Breast Reconstruction Q&A
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Do Breast Reconstruction Tissue Expanders Cause Pain As They Expand?
asked 3 years ago by anon
Latest answer by Chad K. Wheeler, MD
Question viewed 42,324 times
Tags: expander, pain, tissue expander
It seems like a tissue expander would be painful as it stretches the skin - am I crazy?
30 answers to Do Breast Reconstruction Tissue Expanders Cause Pain As They Expand?
+1
Tissue expansion process can have temporary discomfort
The amount of fluid placed into the expander during a visit can be tailored to minimize or avoid pain and discomfort. Tissue expansion is a process by which the skin and pectoralis major muscle are stretched in order to make room for a breast implant at a later date. Whether or not it hurts, or how much it hurts, really depends on how much fluid is placed into the tissue expander at any given time. If you place a small amount of fluid it does not cause much pain if any, but you need more...
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+3
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...
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+3
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...
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Lisa B. Cassileth, MD
Beverly Hills Plastic Surgeon
Beverly Hills Plastic Surgeon
+2
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...
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+2
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...
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+2
Gentle expansion after breast reconstruction should not be painful
Marcia,
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....
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+2
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...
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Shahram Salemy, MD
Seattle Plastic Surgeon
Seattle Plastic Surgeon
+2
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...
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+2
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.
+1
Expanding Tissue expanders does not typically hurt
Tissue expanders are used in breast reconstruction. The breast has been removed at the time of th emastectomy and therefore the nerves that go to the skin are severed. Therefore the numb mastectomy skin does not typically hurt to expand. The pectoralis muscle can ache the day after expansion and feel like you worked out. This pain is usually controled with just ibuprofen
+1
Tissue expander breast reconstruction
During the tissue expansion process, it is not uncommon to experience some discomfort. This may be likened to discomfort associated with a muscle strain or pull (like after a workout). This is usually temporary and relieved with medication such as ibuprofen
Loren Schechter, MD
Chicago Plastic Surgeon
Chicago Plastic Surgeon
+1
Understanding Breast Reconstruction Tissue Expanders
Pain experienced from a breast reconstruction tissue expander typically is caused by the way in which the underlying muscle stretches. In general, the pain is mild, usually described as a discomfort and feeling of pressure by my patients. One strategy that can reduce the pain is to not expand too rapidly. I carefully regulate the volume of saline injected and the expansion intervals for improved patient comfort.
James Romanelli, MD
Long Island City Plastic Surgeon
Long Island City Plastic Surgeon
+1
Initial Discomfort After Breast Reconstruction
Although there is normal post-operative pain after the initial placement of the tissue expander, the expansion process itself should be relatively pain free. The idea is to perform serial tissue expansion. If small amounts are added at regular intervals, the skin and muscle can stretch comfortably and without pain.
Leo Keegan, MD
Manhattan Plastic Surgeon
Manhattan Plastic Surgeon
+1
Tissue expansion can be uncomfortable, but should not be painful
Tissue expansion of any type can cause some amount of discomfort and is highly dependent upon the volume and the rate of the expansion. Pain should be a guide as to when the expansion should stop and allow your tissues catch up to the amount of expansion that can be tolerated. 50cc is an average volume of expansion for breast expanders and is usually well tolerated.
+1
Pain and Implant Expander Breast Reconstruction
Most patients experience some discomfort for several hours after inflating the expander.
The amount of discomfort is often proportional to the amount of fluid instilled into the expander at a given session. However, most patients would not characterize it as painful.
If I find that the patient is very uncomfortable after injecting fluid to enlarge the volume of the expander, I remove some of the fluid and this reduces the discomfort.
If you are...
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+1
YES, try to avoid expanders if possible!
The use of tissue expanders do hurt as the skin and muscle STRETCH. This is why I developed the DIRECT to implant method.
C. Andrew Salzberg, MD
Westchester Plastic Surgeon
Westchester Plastic Surgeon
+1
Tissue Expanders for Breast Reconstruction Typically Cause Pain as They are Expanded
Breast implants used in reconstruction cannot generally be placed directly in the space created by the removal of breast tissue. This is because an implant placed directly below the skin will generally not produce cosmetically desirable results and will be at high risk for eroding through the surgical incision, or through the skin itself.
In order to create space and prepare the chest for reconstruction using a breast implant, a tissue expander can be used to progressively stretch...
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+1
Tissue Expander Expansion
Implant-based reconstruction is done very commonly. Typically, it is done in two stages: 1) placement of tissue expander at the time of mastectomy or delayed, 2) removing tissue expander and placing implants. As you probably know, between the 1st and 2nd stage of the reconstruction, you have to undergo expansion process. Good and bad thing about mastectomy is that you are going to be pretty numb afterwards so when you go through the expansion process, it does not hurt...
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+1
Tissue expanders for breast reconstruction - Painful?
