Do Breast Reconstruction Tissue Expanders Cause Pain As They Expand?

Hello,

All patients will experience some degree of discomfort after an expander breast reconstruction.  This initial discomfort mostly settles over the first 2-3 weeks, but it can take up 6-8 weeks to really feel back to normal and some people still get the odd twinge for a several months.  Most people start their expansion at least 3 weeks after their surgery once most of this initial discomfort has started to settle and the scars have been given sufficient time to heal.  Whilst expansion can be a bit tender, this can usually be avoided by not inflating too much at a time.  In a delayed breast reconstruction after a mastectomy a few months or years previously more expansions are usually required.  
However, these days more women are opting to have breast reconstructions at the same time as their mastectomy.  In these cases most of the skin can usually be preserved and very little, if any, expansion is then required.  Some women are suitable for nipple sparing mastectomies.  This is often a good option for women having risk reducing mastectomies such as BRCA gene carriers, but is also often possible for women with cancer.  When it is possible to preserve the whole of the breast skin including the nipple and areola it is rare to need much if any tissue expansion at all and sometimes also possible to put a permanent silicone implant in at the time of the initial surgery and hopefully save you an extra operation later on.
Regardless of which option you go for the discomfort tends to settle.  The most important thing is to chose the right operation that is most likely to give you a good result long-term.  Do your research carefully and seek advice from an appropriately qualified surgeon that you trust.  If you are having your cancer treated at the same time as your reconstruction you should aim to get on with this within a reasonable time frame.  If you don't have cancer or have had it treated already there is really no pressure with this so take your time to explore all the options.  Good luck with it all!

Thank you for your question. Many breast reconstruction patients ask me about what they can expect with tissue expanders.
For many breast reconstruction patients, the first step involves placement of a breast tissue expander--a breast-shaped device with an easy-to-access port--regardless of whether the patient' final result will be an implant reconstruction or a living tissue reconstruction. This inflatable device is wrapped in a regenerative support scaffold and placed carefully under the mastectomy skin at the time of your initial mastectomy surgery. In some cases, this is placed under the pectoralis muscle. When appropriate, I prefer to do a less invasive implant reconstruction in which the implant is placed on top of the pectoralis muscle. This reconstruction can performed with a nipple-sparing mastectomy for an exceptionally natural-looking result.
Depending on the desired size of your new breast, the tissue expander will be expanded once every 1-2 weeks at your surgeon's office by the addition of saline through the port. This will stretch your skin until it can accommodate your desired breast size.
Surgery to insert the tissue expander takes me about two hours, and I inject a long-lasting pain blocking medication to reduce postoperative pain. My patients spend one night in the hospital. Several surgical drains are used in the breast and stay in for two weeks.
Most patients have little to no pain associated with their tissue expanders. In very thin patients, there are sometimes complaints of discomfort along the upper ribs. This is usually resolved by decreasing the volume of saline in the expander. If the patient is experiencing pain, we will decrease the volume, then add more saline to the expander 1 week before the final implant or living tissue surgery.

Typically there is very little pain with the expansion as the expanders are filled every 7 - 10 days with fluid.