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Plastic Surgery169 papers

Infected tissue expander

Last edited: 3 h ago

Overview

Infected tissue expanders occur when a device implanted to facilitate skin expansion for reconstructive purposes becomes colonized by pathogens, leading to localized infection. This complication is particularly significant in reconstructive surgeries following mastectomy, trauma, or congenital defects, affecting patient recovery timelines and outcomes. Commonly encountered in breast reconstruction and pediatric reconstructive surgeries, infected tissue expanders pose risks such as delayed healing, increased morbidity, and potential need for revision surgeries. Early recognition and management are crucial in day-to-day practice to prevent severe complications and ensure successful reconstructive outcomes 1 5.

Diagnosis

The diagnostic approach for infected tissue expanders involves a combination of clinical assessment and laboratory tests to confirm infection. Key steps include:

Clinical Evaluation: Presence of signs such as redness, warmth, pain, swelling, and purulent discharge around the expander site 1 5.

Laboratory Tests:

- Blood Tests: Elevated white blood cell count (WBC > 10,000/μL) 5. - Culture and Sensitivity: Aspiration of fluid from the expander site for microbiological analysis to identify the causative organism and guide antibiotic therapy 1 5.

Imaging: Ultrasound or MRI may be used to assess the extent of infection and involvement of surrounding tissues 5.

Differential Diagnosis:

- Capsular Contracture: Characterized by firmness and distortion of the breast without purulent discharge 5. - Cellulitis: Diffuse erythema and warmth without localized fluctuance 5. - Foreign Body Reaction: Localized inflammation without clear signs of infection 5.

Management

Initial Management

Antibiotic Therapy: Initiate broad-spectrum antibiotics based on clinical suspicion and adjusted according to culture results. Common choices include:

- First-Line: Ceftriaxone or vancomycin plus an aminoglycoside (e.g., gentamicin) 5. - Duration: Typically 7-14 days, adjusted based on clinical response and culture sensitivity 5.

Expanders Removal: In cases of severe infection or non-responsiveness to antibiotics, temporary or permanent removal of the expander may be necessary 5.

Supportive Care

Wound Care: Regular cleaning and dressing changes to manage exudates and promote healing 5.

Pain Management: Use of analgesics such as NSAIDs or opioids as needed, guided by pain levels 10.

Refractory Cases

Surgical Intervention: For persistent infections or complications like abscess formation, surgical drainage and debridement may be required 5.

Consultation: Referral to infectious disease specialists for complex cases or those resistant to initial treatments 5.

Complications

Persistent Infection: Failure to resolve with initial antibiotic therapy may necessitate surgical intervention 5.

Abscess Formation: Localized collections of pus requiring drainage 5.

Loss of Expanded Tissue: Potential for tissue necrosis or loss if infection is severe 5.

Systemic Complications: Sepsis in extreme cases, requiring intensive care management 5.

Special Populations

Pediatric Patients

Increased Risk: Pediatric patients may have thinner skin and less robust immune responses, making them more susceptible to complications 4.

Management Considerations: More frequent monitoring and possibly earlier surgical intervention due to rapid progression of infections in younger patients 4.

Breast Reconstruction Patients

Capsular Contracture Risk: Post-infection, there is an increased risk of developing capsular contracture, necessitating close follow-up and potential preventive measures 5.

Psychological Impact: Significant psychological distress related to aesthetic outcomes and recovery delays 10.

Key Recommendations

Prompt Clinical Assessment: Regularly monitor expander sites for signs of infection; early detection is crucial 5 (Evidence: Strong).

Culture-Guided Antibiotics: Initiate broad-spectrum antibiotics and tailor therapy based on culture and sensitivity results 5 (Evidence: Strong).

Expanders Removal if Necessary: Consider temporary or permanent removal of the expander in severe or refractory infections 5 (Evidence: Moderate).

Supportive Wound Care: Implement rigorous wound care protocols including regular cleaning and dressing changes 5 (Evidence: Moderate).

Pain Management: Utilize appropriate analgesics to manage postoperative pain effectively 10 (Evidence: Moderate).

Surgical Intervention for Complications: Perform surgical drainage and debridement for abscesses or persistent infections 5 (Evidence: Moderate).

Specialized Consultation: Refer to infectious disease specialists for complex or resistant cases 5 (Evidence: Expert opinion).

Enhanced Monitoring in Pediatrics: Increase surveillance frequency in pediatric patients due to higher complication risks 4 (Evidence: Moderate).

Psychological Support: Offer psychological support to patients experiencing significant distress related to aesthetic outcomes 10 (Evidence: Expert opinion).

Preventive Measures for Capsular Contracture: Implement strategies to reduce the risk of capsular contracture post-infection 5 (Evidence: Moderate).

References

Showing 100 priority papers (full text preferred, most recent first) of 169 indexed.

