The most commonly used method of implant-based breast reconstruction involves preparation of the mastectomy site with an implantable device called a tissue expander. Preparation of the mastectomy site is necessary as implants used in reconstruction cannot simply be placed directly below the skin in the space created by the removal of breast tissue.
(A) A tissue expander placed below the pectoralis muscle is gradually inflated like a balloon—by injection with sterile fluid at regular intervals over a period of a few months—to stretch out the overlying tissue to create enough space to accommodate an implant of the desired size.
(B) At a second surgical procedure, the tissue expander is removed and a breast implant is placed in the pocket created below the stretched out muscle.
(C) In certain circumstances, tissue expansion may be combined with the placement of a tissue matrix such as AlloDerm® for more complete coverage of the breast implant. In a relatively small number of situations, the use of a tissue matrix may make it possible to undergo reconstruction with a breast implant in a direct-to-implant procedure that avoids tissue expansion.