Possible to Have over the Muscle Breast Augmentation After Mastectomy?

It is quite common to have pain during the expansion process. This seems to be particularly worse about 4-6 hours after each expansion rather than immediately with injection. Typically surgeons may over expand and then place a final implant that is smaller than your fully expanded size which should provide you with some relief. The rate of complications and unacceptable appearance wtih over the muscle placement ( exposure, extrusion, capsular contracture, visible rippling, etc) generally preclude placing implants in that location following mastectomy.

Hi,
Thank you for your question.
Expander pain and cardiac pain are very different. However, every patient is different and therefore experience different symptoms. It should not be assumed that the pain is from your expander, althought it is very common to experience this pain while your tissue is expanding. I would definitely seek medical attention just to be safe. Heart issues are often undiagnosed in women. Providing that the pain is from your expanders, the pain does subside in most patients once the implants are in.
Since you had a mastectomy, all of your breast tissue has been removed leaving basically just skin to cover the implant. The implants should be placed under the muscle to give more cushioning to the implants and provide the best results. There are products out there help with breast reconstruction such as Alloderm. It will provide more support. You should discuss all of your options and concerns with your surgeon.
Best regards,
Dr. Speron

Hi there-
Only your surgeon will have the understanding of what has occurred to date necessary to explain what might be causing your pain, and what options you have for improving it.
I would not, however, assume that your pain is due to the expanders being under the muscle, or that putting your implants on top of the muscle will make this better.
Talk to your surgeon about your situation and see what the two of you can come up with.

It is pretty common to be uncomfortable while the expansion process is ongoing. When you change to implants they are much softer and move with the body better than the expanders. I agree that putting the final implants above the muscle is probably not a good idea unless you have very thick skin flaps. You need to have adequate coverage over the implants or they can be felt and in some cases extrude. Discuss your concerns with your plastic surgeon, they should be able to allay your concerns.
Good luck,
Dr T

In most cases, it is best to have the implants below the muscle after mastectomy. During the mastectomy, all of the breast tissue was removed, which leaves only skin. It is not safe to only have a very think skin layer between the outside environment and the implant. If your expanders are in place under your muscle and you are still undergoing expansion prior to the final implants, you may have some discomfort during the expansion process. It is best to discuss this situation with your breast and plastic surgeons. If there is a lack of muscle then sometime a dermal substitute can be used to bridge the gap. Also, if you have muscle spasm, you may want to discuss Botox injection into the muscles to help them relax. Good luck with your recovery.