It can hurt sometimes, especially if you are slim.

If you think about it, an expander is not really expanding your skin very much. Especially if you have received a skin sparing mastectomy, your skin is very close to the right amount of skin that you need. The expander is really stretching out the muscle, which is flat to your chest at the time of mastectomy, and the tissue expander is placed under the muscle with minimal fluid in it. Then the plastic surgeon stretches it out with each fill, giving your breast extra layers of coverage. Now that you have this concept down, you can understand the achiness that sometimes follows expansion. Usually it is more like pressure or muscle soreness. Most people do great with some motrin. Honestly, though, a few patients have to stop expansion because they feel so tight. The pain can be minimized by having your surgeon perform smaller fills - like 25cc at a time. Of course, this does prolong the process. You can ask about flap reconstruction or immediate implant placement as alternatives to the tisue expansion process.

Pain is very subjective and variable. Some patients have little pain and some a great deal. Usually the expansion process is governed by the condition of the soft tissue (i.e. pliable vs. less pliable, well-vascularized vs. less well-vascularized) as well as pain experienced by the patient.

Once a patient feels some tightness or discomfort, I stop the injection, wait to see if the sensation resolves, and then decide to remave a little, quit, or add a bit more. The nice thing about expansion is that you can go as slow as you want and can leave the expanders in as long as you need to.

The other option is to do serial implants. You put in a size that the tissues can comfortably and safely accommodate, wait a few months and let the tissues stretch. Then when things are looser, you go back in and insert a larger implant. This works quite well in patient undergoing skin-sparing mastectomies who don't want to be very large.

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