Beyond expansion: the strategic role of the tissue expander in immediate breast reconstruction

Background

Immediate tissue expander breast reconstruction remains widely used after mastectomy, but its contemporary role extends beyond progressive skin-envelope expansion. By providing adjustable volume and tension control, accommodating oncological sequencing, and preserving future reconstructive options, the tissue expander may serve as a strategic tool when the definitive reconstructive pathway remains uncertain. This focused narrative review evaluates the factors guiding immediate reconstructive strategy, integration with postmastectomy radiotherapy (PMRT), comparison with direct-to-implant (DTI) reconstruction, and the role of tissue expanders in delayed-immediate reconstruction.