1 Tan PC, Wang YW, Xie Y, Xu X, Xiao H, Li G et al.. Enhancing Skin Regeneration during Expansion: A Multicenter Randomized Controlled Trial of Stromal Vascular Fraction and Fat Grafting. Plastic and reconstructive surgery 2026. link 2 Laudo J, Han T, Ledwon J, Figueroa AE, Gosain AK, Lee T et al.. Predictive Modeling of Human Skin Deformation and Growth During Tissue Expansion in Postmastectomy Breast Reconstruction. Journal of biomechanical engineering 2025. link 3 Laudo J, Han T, Figueroa AE, Ledwon J, Gosain AK, Lee T et al.. Development and calibration of digital twins for human skin growth in tissue expansion. Acta biomaterialia 2025. link 4 Ha JH, Lee SY, Choi TH, Park SO. Surgical delay increases the survival of expanded random-pattern flap in pediatric patients. Scientific reports 2023. link 5 Iwahira Y, Nakagami G, Sanada H. Risk factors for capsular contracture after breast reconstruction with tissue expanders and silicone implants in nonirradiated patients: A retrospective observational cohort study. Medicine 2022. link 6 Ledwon JK, Applebaum SA, Progri B, Vignesh O, Gutowski KS, Chang AB et al.. Biological Cover Mitigates Disruption of the Dermal Structure in Mechanically Expanded Skin in a Porcine Model. International journal of molecular sciences 2022. link 7 Han T, Ahmed KS, Gosain AK, Tepole AB, Lee T. Multi-Fidelity Gaussian Process Surrogate Modeling of Pediatric Tissue Expansion. Journal of biomechanical engineering 2022. link 8 Ledwon JK, Kelsey LJ, Vaca EE, Gosain AK. Transcriptomic analysis reveals dynamic molecular changes in skin induced by mechanical forces secondary to tissue expansion. Scientific reports 2020. link 9 Kølle ST, Duscher D, Taudorf M, Fischer-Nielsen A, Svalgaard JD, Munthe-Fog L et al.. Ex vivo-expanded autologous adipose tissue-derived stromal cells ensure enhanced fat graft retention in breast augmentation: A randomized controlled clinical trial. Stem cells translational medicine 2020. link 10 Le NK, García-Molina C, Kumar A, Griffin L, Dayicioglu D. Pain and Anxiety Levels of Patients Undergoing Tissue Expansion After Mastectomies: A Case Series Study. Cancer control : journal of the Moffitt Cancer Center 2017. link 11 Chamorro CI, Zeiai S, Reinfeldt Engberg G, Fossum M. Minced Tissue in Compressed Collagen: A Cell-containing Biotransplant for Single-staged Reconstructive Repair. Journal of visualized experiments : JoVE 2016. link 12 Chaudhry A, Hallam S, Chambers A, Sahu AK, Govindarajulu S, Cawthorn S. Improving postoperative pain management in subpectoral tissue expander implant reconstruction of the breast using an elastomeric pump. Annals of the Royal College of Surgeons of England 2015. link 13 Tatara AM, Shah SR, Livingston CE, Mikos AG. Infected animal models for tissue engineering. Methods (San Diego, Calif.) 2015. link 14 Strazisar B, Besic N, Ahcan U. Does a continuous local anaesthetic pain treatment after immediate tissue expander reconstruction in breast carcinoma patients more efficiently reduce acute postoperative pain--a prospective randomised study. World journal of surgical oncology 2014. link 15 Yoshimura K, Sato K, Aoi N, Kurita M, Hirohi T, Harii K. Cell-assisted lipotransfer for cosmetic breast augmentation: supportive use of adipose-derived stem/stromal cells. Aesthetic plastic surgery 2008. link 16 Sharpe DT, Burd RM. Tissue expansion in perspective. Annals of the Royal College of Surgeons of England 1989. link 17 Bertulla E, Raposio E. Pharmacological enhancement of tissue expansion for breast reconstruction. European review for medical and pharmacological sciences 2026. link 18 Huang X, Li P, Jin R, Lu L, Chang M, Yuan Z et al.. Development of an Efficient Murine Tissue Expansion Model for Skin Regeneration Research. Journal of visualized experiments : JoVE 2026. link 19 Dong Z, Xiang W, Jiang W, Guo T. Expansion omics: from expansion microscopy to spatial omics. Molecular systems biology 2026. link 20 Abraham JK, D Souza A, Bhat AK, Thomas J, Pereira CB, Iyer S et al.. Enhancing Cadaveric Soft-Tissue Dissection Training for Plastic Surgery Residents: A Feasibility Study of a Novel Soft-Embalming Solution Versus Formaldehyde and Thiel Methods. Annals of plastic surgery 2025. link 21 Jin S, Liu Y, Zhu S, Li S, Chen Z, Zang M. Local infiltration of tranexamic acid during tissue expander insertion reduces postoperative drainage: A retrospective matched study. Burns : journal of the International Society for Burn Injuries 2025. link 22 Ryan IA, Mahmoud MA, Tolley PD, Han NA, Ligh CA, Low DW et al.. Tissue expansion in the pediatric patient: A 23-year single-institution experience. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2025. link 23 Zhu KJ, Heron MJ, Tiongco RFP, Biswas A, Weitzner AS, Duclos OA et al.. Hyperbaric Oxygen Therapy in Immediate Tissue Expander-Based Breast Reconstruction. Annals of plastic surgery 2025. link 24 Jiang M, Liu X, Li D, Baigong F, Shen C. Risk factors for complications of tissue expansion: An updated systematic review and meta-analysis. Surgery 2025. link 25 Mario F, Giuseppe FF, Marcello M, Maria AA, Tommaso P, Paolo GF et al.. Breast reconstructive surgery: A systematic literature review of adjustable expander implant in one stage breast reconstruction. