Tissue expanders are similar to a saline implant in which both come empty or as a silicone shell. The expanders are textured and thicker than a regular saline implant. They do have a metal backing behind the valve so when the tissue expander is being filled in the office, the needle doesn't puncture the implant. As women are getting filled each week they are feeling tighter and heavier in their breasts. It can be very uncomfortable but tolerable when the expanders are filled to their capacity or beyond, since they can be over filled. Some patients need a valium for muscle spasms when they are expanded, and fewer patients need pain medicine.. I hope this helps....