Secondary procedure to improve split thickness skin graft on abdomen--tissue expanders?

I have a large split thickness skin graft on my lower abdomen.  It is about 5"high by 6" long, and underneath my belly button, extending down towards my pubic region.  It is the area left from where I had a flap taken.  Because I had very little etra fat, I had to have the skin graft to close the defect.

Now I am about 6 months post op and am looking to get a more normal looking stomach.  I have approached a surgeon and he said tissue expanders could be put along the sides of the scar, slowly expanded, and then the skin brought together giving me a midline scar, which would be awesome.

Does this sound like the best approach?  Does it sound like something insurance will cover?  My skin graft causes me pain and "nerve" type impulses.

Thank you for your advice.  I am in Dallas so I know there are plenty of surgeons to chose from, but most seem to not want to deal with this type of reconstruction.

-Seb

[Howard Rosenberg, MD]

I have several concerns about the circumstances you have described.  First, it seems to me that your original surgeons, having prepared a flap and covered the defect with a skin graft, should be in the best position to determine the feasibility of the potential of removal of the graft for cosmetic purposes.  They best understand your original procedure and the condition and nature of the graft bed and the adjacent tissue.

Secondly, it is not clear to me that placing a skin expander in the abdominal area  (without a rigid base) will work.  I have placed many skin expanders, but always against a solid base like the chest wall rib structure, over the cranium, or over an extremity or hip bone.  This allows expansion of overlying skin with a rigid structure behind the expander.  I have no experience with an expander placed over the non-rigid abdominal cavity.  I wonder if this will work.

Get the advise of your original surgeons and/or some other experienced reconstructive plastic surgeons before proceeding.

[tryingforreal]

thank you for your input.  I'll discuss this with the surgeon.  I'm also getting a second opinion so I'll see what the other doc says.