Causes and Management of Tissue Expander Pain

These may be used in preparation for breast implants or reconstruction

Tissue expanders are temporary, expandable, balloon-like devices used after a mastectomy to stretch breast skin and chest wall muscles. This is done so that the chest wall and skin can accommodate eventual breast implants, should you choose to have them.

Because of the stretching involved, tissue expanders can be painful or uncomfortable. However, there are a variety of ways to deal with the discomfort as you begin the process of breast reconstruction.

Read on to find out more about the process of using tissue expanders, things you can do at home to relieve the pain, medications to help, and physical therapy.

tissue expander
 Verywell / Brianna Gilmartin

Why Tissue Expanders Cause Pain

A tissue expander is usually put in during mastectomy surgery. The expander is inserted between the skin and chest muscle. The device is essentially a small pouch that will be expanded gradually over a period of weeks or months with saline injections through a fill port.

Tissue expanders can feel very hard and unnatural because they are thicker and less flexible than implants. Breast skin and nerves are usually numb after a mastectomy, so the pain is caused by the stretching of the muscle.

While pain is not uncommon when using a tissue expander, it should not cause changes in the color of the breast tissue. If it does, let your healthcare provider know as the device will likely need to be slightly deflated.

Muscle pain tends to be worst in the first 12 to 24 hours after the expander is filled, and generally subsides after two to three days. If you have expanders on both sides, one side may feel more painful than the other.

Sometimes the discomfort can be aggravated by other conditions. Capsular contracture, or scar tissue that forms around the expander, may also become a source of pain and stiffness. This type of pain is characterized by breast tenderness and soreness.

If you are also having radiation treatments, radiation fibrosis may cause pain around your tissue expanders as well. This is characterized by tenderness, redness, and, over time, increased firmness in the breast and chest area.

Simple pain-relieving strategies may be effective in managing tissue expander pain. When those aren't enough, medications or even adjustment of your expanders may be needed.

Self-care strategies for tissue expander pain.

Verywell / Britney Willson

Self-Care Strategies

There are many things that you can do on your own to improve your comfort while you have your expander in place. Some things to try:

  • A cold pack: Try applying a cold gel pack on the painful area for no more than 20 minutes at a time. Wrap the cold pack in a light cloth and move it frequently to avoid frostbite. (If you are receiving radiation therapy, icing may not be a good idea as your skin may be too sensitive.)
  • Distraction: Relaxation tapes and other distractions can take your mind off the pain. Meditation, guided imagery, and music therapy have shown proven benefits for people with cancer pain.
  • Slow stretches: Try some slow and gentle arm exercises to stretch your chest muscles, increasing your range of motion little by little. It's important not to do this too rapidly or you may add to your discomfort.

Medications

Tissue expander pain can be controlled by prescription medications and other strategies. Your healthcare provider may recommend:

  • NSAIDs: A 2017 study in Cancer Control reported that taking a nonsteroidal anti-inflammatory drug (NSAID) like Advil (ibuprofen) or Aleve (naproxen) 30 minutes before each fill and again a few hours afterward can usually provide sufficient pain relief during tissue expansion.
  • Lidocaine skin patch: These patches, available over the counter, may help relieve moderate tissue expander pain. Talk to your healthcare provider before using them as they can sometimes cause skin irritation that increases the risk of infection, especially for those undergoing radiation therapy.
  • Muscle relaxants or opioids: These prescription medications may be used if NSAIDs fail to provide relief but should be used sparingly and only to ease the worst pain directly after a fill.
  • Local anesthetics, blocks, and Botox: Anesthetic injections, nerve blocks, and Botox (botulinum toxin A) injections are reasonable options for women experiencing severe pain during tissue expansion. They should only be used under the direction of the treating healthcare provider.

Physical Therapy

It's extremely common for women to have chest and shoulder discomfort and stiffness after a mastectomy, and it can be difficult to know whether the pain is due to the expander or changes related to surgery and/or radiation.

Some oncologists believe that the majority of women could benefit from cancer rehabilitation, especially physical therapy, after a mastectomy to maximize comfort and mobility.

A 2019 study in the Journal of Breast Cancer concluded that early rehabilitation after mastectomy and tissue expander placement significantly improves shoulder mobility over the long term.

The best option is to see a physical therapist who is specifically trained in cancer rehabilitation and has experience working with women who have had breast cancer surgery.

Together, you can work out a plan that includes both in-office and at-home procedures and exercise to not only minimize pain but better enhance mobility and the tissue expansion procedure.

When to Call a Healthcare Provider

When it comes to tissue expander pain, it's always best to err on the side of caution and call your healthcare provider if the pain is persistent, worsening, or causing you undue stress or loss of sleep.

Tissue expander pain is also typically limited to the first 24 hours following a fill. If your pain lasts longer than a day, it's important to call your healthcare provider.

Your healthcare provider may opt to remove some of the saline so that the muscles don't stretch too fast. (Larger fills can increase the risk of skin breakdown and possibly infection, especially if you are having radiation.)

Pain may also be a sign of an infection. Invariably, infections that are diagnosed early are easier to manage with local or oral antibiotics

Signs of Infection

Call your healthcare provider immediately if you experience any signs of infection during tissue expansion, including:

  • Fever
  • Chills
  • Increased redness, swelling, pain, or tenderness in the breast
  • A pus-like discharge
  • Crusting around the filling port

Summary

If you opt for breast reconstruction post-mastectomy, tissue expanders are used to help prepare the chest wall and skin for the implants. They can be uncomfortable, but there are ways to manage the pain, including home remedies and medication. Physical therapy can also be effective in helping to enhance mobility. If nothing is relieving the pain or there are signs of infection, contact your healthcare provider.

Whatever method you use for pain relief, it's important to take care of your skin. The skin above your expander is at also risk for breakdown and infection if not cared for properly.

If your tissue expanders are very uncomfortable, see your healthcare provider to ensure that your pain isn't due to an underlying infection, especially if you are also receiving radiation therapy.

Frequently Asked Questions

  • Can tissue expanders cause low back pain?

    Yes. Sometimes after an expansion, you may feel some pain or discomfort in the shoulder or back. This usually goes away within a few days.

  • How long is surgery to remove expanders and put in implants?

    After your tissue expander has been the correct size for about one to three months, another surgery will be done. This surgery is to replace the expanders with implants. The surgery lasts about one to two hours, and you'll stay in the hospital for anywhere from a few hours to 24 hours.

  • What is the best sleeping position if you have tissue expanders?

    For the first two weeks, you should sleep on your back or in a recliner chair to be more comfortable. After those two weeks, you can sleep on your side if you'd like. For the first four weeks, you should not sleep on your stomach.

Originally written by
Pam Stephan
Pam Stephan is a breast cancer survivor.
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