Can Tissue Expansion Be Used For Calf Implants?
Q: Dr. Eppley, This is a follow up question in regards to your response to the question about using calf implants to correct the affects of polio. Is it not possible to use some type of balloon to stretch the skin in order to increase the amount of area available to accommodate the implant (similar to what is done for breast implants when someone significantly increases their cup size)?
A: Your question regarding the use of tissue expansion for calf implants is a good one and has some merit. However there is one major problem with it.Tissue expansion works most effectively when it has something hard to push off against. This allows the effects of tissue expansion to go in one direction, outward to the skin which can be stretched. This is why it works so effectively for breast reconstruction (ribcage) and the scalp. (skull) In the calfs, what lies underneath the fascia (which is where calf implants are placed) is the soft gastrocnemius muscle. With a very tight overlying fascia (like a trampoline) and soft muscle underneath, the effects of tissue expansion would be displaced inward and would have little effect on stretching out the overlying skin. One could place the tissue expander above the fascia in the subcutaneous plane right under the skin with the objective of eventually placing the calf implants in that plane. It is associated with a higher rate of complications (infection, visible outline of the implant) but may be reasonable given few other calf implant options. Besides tissue expansion, one could also do a first-stage fat injection to help both stretch the skin and create a better vascular bed for the second stage implant placement.
Dr. Barry Eppley