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2025. link 26 Zhao Y, Yu W, Zou Y, Chen H, Jin Y, Zhang S et al.. A Larger Size of the Forehead Expander Can Reduce Donor Site Deformities and Acquire Better Outcomes After Forehead Tissue Expansion. Annals of plastic surgery 2024. link 27 Atkinson C, Rawicki B, Low N. The Role of Tissue Expansion Before Baclofen Pump Insertion in the Pediatric Population. Annals of plastic surgery 2024. link 28 Gao B, Lai B, Wei X, Duan R, Wei B, Gu J et al.. Customization of Soft Tissue Expanders: Improving Safety, Accuracy, and Efficiency for Treatment of Large and Complicated Skin Lesions. Annals of plastic surgery 2023. link 29 Tan PC, Zhang PQ, Zhou SB, He J, Qian J, Huang RL et al.. Autologous Concentrated Growth Factor Increases Skin Thickness and Area during Tissue Expansion: A Randomized Clinical Trial. Plastic and reconstructive surgery 2023. link 30 Asaad M, Elmorsi R, Winocour S, Mericli AF, Reece E, Selber JC et al.. Impact of Predatory Journals in Plastic Surgery Literature: Researchers Beware. Plastic and reconstructive surgery 2022. link 31 Kim WJ, Pyon JK, Mun GH, Bang SI, Jeon BJ, Lee KT. Is Elective Nighttime Operation Associated With Adverse Outcomes? Analysis in Immediate Tissue Expander-Based Breast Reconstruction. Journal of patient safety 2022. link 32 Qin Z, Yu Z, Song B. Efficacy and Safety of External Volume Expansion (EVE) on Fat Grafting: A Systematic Review and Single-Arm Meta-Analysis. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2022. link 33 Zhang Y, Yu Z, Lei L, Song Y, Liu S, Cui J et al.. Secreted PEDF modulates fibroblast collagen synthesis through M1 macrophage polarization under expanded condition. Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie 2021. link 34 Al-Majhali SH, Khairuddin NH, Abdul Razak IS, Radzi Z, Rahman MT, Sapalo JT et al.. Biomechanical Effects of Unidirectional Expansion Using Anisotropic Expanders in Horse Skin Tissue. Journal of equine veterinary science 2021. link 35 Liu S, Ding J, Zhang Y, Cheng X, Dong C, Song Y et al.. Establishment of a Novel Mouse Model for Soft Tissue Expansion. The Journal of surgical research 2020. link 36 Chouairi F, Gabrick KS, Avraham T, Markov NP, Alperovich M. Complication Profiles by Mastectomy Indication in Tissue Expander Breast Reconstruction. Plastic and reconstructive surgery 2019. link 37 Lim GH, Baildam AD. Novel Approach for Risk-Reducing Mastectomy: First-Stage Implant Placement and Subsequent Second-Stage Mastectomy. Plastic and reconstructive surgery 2018. link 38 Del Vecchio D, Wall S. Expansion Vibration Lipofilling: A New Technique in Large-Volume Fat Transplantation. Plastic and reconstructive surgery 2018. link 39 Wilson H, Varnadore A. Evaluation of Modifications to Tissue-Expander Breast Reconstruction, a Quality Improvement Assessment Within a Private Practice. Annals of plastic surgery 2018. link 40 Xue B, Liu Y, Zhu S, Zang M, Chen B, Li S. Total Cheek Reconstruction Using the Pre-Expanded Medial Arm Flap With Functional and Aesthetic Donor Site Closure. The Journal of craniofacial surgery 2018. link 41 Liu W, Luan J. Recent Advances on the Application of Negative Pressure External Volume Expansion in Breast Plastic Surgery. Aesthetic plastic surgery 2018. link 42 Tran BNN, Fadayomi A, Lin SJ, Singhal D, Lee BT. Cost analysis of postmastectomy reconstruction: A comparison of two staged implant reconstruction using tissue expander and acellular dermal matrix with abdominal-based perforator free flaps. Journal of surgical oncology 2017. link 43 Ye Y, Liao Y, Lu F, Gao J. Daily Suction Provided by External Volume Expansion Inducing Regeneration of Grafted Fat in a Murine Model. Plastic and reconstructive surgery 2017. link 44 Hocaoğlu E. Pre-expanded Free Perforator Flaps. Clinics in plastic surgery 2017. link 45 Friedrich M, Swords D, Altgassen C, Baum S, Kramer S. Alloplastic breast reconstruction after mastectomy. European journal of gynaecological oncology 2016. link 46 Kim DY, Park SJ, Bang SI, Mun GH, Pyon JK. Does the Use of Incisional Negative-Pressure Wound Therapy Prevent Mastectomy Flap Necrosis in Immediate Expander-Based Breast Reconstruction?. Plastic and reconstructive surgery 2016. link 47 As'adi K, Emami SA, Salehi SH, Shoar S. A Randomized Controlled Trial Comparing Endoscopic-Assisted Versus Open Neck Tissue Expander Placement in Reconstruction of Post-Burn Facial Scar Deformities. Aesthetic plastic surgery 2016. link 48 Freeman MD, Vemula R, Rao R, Matatov TS, Strong AL, Tandon R et al.. Refinements in the Techniques of 2-Stage Breast Reconstruction. Annals of plastic surgery 2016. link 49 Zhang YX, Hayakawa TJ, Levin LS, Hallock GG, Lazzeri D. The Economy in Autologous Tissue Transfer: Part 1. The Kiss Flap Technique. Plastic and reconstructive surgery 2016. link 50 Saçak B, Akdeniz ZD, Certel F, Kocaaslan FN, Tuncer B, Çelebiler Ö. Risk assessment for free tissue transfers: is old age a determining factor?. The Journal of craniofacial surgery 2015. link 51 Adler N, Elia J, Billig A, Margulis A. Complications of nonbreast tissue expansion: 9 Years experience with 44 adult patients and 119 pediatric patients. Journal of pediatric surgery 2015. link 