Continued pain with tissue expanders. What should I do?

Question

I had delayed breast reconstruction with bilateral tissue expanders in January 2015. My last fill was 2 weeks ago. My right breast is free of any pain, but my left breast (previous cancer side) is very painful 24/7...the pain extends to my left shoulder blade area. I've tried Advil, Percocet and Soma without any relief. There is no redness or fever. My PS suggested a Pet CT scan. I'm worried about getting that done due to the high amount of radiation and more cancer risk. What should I do? Help!

Dean Trotter, MBBS, FRACS · Answer

It is not uncommon for tissue expanders to be painful.  I think in the short term if you are very uncomfortable and not coping with regular painkillers then you may have to see your PS to have some fluid removed from the device.In the longer term, you may have to expand slowly with small volumes so that you don't flare up the pain.If you've had radiation therapy to that side then you may need to consider other options - your PS will be able go over these with you.I'm not sure that you need a CT scan however your PS knows your medical history well and probably has a good reason for ordering one.  I suggest you discuss your concerns regarding the scan with them.  You are correct in saying that there is radiation from the scan but it is thought to be a very low risk for inducing cancer and most likely the benefits vastly outweigh the risks.Your PS will also be able to advise some other medications that you can try.  Massage also helps in most cases.All the best,Dean

Jeffrey Nelson, MD · Answer

I'm sorry your having some pain issues with your expansion, however this is not uncommon. Since you didn't mention it I will guess you didn't have radiation therapy on the left side. If you did, the radiation therapy alone can cause some more nerve pain on the radiated side. Don't expect your pain to be the same on both sides, it can be very different one side or the other during expansion. All it takes is one nerve or portion of muscle to be more scared in or irritated and the pain can be much greater, especially in a delayed reconstruction where more scar tissue build before starting this stage. If it's sever enough the surgeon can remove some fluid from the expander, but then you loose some time getting to the next stage. Neurontin and some other meds might be considered, but that's a call for your doctors to make on your behalf.

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