After Bilateral Mastectomy, my Expanders Are Excruciating

Although your symptoms may be entirely normal, I would need more information to advise about your specific case. For example, the traditional approach using the "total submuscular" technique is typically quite painful, and the expansions can be difficult as well. The trend now is to use Alloderm to support the bottom and sides around the expander. This avoids having to dissect up the muscles that are the most tight and painful, while also giving a lot of control over the shape. Hopefully this was done in your case, and things will settle down. Either way it is early and it will get better.

The smallest tissue expanders are 350 cc, and I have reconstructed breasts where the total volume removed from each breast was 80-90 cc. Thus, I can understand completely if even the smallest completely unexpanded tissue expander under your muscle causes pain in a small-breasted woman. In these cases, you have a few options. First, you should know that the smallest size implant is 100 cc, so when you exchange your tissue expander for the permanent implant, you can have a smaller implant. That said, a 100 cc implant may have a narrow base width that makes it look like you have a small bean bag under your skin. Another option is to forego implant-based breast reconstruction altogether. If you undergo autologous tissue breast reconstruction (with your own tissue), you can have a natural and normal-looking breast that is closer to your original size. If you don't have enough tissue in your abdominal area, you can go to other donor sites such as the upper inner thighs (PAP flap) or buttock (GAP flap). With autologous tissue breast reconstruction, you can have a natural appearing breast reconstruction that is over your muscle, so that you don't have the discomfort of stretching out your pectoralis muscle. 

Breast reconstruction with tissue expanders is a very painful operation. I doubt that there is any way that your body is too small to accommodate the smallest expanders. I don’t think that this is the problem. Creating the pockets for the expanders is what hurts, and now that this has been done, you have been through the worst part. You are probably still experiencing the normal pain expected after surgery. It seems that it is somewhat more severe in your case. I would encourage you not to end the reconstruction. Things should get better soon. Filling the expanders can wait until you are feeling better. In fact, removing some of the fluid placed in the expanders at the initial surgery may relieve some of your discomfort. Another option is to ask your surgeon for a referral to a pain management specialist. There may be some more effective pain medications for you to take. Topical anesthetics or even intercostal nerve blocks may also be of help in getting you through this difficult but temporary phase.