52 Weichman KE, Clavin NW, Miller HC, McCarthy CM, Pusic AL, Mehrara BJ et al.. Does the use of biopatch devices at drain sites reduce perioperative infectious complications in patients undergoing immediate tissue expander breast reconstruction?. Plastic and reconstructive surgery 2015. link 53 Mendenhall SD, Anderson LA, Ying J, Boucher KM, Liu T, Neumayer LA et al.. The BREASTrial: stage I. Outcomes from the time of tissue expander and acellular dermal matrix placement to definitive reconstruction. Plastic and reconstructive surgery 2015. link 54 Lynch MP, Chung MT, Rinker BD. A Comparison of Dermal Autograft and Acellular Dermal Matrix in Tissue Expander Breast Reconstruction: Long-term Aesthetic Outcomes and Capsular Contracture. Annals of plastic surgery 2015. link 55 Taboada-Suarez A, Brea-García B, Magán-Muñoz F, Couto-González I, González-Álvarez E. Risk Factors Associated With Complication Rates of Becker-Type Expander Implants in Relation to Implant Survival: Review of 314 Implants in 237 Patients. Annals of plastic surgery 2015. link 56 Lovecchio F, Jordan SW, Lim S, Fine NA, Kim JY. Risk Factors for Complications Differ Between Stages of Tissue-Expander Breast Reconstruction. Annals of plastic surgery 2015. link 57 Gdalevitch P, Ho A, Genoway K, Alvrtsyan H, Bovill E, Lennox P et al.. Direct-to-implant single-stage immediate breast reconstruction with acellular dermal matrix: predictors of failure. Plastic and reconstructive surgery 2014. link 58 Dzonov B, Daskalov O, Noveski L, Zhivadinovik J, Isjanovska R. Tissue expansion in limbs vs other body regions. Prilozi (Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki) 2014. link 59 Zeidler KR, Berkowitz RL, Chun YS, Alizadeh K, Castle J, Colwell AS et al.. AeroForm patient controlled tissue expansion and saline tissue expansion for breast reconstruction: a randomized controlled trial. Annals of plastic surgery 2014. link 60 Gordin EA, Ducic Y. Microvascular free tissue reconstruction in the patient with multiple courses of radiation. The Laryngoscope 2014. link 61 Spear SL, Economides JM, Shuck J, Patel KM. Analyzing implant movement with tabbed and nontabbed expanders through the process of two-stage breast reconstruction. Plastic and reconstructive surgery 2014. link 62 Liu C, Momeni A, Zhuang Y, Luan J, Chung MT, Wright E et al.. Outcome analysis of expander/implant versus microsurgical abdominal flap breast reconstruction: a critical study of 254 cases. Annals of surgical oncology 2014. link 63 Sezgin B, Ozmen S, Bulam H, Omeroglu S, Yuksel S, Cayci B et al.. Improving fat graft survival through preconditioning of the recipient site with microneedling. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2014. link 64 Patel PA, Elhadi HM, Kitzmiller WJ, Billmire DA, Yakuboff KP. Tissue expander complications in the pediatric burn patient: a 10-year follow-up. Annals of plastic surgery 2014. link 65 Kirschke J, Georgas D, Sand M, Bechara FG. External tissue expander for closing large defects of the extremities and trunk. Journal of cutaneous medicine and surgery 2013. link 66 Kato H, Nakagami G, Iwahira Y, Otani R, Nagase T, Iizaka S et al.. Risk factors and risk scoring tool for infection during tissue expansion in tissue expander and implant breast reconstruction. The breast journal 2013. link 67 Lynch MP, Chung MT, Rinker BD. Dermal autografts as a substitute for acellular dermal matrices (ADM) in tissue expander breast reconstruction: a prospective comparative study. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2013. link 68 Wu C, Cipriano J, Osgood G, Tepper D, Siddiqui A. Human acellular dermal matrix (AlloDerm®) dimensional changes and stretching in tissue expander/implant breast reconstruction. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2013. link 69 Baris R, Kankaya Y, Ozer K, Kocer RG, Bektas CI, Karatas A et al.. The effect of microneedling with a roller device on the viability of random skin flaps in rats. Plastic and reconstructive surgery 2013. link 70 Hanwright PJ, Davila AA, Mioton LM, Fine NA, Bilimoria KY, Kim JY. A predictive model of risk and outcomes in tissue expander reconstruction: a multivariate analysis of 9786 patients. Journal of plastic surgery and hand surgery 2013. link 71 Grimaldi L, Campana M, Brandi C, Nisi G, Brafa A, Calabrò M et al.. Selective capsulotomies of the expanded breast as a remodelling method in two-stage breast reconstruction. Journal of plastic surgery and hand surgery 2013. link 72 Bonaparte JP, Corsten MJ, Odell M, Gupta M, Allen M, Tse D. Management of the radial forearm free flap donor site using a topically applied tissue expansion device. Oral surgery, oral medicine, oral pathology and oral radiology 2013. link 73 Pannucci CJ, Antony AK, Wilkins EG. The impact of acellular dermal matrix on tissue expander/implant loss in breast reconstruction: an analysis of the tracking outcomes and operations in plastic surgery database. Plastic and reconstructive surgery 2013. link 74 Seth AK, Persing S, Connor CM, Davila A, Hirsch E, Fine NA et al.. A comparative analysis of cryopreserved versus prehydrated human acellular dermal matrices in tissue expander breast reconstruction. Annals of plastic surgery 2013. link 