treated by overexpansion of the implant and subsequent removal of saline to decrease the pressure. A second operative procedure to change an implant that is too small is unnecessary, and greater symmetry of the breasts can be obtained by adjusting the volume of the implant postoperatively. The expander has proven to be of great benefit in augmentation mammaplasty, the creation of symmetric breasts that are of a size and shape that completely satisfies the patient's demands. This is facilitated by the use of an implant that permits the patient and surgeon to effect expansion and volume adjustments. The patient can be more confident that her conception of an acceptable physical appearance will be realized, and the surgeon can thus decrease the incidence of patient disappointment. The implant has been used to reconstruct breasts following mastectomy (secondary reconstruction), at the time of mastectomy (primary reconstruction), following subcutaneous mastectomy, in Poland's syndrome, in breast augmentation, and even in buttocks asymmetry.