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Tissue Expander / Direct to Implant

Breast Reconstruction Using Tissue Expander

Tissue Expanders and Direct to Implant (DTI)

Tissue Expander / Implant / Acellular Dermal Matrix

Midwest Breast and Aesthetics Surgery Tissue Expander OhioBreast reconstruction can also be accomplished by using prosthetic, implanted devices. With this method, the final reconstruction consists of a permanent breast implant, either silicone or saline, positioned under the skin and pectoralis muscle. Generally speaking, implant-based reconstruction can be done in multiple stages or as a single step.

Staged expander-implant

In the staged method, a device known as a tissue expander is placed at the initial operation. This can be placed at the same time as the mastectomy or at a later date, in a delayed fashion. Two to three weeks after surgery, the tissue expander is gradually inflated by adding saline to the device. This is done in the outpatient setting and continued until the expander is filled to a desired size. The main goal of this first stage is to expand the skin and create a pocket where the permanent implant will ultimately reside.

The second stage involves removal of the tissue expander and placement of the permanent implant. This is usually an outpatient procedure and involves less recovery time than the initial operation.

Dr. Kocak is a wonderful and skilled Plastic Surgeon. He was warm and professional and his office staff was equally caring......

He's very knowledgeable, honest, kind, and sincere. He made me feel comfortable......

Highly recommend Dr. Kocak. The whole team from front office to Doctor are caring and very professional. They put me at ease on my first visit and were honest, incredibly knowledgeable and detailed with explaining the procedure......

He wants the best for his patients and make sure his patients are informed so that they can make the right decision for them. The staff, as well as Dr Tiwari, are very nice and always helpful......

He is a great surgeon. He answered all my questions. He was very easy to talk to. The procedure went well and my recovery was short and less painful than I thought. The staff is great and made me feel very comfortable! I highly recommend Kocak, he??s ......

Dr. Tiwari is an excellent board certified plastic surgeon......

I had a great experience with Dr. Tiwari. He is amazing at what he does, he made me feel beautiful again. His staff was super friendly and welcoming. I am so pleased with the quality of care, the staff and the results......

Dr. Kocak is an amazing doctor. He has the best bedside manner of any doctor I've ever been to. Dr. Kocak is truly an artist in what he does. I highly recommend him. His staff is very well-mannered and expert in what they do......

Dr. Kocak is wonderful! I recently had a breast reconstruction surgery with Dr. Ergun Kocak and it was one of the best decisions I have ever made. I am so contented with the result. He was reassuring every step of the way and explained everything to me and made......

Dr. Kocak & Dr. Tiwari performed my DIEP reconstruction when I had my prophylactic double mastectomy due to having a BRCA1 mutation. Their excellent surgical skills are equally matched by their compassion, accessibility, and dedication to their patients. Their confidence and guidance led me ......

Dr. Kocak and Dr. Tiwari are amazing surgeons.  They are caring, thorough, easy to get in contact with for questions and all around great doctors.  After many years of painful, deformed implant reconstruction I chose to have the DIEP flap reconstruction, Drs. Tiwari and Kocak did a great job......

Single stage or Direct-to-Implant

A traditional mastectomy procedure removes the breast tissue and skin, leaving a relatively flat surface on the chest. In such cases, the staged approach with initial tissue expansion is necessary to expand skin and create a space for the permanent implant. Other mastectomy techniques, such as the skin-sparing and nipple-sparing procedures, remove mainly the breast tissue while leaving much of the skin of breast and chest intact. If an adequate amount of skin is spared, it is sometimes possible to avoid the initial expander stage and place the permanent implant at the time of mastectomy, this approach is also known as a Direct to Implant breast reconstruction.  The ideal candidate for such an approach is typically a smaller cup size patient with excellent skin quality that can be evaluated at the time of physical examination. The Direct-to-implant reconstruction is only possible immediately after the mastectomy and not an option for patients seeking a delayed reconstruction.

Acellular Dermal Matrix

The tissue expander and implant method may, in some cases, require the use of a biologic implant known as acellular dermal matrix. This material is derived from the skin of either animals or cadavers and is treated to contain no living cells. Instead, it serves as a biologic scaffold, or sheet, that can be used to facilitate the reconstruction. There are several different products available such as AlloDerm (Lifecell), AlloMax (Bard), and Flex HD (Ethicon) to only name a few.

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Dr. Tiwari, Ten months ago all I could think about was getting rid of these cancer cells. You walked me through everything else I also had to think about and, today, I am not only cancer-free and "normal" looking but healthier and more fit than in many years. You and your team are amazing - truly ......
I just got home from my check up with Dr. Chin. I have been given The ok to have my tattoos done and revisit her in a year. My reconstruction Battle started in April 2012. Originally in Nebraska, my husband was transferred to the Dayton area and two months after that Midwest Breast came into my life......
I'm now 7 weeks out from my capsulectomy, and even though I had a few unexpected complications, I don't regret it for one moment! Dr. T is an amazing doctor, and he worked miracles considering what he started with. Not only does it look better, I feel so much better! Thank you to Dr. T and his ......
Thank you so much. Everyone has been so kind. Maggie always has that warm and inviting smile! Dr. Kocak, made me feel confident on my choices. His bed side manner was comforting, reassuring and most of all compassionate! I was scared, lonely and most of all lost. I realize this is his job but, for ......
My RESULTS are WOW. My breasts look really natural and are the perfect size, They look and feel totally natural. I would highly recommend my doctors and suggest that people do not just take my word for it, shop around and compare so you can see for yourself. - SA......
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In both the staged and Direct-to-implant methods, the prosthesis is placed under the pectoralis muscle. In its natural, uninterrupted state, the pectoralis muscle sits closely on the chest wall and there is very little space between these two structures. Additionally, the lower attachments of the pectoralis muscle to the chest wall are generally higher than the natural position of the breast crease (inframammary fold). Therefore, dividing these lower attachments can allow for improved positioning of the tissue expander or implant and more space under the muscle making it possible to accommodate a larger volume in the device. However, when it is cut, the lower part of the muscle retracts upwards and creates a gap between the muscle and the chest wall. This is where acellular dermal matrix is placed, essentially forming a bridge or sling between the lower, cut edge of the muscle and the chest wall. Once placed, the biologic material is gradually replaced by ingrowth of one’s own cells and tissue and does not need to be removed at a later date.

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