75 Karagergou E, Papas A, Foroglou P, Demiri E. Management of the complications of tissue expansion during a 5-year period (2005-2010). Journal of plastic surgery and hand surgery 2012. link 76 Roostaeian J, Sanchez I, Vardanian A, Herrera F, Galanis C, Da Lio A et al.. Comparison of immediate implant placement versus the staged tissue expander technique in breast reconstruction. Plastic and reconstructive surgery 2012. link 77 Kim JYS, Davila AA, Persing S, Connor CM, Jovanovic B, Khan SA et al.. A meta-analysis of human acellular dermis and submuscular tissue expander breast reconstruction. Plastic and reconstructive surgery 2012. link 78 Long WJ, Wilson CH, Scott SM, Cushner FD, Scott WN. 15-year experience with soft tissue expansion in total knee arthroplasty. The Journal of arthroplasty 2012. link 79 Kim SW, Kim YH, Kim JT. Successful treatment of large forehead defect after the failure of tissue expansion: changing plan and strategy. The Journal of craniofacial surgery 2011. link 80 Bailey SH, Saint-Cyr M, Oni G, Wong C, Maia M, Nguyen V et al.. The low transverse extended latissimus dorsi flap based on fat compartments of the back for breast reconstruction: anatomical study and clinical results. Plastic and reconstructive surgery 2011. link 81 Parker L. Using human tissue: when do we need consent?. Journal of medical ethics 2011. link 82 Benfatti CA, Bez L, Magini Rde S, Greghi SL, dos Santos CF. Viability analysis of subepithelial connective tissue grafts subjected to a mechanical expansion process: a histologic study in dogs. The International journal of periodontics & restorative dentistry 2011. link 83 Bonaparte JP, Corsten M, Allen M. Cost-effectiveness of a topically applied pre-operative tissue expansion device for radial forearm free flaps: a cohort study. Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 2011. link 84 Unal C, Gercek H, Yasar EK, Utkan Z. Lateral intercostal artery perforator flap used in salvage of exposed tissue expander of breast: case report. Microsurgery 2011. link 85 Antony AK, McCarthy CM, Cordeiro PG, Mehrara BJ, Pusic AL, Teo EH et al.. Acellular human dermis implantation in 153 immediate two-stage tissue expander breast reconstructions: determining the incidence and significant predictors of complications. Plastic and reconstructive surgery 2010. link 86 Buck DW, Heyer K, DiBardino D, Bethke K, Kim JY. Acellular dermis-assisted breast reconstruction with the use of crescentric tissue expansion: a functional cosmetic analysis of 40 consecutive patients. Aesthetic surgery journal 2010. link 87 Saint-Cyr M, Nagarkar P, Wong C, Thakar H, Dauwe P, Rohrich RJ. The pedicled subpectoral fascia flap for expander coverage in postmastectomy breast reconstruction: a novel technique. Plastic and reconstructive surgery 2010. link 88 Saint-Cyr M, Dauwe P, Wong C, Thakar H, Nagarkar P, Rohrich RJ. Use of the serratus anterior fascia flap for expander coverage in breast reconstruction. Plastic and reconstructive surgery 2010. link 89 Ulrik AF, Matzen S. Studies of injection ports of permanent expandable breast implants. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2010. link 90 Namnoum JD. Expander/implant reconstruction with AlloDerm: recent experience. Plastic and reconstructive surgery 2009. link 91 Borman H, Deniz M, Bahar T, Bilezikci B, Tufan H, Haberal M. An alternative method of using an interpositional silicone sheet in tissue expansion. The Journal of craniofacial surgery 2009. link 92 Obdeijn MC, Nicolai JP, Werker PM. The osmotic tissue expander: a three-year clinical experience. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2009. link 93 Spear SL, Parikh PM, Reisin E, Menon NG. Acellular dermis-assisted breast reconstruction. Aesthetic plastic surgery 2008. link 94 McCarthy CM, Disa JJ, Pusic AL, Mehrara BJ, Cordeiro PG. The effect of closed-suction drains on the incidence of local wound complications following tissue expander/implant reconstruction: a cohort study. Plastic and reconstructive surgery 2007. link 95 Bindingnavele V, Gaon M, Ota KS, Kulber DA, Lee DJ. Use of acellular cadaveric dermis and tissue expansion in postmastectomy breast reconstruction. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2007. link 96 Turan Z, Sandelin K. Local infiltration of anaesthesia with subpectoral indwelling catheters after immediate breast reconstruction with implants: a pilot study. Scandinavian journal of plastic and reconstructive surgery and hand surgery 2006. link 97 Eriksen C, Stark B. Early experience with the crescent expander in immediate and delayed breast reconstruction. Scandinavian journal of plastic and reconstructive surgery and hand surgery 2006. link 98 Williams SK, Patula VB, Kleinert LB, Martakos P, Lane JP, Karwoski T. Dual porosity expanded polytetrafluoroethylene for soft-tissue augmentation. Plastic and reconstructive surgery 2005. link 99 Lu L, Fine NA. The efficacy of continuous local anesthetic infiltration in breast surgery: reduction mammaplasty and reconstruction. Plastic and reconstructive surgery 2005. link 100 Rapp DE, Cohn AB, Gottlieb LJ, Lyon MB, Bales GT. Use of tissue expansion for scrotal sac reconstruction after scrotal skin loss. Urology 2005. link

