It seems like a tissue expander would be painful as it stretches the skin - am I crazy?
Do Breast Reconstruction Tissue Expanders Cause Pain As They Expand?
Doctor Answers (39)
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.
Tissue Expander Breast Reconstruction and Pain
Trey Aquadro, M.D.
East Alabama Plastic Surgery
Tissue expanders placed beneath the muscle for breast reconstruction can be painful
The traditional technique for breast reconstruction using an implantable prosthesis involves at least two stages, including placing a flat tissue expander beneath the pectoralis major muscle. This expander is slowly inflated over weeks to months, and then a permanent implant is placed at a second operation. Often, a third procedure is needed to recreate a nipple and areola, if these have also been removed.
In my practice, I usually perform a single-stage, immediate implant reconstruction in women who wish to have implants for reconstruction and where the mastectomy is performed at the same time - i.e. and "immediate reconstruction".
The main difference is the device used: I use a permanent, but postoperatively adjustable device that is mostly filled at the time of the mastectomy (60% to 80% of the way). The skin of the breast is in fact not stretched or expanded, but simply "filled" out by one or two additional inflations in the office. By two weeks after surgery, the size of the breast is achieved!
In addition, I rarely place the implant beneath the muscle. I instead place the implant directly where the breast tissue was, beneath the skin and fat of the breasts. This avoids pain of stretching out the pectoralis muscle (which is a flat muscle), and also avoids deformity of the breasts every time the muscle is activated - i.e. with most upper arm motions.
For additional information on this option for breast reconstruction, I invite you to visit my practice website where the technique is described in much greater detail.
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.
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Tissue expander pain
The discomfort from tissue expansion in mastectomies is usually from stretching of the muscle. The skin that remains after mastectomy is usually numb as the nerves to it have been cut. The muscle pain is often described as tightness or a spasm, and is caused by the stretching of the muscle as the expander is filled.
There are several ways to decrease the pain associated with expansion. It begins by the technique used during the initial surgery. If your surgeon uses a tissue matrix (such as Alloderm) to cover the lower half of the expander, this allows for less painful expansion. Also, muscle relaxants can give excellent pain relief. When undergoing an expansion, you may feel some tightness as the expander fills. Letting your surgeon know when you feel this tightness and halting expansion that day can minimize your discomfort.
Gentle expansion after breast reconstruction should not be painful
You are not crazy. Aggressive expansion can be painful. However, if you do not rush the process and use appropriate medications, such as pain medications and valium, gentle expansion of the muscle/skin envelope does not have to be painful.
Additionally, if your surgeon uses Alloderm or some other dermal substitute during your expander placement, it may be possible to expand more during the initial operation, leaving less expansion to do in the office. Good luck with your surgery.
You shouldn't have pain from breast reconstruction expanders
In my San Francisco area practice we perform autologous and implant reconstructions.
Breast implant reconstructions typically need to be performed in stages. The first stage is the placement of a tissue expander that has a much thicker shell and a specialized port designed to allow injections to expand the implant over time.
This expansion stretches your skin, subcutaneous tissue and pectoralis muscle (if the expander was placed under the muscle - which is typical).
Expansion is performed usually in the office and is a quick 10 minute procedure. The feeling of a slight tightness is used by a guide as to when to stop the expansion. It should not be painful. Most patients can tolerate about 60 - 100 cc per expansion. Typically this number is larger as time goes on. It is important to remember that some patients may tolerate significantly more or less.
Patients will also notice that tissue expanders are significantly more firm than normal implants and some adjustment may need to be made in terms of placement.
Any time you have post-operative concerns be sure to discuss these with your surgeon.
I hope this helps.
The discomfort from expanders is usually minimal
Breast reconstruction with tissue expanders and implants continues to be a very popular option for women with breast cancer. After the expander is placed, saline is used to slowly fill the expander and stretch the skin on a regular basis-- this can vary from every week to once every several weeks. Some women experience some mild discomfort for a day or so after the expansion, in particular if there is a large amount of saline used at each visit. However, this discomfort is usally controlled with tylenol, is temporary, and resolves within a day or so.
Pain may be a determinant of rate of expansion
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.
Expanders are well tolerated
The first time the expander is inflated, there is often anxiety on the part of the patient but once they realize that the process is easy and usually painless, they tolerate the remaining expansions well. The first expansion might cause some very mild discomfort, but the subsequent ones are quite smooth.
Pain with expansion in breast reconstruction
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.