One of the most common techniques for breast reconstruction is the use of tissue expanders (with or without a dermal matrix graft e.g. Alloderm). It is a relatively shorter procedure than autologous reconstruction (e.g. TRAM, DIEP). In my opinion, implant-based breast reconstruction is a good option for the following patients:
1) Women who already have breast implants,
2) Women who have A-cup or B-cup breasts,
3) Women with minimal breast ptosis (sagging breasts),...
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Peter Ashjian, MD
Bakersfield Plastic Surgeon
Bakersfield Plastic Surgeon
+1
Breast Reconstruction - Tissue Expanders
To date, the most common form of breast reconstruction is with tissue expansion and ultimately expander/implant exchange. The expansion process can be uncomfortable, but most women are able to continue their daily activities during the expansion process. Pressure or discomfort can be used as a signal to stop the expansion in any given session to limit the amount of pain associated with expansion.
Asaad H. Samra, MD
Red Bank Plastic Surgeon
Red Bank Plastic Surgeon
+1
Do Tissue Expanders cause Pain?
During the expansion process, the goal is to expand the skin and muscle over time ensuring the skin is not stretched too fast and patients do not suffer through any unnecessary pain. If the expansion process is done gradually, most patients are able to continue their daily activities. Some patients can have some pain during the last few weeks of expansion.
Ankit Desai, MD
Jacksonville Plastic Surgeon
Jacksonville Plastic Surgeon
+1
Expansion can have minimal discomfort if done properly
Placement of tissue expanders following breast reconstruction is a very common method of reconstruction. The process involves injecting saline, through a port in the expander, in the office on a weekly basis. The amount of saline placed is determined by your plastic surgeon at each visit. The amount of saline injected can vary based on the amount of discomfort you experience during and after each expansion. When done properly, with the patients feedback, tissue expansion can be a...
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David A. Robinson, MD
Munster Plastic Surgeon
Munster Plastic Surgeon
+1
Breast reconstruction tissue expanders can cause pain but usually not
Hello,
Sensations are blunted a great deal by the mastectomy (surgery to remove the breast with the cancer) that preceeds tissue expansion. Sometimes patients feel a little discomfort but usually they are numb. A feeling of "pressure" with expansion is more common which is not uncomfortable. Expanding slowly can also make the expansion experience less uncomfortable.
Best Regards,
John Di Saia MD
+1
Tissue expanders should not
If the expansion process is done correctly, there should be no discomfort at all. Some tightness may be felt but again, can be kept to a minimum when a good, experienced person is performing the expenasion.
Michael S. Beckenstein, MD
Birmingham Plastic Surgeon
Birmingham Plastic Surgeon
+1
Pain gets beter with time
When adding fluid to a tissue expander via the filling port the idea is to fill it up to the level of patient tolerance. Most of my patients take Advil or similar products the night of the filling. As the tissue begins to loosen up the discomfort will definitely decrease.
Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
Atlanta Plastic Surgeon
+1
Tissue expander pain happens
In my experience as related by my patients, it is not unusual for patients to tolerate the expansions as they occur. However, they often reported discomfort 4-6 hours later which could be managed with tylenol or pain medications.
If a patient experienced pain or excessive tightness during the expansion injection, I would simply remove some fluid until relief was felt.
Otto Joseph Placik, MD
Chicago Plastic Surgeon
Chicago Plastic Surgeon
+1
Tissue expanders may cause discomfort
As the tissue is expanded, it can be uncomfortable for some patients. Most tolerate it extremely well. Some patients prefer autologous tissue reconstruction just to avoid these intermittent steps of treatment after expander placement and then subsequent additional surgery for the permanent implant placement.
+1
Very Little pain with expansion - breast reconstruction tissue expanders
Tissue expanders are relatively painless. Skin and many of your soft tissues can be stretched with relatively little to no pain at all.
Think about when you eat a large meal like Thanksgiving and your belly sticks out. If you measure your waist it's probably a few inches larger than it was just before Thanksgiving. Now imagine doing that every week for a few months. You're belly would get quite alot larger with realtively little pain. (This is not an experiment you should try :)) Your...
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Edward S. Lee, MD
Englewood Plastic Surgeon
Englewood Plastic Surgeon
+1
Expansion should be done short of pain following mastectomy
Adding more volume to expanders following mastectomy is done slowly allowing the tissues to expand with minimal tension.
The office injection has to be short of pain. If the patient feels some pain, the injection stops or some fluid could be taken out.
Hope that helps!
+1
May be a bit uncomfortable but not painful.
Tissue expanders are used for many different purposes in plastic surgery. The most common is for breast reconstruction. In order to fill the tissue expander, a small needle is passed through the skin to the injection port. This port can be part of the tissue expander, or separate from it. Injectable saline (sterile water) is placed inside the expander. This is done until the expansion is slightly uncomfortable but not painful (basically as much as the person can take). I generally tell...
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