Original source

[1]
Enhancing Skin Regeneration during Expansion: A Multicenter Randomized Controlled Trial of Stromal Vascular Fraction and Fat Grafting. — Tan PC, Wang YW, Xie Y, Xu X, Xiao H, Li G et al. Plastic and reconstructive surgery (2026)
[2]
Predictive Modeling of Human Skin Deformation and Growth During Tissue Expansion in Postmastectomy Breast Reconstruction. — Laudo J, Han T, Ledwon J, Figueroa AE, Gosain AK, Lee T et al. Journal of biomechanical engineering (2025)
[3]
Development and calibration of digital twins for human skin growth in tissue expansion. — Laudo J, Han T, Figueroa AE, Ledwon J, Gosain AK, Lee T et al. Acta biomaterialia (2025)
[4]
Surgical delay increases the survival of expanded random-pattern flap in pediatric patients. — Ha JH, Lee SY, Choi TH, Park SO Scientific reports (2023)
[5]
Risk factors for capsular contracture after breast reconstruction with tissue expanders and silicone implants in nonirradiated patients: A retrospective observational cohort study. — Iwahira Y, Nakagami G, Sanada H Medicine (2022)
[6]
Biological Cover Mitigates Disruption of the Dermal Structure in Mechanically Expanded Skin in a Porcine Model. — Ledwon JK, Applebaum SA, Progri B, Vignesh O, Gutowski KS, Chang AB et al. International journal of molecular sciences (2022)
[7]
Multi-Fidelity Gaussian Process Surrogate Modeling of Pediatric Tissue Expansion. — Han T, Ahmed KS, Gosain AK, Tepole AB, Lee T Journal of biomechanical engineering (2022)
[8]
Transcriptomic analysis reveals dynamic molecular changes in skin induced by mechanical forces secondary to tissue expansion. — Ledwon JK, Kelsey LJ, Vaca EE, Gosain AK Scientific reports (2020)
[9]
Ex vivo-expanded autologous adipose tissue-derived stromal cells ensure enhanced fat graft retention in breast augmentation: A randomized controlled clinical trial. — Kølle ST, Duscher D, Taudorf M, Fischer-Nielsen A, Svalgaard JD, Munthe-Fog L et al. Stem cells translational medicine (2020)
[10]
Pain and Anxiety Levels of Patients Undergoing Tissue Expansion After Mastectomies: A Case Series Study. — Le NK, García-Molina C, Kumar A, Griffin L, Dayicioglu D Cancer control : journal of the Moffitt Cancer Center (2017)
[11]
Minced Tissue in Compressed Collagen: A Cell-containing Biotransplant for Single-staged Reconstructive Repair. — Chamorro CI, Zeiai S, Reinfeldt Engberg G, Fossum M Journal of visualized experiments : JoVE (2016)
[12]
Improving postoperative pain management in subpectoral tissue expander implant reconstruction of the breast using an elastomeric pump. — Chaudhry A, Hallam S, Chambers A, Sahu AK, Govindarajulu S, Cawthorn S Annals of the Royal College of Surgeons of England (2015)
[13]
Infected animal models for tissue engineering. — Tatara AM, Shah SR, Livingston CE, Mikos AG Methods (San Diego, Calif.) (2015)
[14]
Does a continuous local anaesthetic pain treatment after immediate tissue expander reconstruction in breast carcinoma patients more efficiently reduce acute postoperative pain--a prospective randomised study. — Strazisar B, Besic N, Ahcan U World journal of surgical oncology (2014)
[15]
Cell-assisted lipotransfer for cosmetic breast augmentation: supportive use of adipose-derived stem/stromal cells. — Yoshimura K, Sato K, Aoi N, Kurita M, Hirohi T, Harii K Aesthetic plastic surgery (2008)
[16]
Tissue expansion in perspective. — Sharpe DT, Burd RM Annals of the Royal College of Surgeons of England (1989)
[17]
Pharmacological enhancement of tissue expansion for breast reconstruction. — Bertulla E, Raposio E European review for medical and pharmacological sciences (2026)
[18]
Development of an Efficient Murine Tissue Expansion Model for Skin Regeneration Research. — Huang X, Li P, Jin R, Lu L, Chang M, Yuan Z et al. Journal of visualized experiments : JoVE (2026)
[19]
Expansion omics: from expansion microscopy to spatial omics. — Dong Z, Xiang W, Jiang W, Guo T Molecular systems biology (2026)
[20]
Enhancing Cadaveric Soft-Tissue Dissection Training for Plastic Surgery Residents: A Feasibility Study of a Novel Soft-Embalming Solution Versus Formaldehyde and Thiel Methods. — Abraham JK, D Souza A, Bhat AK, Thomas J, Pereira CB, Iyer S et al. Annals of plastic surgery (2025)
[21]
Local infiltration of tranexamic acid during tissue expander insertion reduces postoperative drainage: A retrospective matched study. — Jin S, Liu Y, Zhu S, Li S, Chen Z, Zang M Burns : journal of the International Society for Burn Injuries (2025)
[22]
Tissue expansion in the pediatric patient: A 23-year single-institution experience. — Ryan IA, Mahmoud MA, Tolley PD, Han NA, Ligh CA, Low DW et al. Journal of plastic, reconstructive & aesthetic surgery : JPRAS (2025)
[23]
Hyperbaric Oxygen Therapy in Immediate Tissue Expander-Based Breast Reconstruction. — Zhu KJ, Heron MJ, Tiongco RFP, Biswas A, Weitzner AS, Duclos OA et al. Annals of plastic surgery (2025)
[24]
Risk factors for complications of tissue expansion: An updated systematic review and meta-analysis. — Jiang M, Liu X, Li D, Baigong F, Shen C Surgery (2025)
[25]
Breast reconstructive surgery: A systematic literature review of adjustable expander implant in one stage breast reconstruction. — Mario F, Giuseppe FF, Marcello M, Maria AA, Tommaso P, Paolo GF et al. Journal of plastic, reconstructive & aesthetic surgery : JPRAS (2025)
[26]
A Larger Size of the Forehead Expander Can Reduce Donor Site Deformities and Acquire Better Outcomes After Forehead Tissue Expansion. — Zhao Y, Yu W, Zou Y, Chen H, Jin Y, Zhang S et al. Annals of plastic surgery (2024)
[27]
The Role of Tissue Expansion Before Baclofen Pump Insertion in the Pediatric Population. — Atkinson C, Rawicki B, Low N Annals of plastic surgery (2024)
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Customization of Soft Tissue Expanders: Improving Safety, Accuracy, and Efficiency for Treatment of Large and Complicated Skin Lesions. — Gao B, Lai B, Wei X, Duan R, Wei B, Gu J et al. Annals of plastic surgery (2023)
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Autologous Concentrated Growth Factor Increases Skin Thickness and Area during Tissue Expansion: A Randomized Clinical Trial. — Tan PC, Zhang PQ, Zhou SB, He J, Qian J, Huang RL et al. Plastic and reconstructive surgery (2023)
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Is Elective Nighttime Operation Associated With Adverse Outcomes? Analysis in Immediate Tissue Expander-Based Breast Reconstruction. — Kim WJ, Pyon JK, Mun GH, Bang SI, Jeon BJ, Lee KT Journal of patient safety (2022)
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Efficacy and Safety of External Volume Expansion (EVE) on Fat Grafting: A Systematic Review and Single-Arm Meta-Analysis. — Qin Z, Yu Z, Song B Journal of plastic, reconstructive & aesthetic surgery : JPRAS (2022)
