Tissue expansion for breast reconstruction and for improvement of large unsightly scars, not possible with standard local flaps, is a well-tried, effective method. Fifty-nine tissue expanders have been used in 46 patients at Groote Schuur Hospital since August 1982 for both breast reconstruction and scar revision. Expanders were placed in surgically dissected pockets and filling was performed on an outpatient basis. At a second operation the filled expanders were removed and the definitive operation performed. Complications encountered included deflation, exposure, infection, seroma and skin necrosis. Final results in most patients have been satisfactory. Tissue expansion has a wide application in reconstruction and has potential for even greater use in the future.