Tissue expander placement in breast reconstruction, including subsequent expansion(s)
CPT4 code
Name of the Procedure:
Tissue Expander Placement in Breast Reconstruction
Common name(s): Breast Tissue Expander Insertion
Medical term(s): Breast Reconstruction with Tissue Expander, Breast Expanders
Summary
Tissue expander placement is a surgical procedure used in breast reconstruction. It involves inserting an expandable device under the skin and muscles of the chest, which is gradually filled with saline over time to stretch the tissue and create space for a future breast implant.
Purpose
This procedure addresses breast tissue loss, commonly due to mastectomy (breast removal surgery as part of breast cancer treatment). The goal is to prepare the chest area for a permanent breast implant, restoring the breast's shape and appearance.
Indications
- Patients who have undergone mastectomy
- Those seeking breast reconstruction to restore breast contour
- Patients with sufficient tissue and skin quality to accommodate a tissue expander
Preparation
- Pre-operative consultation and assessment by the surgical team
- Mammogram or other relevant imaging tests
- Discuss any medications you are taking, as some may need adjustment or discontinuation
- Fasting typically required starting midnight before the surgery
- Arrange for post-surgery transportation and support
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: A small incision is made in the chest, usually along the mastectomy scar.
- Placement: The surgeon creates a pocket under the pectoral muscle to place the tissue expander.
- Insertion: The tissue expander, which is initially flat, is positioned in the pocket.
- Closure: The incision is closed with sutures.
- Expansion: Over weeks to months, saline is gradually injected into the expander through a port to stretch the skin and tissue.
Duration
The initial surgical procedure typically takes 1 to 2 hours. Subsequent expansions take about 15-30 minutes each.
Setting
The initial surgery is generally performed in a hospital or surgical center. Expansions are done in an outpatient clinic.
Personnel
- Plastic surgeon
- Surgical nurse
- Anesthesiologist
Risks and Complications
- Infection
- Bleeding or hematoma
- Pain and discomfort
- Expander rupture or failure
- Asymmetry or implant displacement
- Scarring issues
- Reaction to anesthesia
Benefits
- Prepares the chest area for a more natural-looking breast implant
- Allows for gradual tissue accommodation, reducing skin and muscle stress
- Facilitates emotional and physical recovery post-mastectomy
Recovery
- Initial recovery in a hospital for 1-2 days
- Drains may be in place and removed after several days
- Avoid strenuous activities and heavy lifting for 4-6 weeks
- Follow-up visits for saline expansions
- Postoperative pain management with prescribed medications
Alternatives
- Direct-to-implant reconstruction: Immediate placement of a breast implant without an expander.
- Autologous tissue reconstruction: Using tissue from another part of the body (e.g., abdomen) for breast reconstruction.
- External prostheses or bras with inserts: Non-surgical option for enhancing breast contour.
Patient Experience
- During the procedure: The patient is under general anesthesia and will not feel pain during surgery.
- After the procedure: Some pain, swelling, and bruising are expected. Pain is managed with medications.
- During expansions: Mild discomfort or pressure during saline injections.
- Post-expansion period: Limited activity and follow-up appointments for monitoring progress.