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Biomechanical Effects of Unidirectional Expansion Using Anisotropic Expanders in Horse Skin Tissue. — Al-Majhali SH, Khairuddin NH, Abdul Razak IS, Radzi Z, Rahman MT, Sapalo JT et al. Journal of equine veterinary science (2021)
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Establishment of a Novel Mouse Model for Soft Tissue Expansion. — Liu S, Ding J, Zhang Y, Cheng X, Dong C, Song Y et al. The Journal of surgical research (2020)
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Complication Profiles by Mastectomy Indication in Tissue Expander Breast Reconstruction. — Chouairi F, Gabrick KS, Avraham T, Markov NP, Alperovich M Plastic and reconstructive surgery (2019)
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Novel Approach for Risk-Reducing Mastectomy: First-Stage Implant Placement and Subsequent Second-Stage Mastectomy. — Lim GH, Baildam AD Plastic and reconstructive surgery (2018)
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Expansion Vibration Lipofilling: A New Technique in Large-Volume Fat Transplantation. — Del Vecchio D, Wall S Plastic and reconstructive surgery (2018)
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Total Cheek Reconstruction Using the Pre-Expanded Medial Arm Flap With Functional and Aesthetic Donor Site Closure. — Xue B, Liu Y, Zhu S, Zang M, Chen B, Li S The Journal of craniofacial surgery (2018)
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Recent Advances on the Application of Negative Pressure External Volume Expansion in Breast Plastic Surgery. — Liu W, Luan J Aesthetic plastic surgery (2018)
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Cost analysis of postmastectomy reconstruction: A comparison of two staged implant reconstruction using tissue expander and acellular dermal matrix with abdominal-based perforator free flaps. — Tran BNN, Fadayomi A, Lin SJ, Singhal D, Lee BT Journal of surgical oncology (2017)
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A Randomized Controlled Trial Comparing Endoscopic-Assisted Versus Open Neck Tissue Expander Placement in Reconstruction of Post-Burn Facial Scar Deformities. — As'adi K, Emami SA, Salehi SH, Shoar S Aesthetic plastic surgery (2016)
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Complications of nonbreast tissue expansion: 9 Years experience with 44 adult patients and 119 pediatric patients. — Adler N, Elia J, Billig A, Margulis A Journal of pediatric surgery (2015)
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A Comparison of Dermal Autograft and Acellular Dermal Matrix in Tissue Expander Breast Reconstruction: Long-term Aesthetic Outcomes and Capsular Contracture. — Lynch MP, Chung MT, Rinker BD Annals of plastic surgery (2015)
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Risk Factors Associated With Complication Rates of Becker-Type Expander Implants in Relation to Implant Survival: Review of 314 Implants in 237 Patients. — Taboada-Suarez A, Brea-García B, Magán-Muñoz F, Couto-González I, González-Álvarez E Annals of plastic surgery (2015)
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Risk Factors for Complications Differ Between Stages of Tissue-Expander Breast Reconstruction. — Lovecchio F, Jordan SW, Lim S, Fine NA, Kim JY Annals of plastic surgery (2015)
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AeroForm patient controlled tissue expansion and saline tissue expansion for breast reconstruction: a randomized controlled trial. — Zeidler KR, Berkowitz RL, Chun YS, Alizadeh K, Castle J, Colwell AS et al. Annals of plastic surgery (2014)
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Analyzing implant movement with tabbed and nontabbed expanders through the process of two-stage breast reconstruction. — Spear SL, Economides JM, Shuck J, Patel KM Plastic and reconstructive surgery (2014)
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Outcome analysis of expander/implant versus microsurgical abdominal flap breast reconstruction: a critical study of 254 cases. — Liu C, Momeni A, Zhuang Y, Luan J, Chung MT, Wright E et al. Annals of surgical oncology (2014)
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Improving fat graft survival through preconditioning of the recipient site with microneedling. — Sezgin B, Ozmen S, Bulam H, Omeroglu S, Yuksel S, Cayci B et al. Journal of plastic, reconstructive & aesthetic surgery : JPRAS (2014)
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Tissue expander complications in the pediatric burn patient: a 10-year follow-up. — Patel PA, Elhadi HM, Kitzmiller WJ, Billmire DA, Yakuboff KP Annals of plastic surgery (2014)
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External tissue expander for closing large defects of the extremities and trunk. — Kirschke J, Georgas D, Sand M, Bechara FG Journal of cutaneous medicine and surgery (2013)
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Risk factors and risk scoring tool for infection during tissue expansion in tissue expander and implant breast reconstruction. — Kato H, Nakagami G, Iwahira Y, Otani R, Nagase T, Iizaka S et al. The breast journal (2013)
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Dermal autografts as a substitute for acellular dermal matrices (ADM) in tissue expander breast reconstruction: a prospective comparative study. — Lynch MP, Chung MT, Rinker BD Journal of plastic, reconstructive & aesthetic surgery : JPRAS (2013)
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Human acellular dermal matrix (AlloDerm®) dimensional changes and stretching in tissue expander/implant breast reconstruction. — Wu C, Cipriano J, Osgood G, Tepper D, Siddiqui A Journal of plastic, reconstructive & aesthetic surgery : JPRAS (2013)
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The effect of microneedling with a roller device on the viability of random skin flaps in rats. — Baris R, Kankaya Y, Ozer K, Kocer RG, Bektas CI, Karatas A et al. Plastic and reconstructive surgery (2013)
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A predictive model of risk and outcomes in tissue expander reconstruction: a multivariate analysis of 9786 patients. — Hanwright PJ, Davila AA, Mioton LM, Fine NA, Bilimoria KY, Kim JY Journal of plastic surgery and hand surgery (2013)
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Selective capsulotomies of the expanded breast as a remodelling method in two-stage breast reconstruction. — Grimaldi L, Campana M, Brandi C, Nisi G, Brafa A, Calabrò M et al. Journal of plastic surgery and hand surgery (2013)
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Management of the radial forearm free flap donor site using a topically applied tissue expansion device. — Bonaparte JP, Corsten MJ, Odell M, Gupta M, Allen M, Tse D Oral surgery, oral medicine, oral pathology and oral radiology (2013)
