Tissue Expansion

Tissue expansion involves the stretching of skin and soft tissue. It is done before reconstructive surgery to replace skin that has been burned, injured, or that has a large birthmark.

At Nationwide Children’s Hospital, tissue expansion is done by our Plastic and Reconstructive Surgery team. We do many of these procedures each year for children with a wide variety of health conditions.

We understand that tissue expansion can be both exciting and intimidating. We’re here to help explain the process so that parents and children know what to expect, both with the actual expansion and the subsequent surgery.

Depending on the type of skin problem, our plastic surgeons may work with other experts, such as dermatologists, gastroenterologists, orthopedic and general surgeons, psychologists and more. This helps us craft a meaningful, personalized care program to meet your child’s health needs in full — not just their skincare needs.

What Is Tissue Expansion, and How Is It Done?

Tissue expansion is a way to stretch skin, so that the body’s own tissue can be used to fix or replace skin that is going to be removed. It takes place in three main steps:

  1. Placement: To help the skin stretch, a small incision is made, and the expander—a little balloon attached to a tube and “port”—is inserted under an area of healthy skin, usually near the section of skin that is going to eventually be removed. Children are placed under anesthesia during placement.
  2. Filling and Stretching: After the initial cut heals, you must come to the office about once a week to have saline (a sterile liquid that is safe for the body if it leaks) added to the pouch through the port. The port may be under the skin, meaning the area has to be numbed and held still to inject saline into the expander. Week by week, the bag will be filled with more liquid during clinic visits, which will slowly stretch the skin.
  3. Removal: Once there is enough new skin, the expander will be taken out and the new skin can be pulled over to replace the damaged skin.

The expander may need to be in for several months before the skin is ready for surgery. The exact amount of time it will take to stretch the skin depends on where on the body the expander is placed, how much damaged skin needs to be replaced, and how well your child tolerates the expansion process.

You can read more about the operation and home care in our Helping Hands article on tissue expansion.

Repeat Tissue Expansions

Sometimes, tissue expansion has to be done in stages. This may mean that a child could need expander placement (and removal) and reconstructive surgery more than once, so that the skin can be stretched and replaced slowly.

Multiple stages are more likely to be needed when the area of damaged skin is large or on a part of the body that has skin that is difficult to stretch, such as the lower leg or scalp.

What Is It like to Have a Tissue Expander in Place?

The site where the expander is inserted should heal in a few weeks. After the cut is better, the expander feels like a water balloon under the skin and should not cause pain. In most cases, children are back to their usual activities as soon as each week’s fill-up is done.

The expanders don’t prevent kids from being active. Many children with expanders can even run, swim, dance and bike without limitations from the expander.

For older children, the tissue expander may be a source of questions or teasing. However, many children find that it is a temporary inconvenience that can help them get rid of damaged skin (which may also draw unwanted attention).

Our plastic surgery team is prepared to help your child with every aspect of care—including emotional and behavioral health needs—that may come with tissue expansion.

Before and After Tissue Expansion

Tissue expansion is usually done to improve the appearance of skin. The operation pulls over healthy skin that is a child’s natural color and texture, unlike with a skin graft. However, the process does leave a scar that runs along three edges of where the damaged skin was removed.

Many children find that the scar is easy to explain and less distracting than the damaged skin was. And for children at higher risk of skin cancer due to congenital melanocytic nevi, the procedure returns the child’s cancer risk to normal.

Who Is a Candidate for Tissue Expansion?

Tissue expansion is commonly used for children with many kinds of skin-related damage and other health conditions, including:

  • Large birthmarks, such as congenital melanocytic nevi
  • Scarring from dog bites, car accidents and other trauma
  • Infection-related skin loss
  • Asymmetrical breasts
  • Hernia and omphalocele
  • Scar tethering
  • Burns
  • Baldness caused by burns or trauma

Our surgeons will evaluate your child to figure out whether tissue expansion is a good option to meet their needs. Families with a child undergoing tissue expansion must commit to regular appointments in order for the long-term process to be effective. The age of your child and the amount and location of the damaged skin will also factor into whether tissue expansion is the best choice.

Choosing a Team for Tissue Expansion

Tissue expansion can be done at many children’s hospitals and plastic surgery centers. What makes the Nationwide Children’s experience unique is the combination of expert surgeons and clinicians from multiple specialties.

Our comprehensive care approach recognizes your child as more than just their skin. In addition to making sure that form and function come together, we customize our treatment team to meet all of the health needs of your child — no matter how complicated those needs are.

Meet our team of experts in Plastic and Reconstructive Surgery.

Undergoing Tissue Expansion: Chloe's Story