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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.
Yes, breast reconstruction tissue expanders can cause pain as they expand. Expanders that are under the muscle have been shown to be slightly more painful than those on top of the muscle. I do perform both kinds of tissue expander placements. I offer and make sure the patients have adequate pain medication and pain control during the expansion process to help alleviate pain. Most women can tolerate expansion process with over the counter Tylenol or Ibuprofen, however some may need a muscle relaxer.
Most patients do not experience too much discomfort during the tissue expansion process. In order to perform the expansion the skin will be cleaned and prepped, using a special magnet the port on the expander will be located. A needle is placed through the skin into the tissue expander. Most women experience numbess of the breast after mastectomy so the use of the needle isn't typically painful. On average we expand 60-100cc's (1.7-3.5oz) per weekly visit. As your expander becomes more full, sometimes patient experience soreness after the procedure. This is normally managed with NSAIDs and ice. There is a new type of tissue expander which contains air. AeroForm expanders contain a small CO2 cartridge that all the expander to be inflated slowly. This expander also doesn't require any needles. Most patients perform the expansions themselves on a daily basis. The expander works with a personal remote control. When the remote is held up to the breast in the correct position, it just requires the touch of a button to inflate the expander 10cc's (1/3rd of an ounce). This also saves patients from weekly office visits for expansion. Not all hospitals offer AeroForm expanders, but they are a great option for breast reconstruction patients.
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.