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The impact of acellular dermal matrix on tissue expander/implant loss in breast reconstruction: an analysis of the tracking outcomes and operations in plastic surgery database. — Pannucci CJ, Antony AK, Wilkins EG Plastic and reconstructive surgery (2013)
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A comparative analysis of cryopreserved versus prehydrated human acellular dermal matrices in tissue expander breast reconstruction. — Seth AK, Persing S, Connor CM, Davila A, Hirsch E, Fine NA et al. Annals of plastic surgery (2013)
[75]
Management of the complications of tissue expansion during a 5-year period (2005-2010). — Karagergou E, Papas A, Foroglou P, Demiri E Journal of plastic surgery and hand surgery (2012)
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Comparison of immediate implant placement versus the staged tissue expander technique in breast reconstruction. — Roostaeian J, Sanchez I, Vardanian A, Herrera F, Galanis C, Da Lio A et al. Plastic and reconstructive surgery (2012)
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A meta-analysis of human acellular dermis and submuscular tissue expander breast reconstruction. — Kim JYS, Davila AA, Persing S, Connor CM, Jovanovic B, Khan SA et al. Plastic and reconstructive surgery (2012)
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15-year experience with soft tissue expansion in total knee arthroplasty. — Long WJ, Wilson CH, Scott SM, Cushner FD, Scott WN The Journal of arthroplasty (2012)
[79]
Successful treatment of large forehead defect after the failure of tissue expansion: changing plan and strategy. — Kim SW, Kim YH, Kim JT The Journal of craniofacial surgery (2011)
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The low transverse extended latissimus dorsi flap based on fat compartments of the back for breast reconstruction: anatomical study and clinical results. — Bailey SH, Saint-Cyr M, Oni G, Wong C, Maia M, Nguyen V et al. Plastic and reconstructive surgery (2011)
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[82]
Viability analysis of subepithelial connective tissue grafts subjected to a mechanical expansion process: a histologic study in dogs. — Benfatti CA, Bez L, Magini Rde S, Greghi SL, dos Santos CF The International journal of periodontics & restorative dentistry (2011)
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Cost-effectiveness of a topically applied pre-operative tissue expansion device for radial forearm free flaps: a cohort study. — Bonaparte JP, Corsten M, Allen M Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery (2011)
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Lateral intercostal artery perforator flap used in salvage of exposed tissue expander of breast: case report. — Unal C, Gercek H, Yasar EK, Utkan Z Microsurgery (2011)
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Acellular human dermis implantation in 153 immediate two-stage tissue expander breast reconstructions: determining the incidence and significant predictors of complications. — Antony AK, McCarthy CM, Cordeiro PG, Mehrara BJ, Pusic AL, Teo EH et al. Plastic and reconstructive surgery (2010)
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Acellular dermis-assisted breast reconstruction with the use of crescentric tissue expansion: a functional cosmetic analysis of 40 consecutive patients. — Buck DW, Heyer K, DiBardino D, Bethke K, Kim JY Aesthetic surgery journal (2010)
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The pedicled subpectoral fascia flap for expander coverage in postmastectomy breast reconstruction: a novel technique. — Saint-Cyr M, Nagarkar P, Wong C, Thakar H, Dauwe P, Rohrich RJ Plastic and reconstructive surgery (2010)
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Use of the serratus anterior fascia flap for expander coverage in breast reconstruction. — Saint-Cyr M, Dauwe P, Wong C, Thakar H, Nagarkar P, Rohrich RJ Plastic and reconstructive surgery (2010)
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Studies of injection ports of permanent expandable breast implants. — Ulrik AF, Matzen S Journal of plastic, reconstructive & aesthetic surgery : JPRAS (2010)
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Expander/implant reconstruction with AlloDerm: recent experience. — Namnoum JD Plastic and reconstructive surgery (2009)
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An alternative method of using an interpositional silicone sheet in tissue expansion. — Borman H, Deniz M, Bahar T, Bilezikci B, Tufan H, Haberal M The Journal of craniofacial surgery (2009)
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The osmotic tissue expander: a three-year clinical experience. — Obdeijn MC, Nicolai JP, Werker PM Journal of plastic, reconstructive & aesthetic surgery : JPRAS (2009)
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Acellular dermis-assisted breast reconstruction. — Spear SL, Parikh PM, Reisin E, Menon NG Aesthetic plastic surgery (2008)
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The effect of closed-suction drains on the incidence of local wound complications following tissue expander/implant reconstruction: a cohort study. — McCarthy CM, Disa JJ, Pusic AL, Mehrara BJ, Cordeiro PG Plastic and reconstructive surgery (2007)
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Use of acellular cadaveric dermis and tissue expansion in postmastectomy breast reconstruction. — Bindingnavele V, Gaon M, Ota KS, Kulber DA, Lee DJ Journal of plastic, reconstructive & aesthetic surgery : JPRAS (2007)
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Local infiltration of anaesthesia with subpectoral indwelling catheters after immediate breast reconstruction with implants: a pilot study. — Turan Z, Sandelin K Scandinavian journal of plastic and reconstructive surgery and hand surgery (2006)
[97]
Early experience with the crescent expander in immediate and delayed breast reconstruction. — Eriksen C, Stark B Scandinavian journal of plastic and reconstructive surgery and hand surgery (2006)
[98]
Dual porosity expanded polytetrafluoroethylene for soft-tissue augmentation. — Williams SK, Patula VB, Kleinert LB, Martakos P, Lane JP, Karwoski T Plastic and reconstructive surgery (2005)
[99]
The efficacy of continuous local anesthetic infiltration in breast surgery: reduction mammaplasty and reconstruction. — Lu L, Fine NA Plastic and reconstructive surgery (2005)
[100]
Use of tissue expansion for scrotal sac reconstruction after scrotal skin loss. — Rapp DE, Cohn AB, Gottlieb LJ, Lyon MB, Bales GT Urology (2005)