After Bilateral Mastectomy, my Expanders Are Excruciating

I Was a 34A at Best. I am afraid my body is too small to accommodate the smallest expanders available, and I am seriously thinking of ending the reconstruction. I should mention that my mastectomy was a little over 3 weeks ago, and we have not yet started filling the expanders.

Doctor Answers 15

Improving expander breast reconstruction recovery

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.

Seattle Plastic Surgeon
4.9 out of 5 stars 54 reviews

Submuscular tissue expanders are painful, but a revision can be done for a better cosmetic result, less pain & deformity

The traditional technique of breast reconstruction using implants employs a two-stage technique, whereby a flat tissue expander is first inserted beneath the pectoralis major muscle, slowly (and very painfully) expanded.  Later, the temporary tissue expander is removed and a permanent implant is placed.

Unfortunately, for most women, this entire process is lengthy and is associated with a significant degree of discomfort!  This is why I was tempted to find a better way to do breast reconstruction using implants!!!

In my practice, I perform a state-of-the-art technique whereby a single-stage implant reconstruction is done.  At the time of the mastectomy, a permanent, adjustable implant is placed, and inflated 60% to 80% of the way at the time of surgery.

The adjustable implant is not placed beneath any muscle, but in the exact space that the breast tissue was in - i.e. "subcutaneously". This is often combined with a nipple-sparing mastectomy (NSM) for the optimal cosmetic result!

One to two weeks later, one or two additional inflations are performed in the office until the desired aesthetic result is achieved.  This gives the patient (i.e. YOU!) control over the final result, instead of you having the surgeon's vision of what they would like for you. 

If you have had a first-stage of a traditional two-stage reconstruction, or even if you have had your "final stage" and your implants are beneath the muscle, there is still hope!  A revision surgery can be done to replace your pectoralis muscles back to your chest wall (where they belong!), and implants moved to the space where the breast tissue used to be. 

This is major surgery that will involve drains, downtime and rest.  However, the results are often more natural-looking, with less discomfort and avoidance of the "motion deformity" with pectoralis major muscle movement.

Karen M. Horton, M.D., M.Sc., F.R.C.S.C.

Karen M. Horton, MD
San Francisco Plastic Surgeon
3.5 out of 5 stars 10 reviews

Breast Reconstruction with Tissue Expanders

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.

Max Polo, MD
Miami Plastic Surgeon
4.9 out of 5 stars 40 reviews

Pain with tissue expansion

Unfortunately, some pain with the tissue expansion process is normal, however, it sounds like your pain is more than is typically expected. You may want to visit with your surgeon to double check that everything is OK and that the pain is not the sign of a problem like a hematoma (which hopefully it is not).

In the event that the pain is not  the result of a problem, and just your body's response to the tissue expansion, you may want to consider alternate methods of reconstruction. Some natural tissue methods of reconstruction such as perforator flaps or fat grafting can be much less painful than tissue expansion. Perforator flas such as the DIEP and the SGAP flaps are generally very well tolerated, and almost every woman has a donor site available that can provide enough tissue for breast reconstruction in proportion to her body (even though this may not be possible from the abdominal tissue).

Best of luck, and I hope you are able to achieve a sucessful reconstruction with a minimum of further discomfort.

Tissue Expander Pain

I am sorry to hear of your pain after tissue expander placement.   I can understand your frustration in consideration of ending your reconstruction.   I ask that you consider a few points on the subject:

1.  You are only 3 weeks out, your pain is going to improve with time 

2.  Have your surgeon evaluate you frequently to ensure that you do not have an early infection or a retained fluid collection (r your drains still in?)

3.  Discuss with your surgeon the option of a muscle relaxer or anti-inflammatory agent to help ease your pain.

4.  Consider physical therapy to help with range of motion exercises and deep tissue massage.   the combination of these will help subside any pain due to scar tissue formation

I wish you a safe recovery and hope you are able to undergo your reconstruction.  All the best.


Paul S. Gill, M.D.

GIll Plastic Surgery

Houston Double Board Certified Plastic Surgeon

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 85 reviews

Give it some time

I would  give it a little more time yet for your pectoralis muscle in the chest to relax after being stretched.  This will likely improve in a couple more weeks then you can begin expansion in small increments.

Samer W. Cabbabe, MD, FACS
Saint Louis Plastic Surgeon
4.9 out of 5 stars 59 reviews

Pain After Tissue Expander Insertion

It is very normal to be in pain after a tissue expander reconstruction - even 3 weeks out from the insertion.  Some people are just more sensiive than others to this type of discomfort.  You can ask your surgeon if he can remove some of the fluid that was injected into the expander at the time of your surgery.  Also, 4mg valium every 6 hrs as needed is very effective at relieving the musculoskeletal discomfort associated with expanders.

Gary D. Breslow, MD, FACS
Paramus Plastic Surgeon
5.0 out of 5 stars 44 reviews

Bilateral Mastectomy, my Expanders Are Excruciating

After mastectomy, breasts can be reconstructed using a variety of methods. In general, techniques use autologous tissue (from your own body), implants, or a combination of the 2.

You and your surgeon chose to go with tissue expanders and from the preoperative size of your breasts, it sounds like you needed additional volume and stretching of your skin.

You are having pain after surgery. You are frustrated and are thinking about ending the reconstruction. Try to stick with it and see if you can make some adjustments. This is the most difficult time and things will become easier.

A few questions to consider…Did your surgeon fill the tissue expander intra-operatively? Are they submuscular? If yes, then ask your surgeon to deflate the tissue expander and see if that helps. If you are still having pain, then there should be some consideration to changing your tissue expander to a subglandular (above the muscle) location. That should do the trick, but remember, putting the TE above the muscle increases other issues with your implant. Ask your surgeon. Hope this helps, good luck.

Kenneth Bermudez, MD
San Francisco Plastic Surgeon
4.9 out of 5 stars 15 reviews

Tissue expanders are excruciating

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. 

Post op pain

I am assuming that you underwent a bilateral mastectomy and bilateral immediate reconstruction with tissue expanders. It is not unusual to have pain 3 weeks after the surgery.  You may be also experiencing some muscle spasms from the stretching of the pectoralis muscle.  Make sure you have adequate pain pills and maybe add a muscle relaxant.

If the pain is so severe that it can not be controlled with oral medication, then you might consider removing the expanders.  BUT, there is no guarantee that the expanders are causing the pain, it may be just normal post op pain from the mastectomies.  Removing the expanders would require another anesthetic and reopening your incisions again, maybe even replacing the drain tubes.  It would not be a picnic.

I would recommend holding off on any surgery for now and see if you can get a better handle on the pain control.

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 75 reviews

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.