Causes and Management of Tissue Expander Pain

These may be used in preparation for breast implants or reconstruction

Tissue expander pain is common in women who undergo breast reconstruction after mastectomy.

includes the placement of synthetic breast implants. Before this procedure, you'll need tissue expanders—temporary, inflatable breast implants designed to stretch skin and muscle so your chest can accommodate the permanent implant. Because of the stretching involved, tissue expanders can be painful.

Here's what to expect and what you can do to manage the pain.

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. It 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.

Pain from tissue expanders will feel similar to muscle spasms, cramps, or muscular tightness.

Muscle pain tends to peak in the first 12 to 24 hours after the expander is filled and 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. Pain may also result if you develop an infection.

Treatment

Simple pain-relieving strategies may be all that's needed for you to manage tissue expander pain. When those aren't enough, medications or even adjustment of your expanders may be needed.

Self-Care Strategies

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

  • A cold pack: Try applying a cold gel pack on the painful area for about 20 minutes. If you don't have a cold gel pack, you might try a package of frozen corn or peas, or ice cubes in a small bag. It's best to wrap whatever you use in a light cloth or towel to help prevent skin damage (and subsequently, infection). If you are receiving radiation therapy, icing may not be a good idea as your skin may be too sensitive.
  • Distractions: Relaxation tapes and other distractions can take your mind off the pain. Meditation and guided imagery can be helpful and appear to have other benefits for people with cancer as well. Music therapy, or even just listening to your favorite tunes, is also helpful.
  • 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 and Interventions

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

  • NSAIDs: Taking a non-steroidal anti-inflammatory drug (NSAID) such as Advil (ibuprofen) or Aleve (naproxen sodium) at least 30 minutes before each fill and again a few hours afterward may head off pain. One study found that some women undergoing tissue expansion achieved sufficient pain relief from such over-the-counter NSAIDs. In some cases, your doctor may instead recommend a stronger, prescription version.
  • Muscle relaxants or opioids: These medications should be used sparingly and only to ease the worst pain directly after a fill.
  • A lidocaine skin patch: This may be used to reduce moderate tissue expander pain. Lidocaine patches are now available over the counter, though it's a good idea to talk to your doctor before using them. Some people may develop skin irritation with lidocaine patches that could increase the risk of infection, especially for those going through radiation therapy. If you go this route, make sure to read the package directions carefully and do not leave the patch in place longer than the recommended duration.
  • 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 pain is due to the expander, or instead due to 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. This thought was reinforced by a 2019 study that found that early rehabilitation after mastectomy and tissue expander placement significantly improved shoulder mobility (enough so that the conclusion was to recommend early rehabilitation for all women who undergo a mastectomy and immediate reconstruction with tissue expanders). 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.
  • Expander adjustments: If you are feeling too uncomfortable, your doctor can remove some of the saline solution so that your muscles don't stretch too fast. You may also ask for smaller fills going forward. (Larger fills can increase the risk of skin breakdown and possibly infection, especially if you are having radiation.)
  • Local anesthetics, blocks, and Botox: Studies have shown that in cases of severe pain, local IV anesthetics, nerve blocks, and Botox (botulinum toxin A) injections can relieve pain. These are meant to be used right after a fill for a short period of time.

When to Call The Doctor

Since many people experience some discomfort with tissue expanders, you may wonder when you should contact your doctor. It's always best to err on the side of caution, as pain may also be a sign of an infection; and infections that are caught early are much easier to manage.

It may be helpful to rank your pain on a scale of 1 to 10, with a 1 meaning pain that is barely noticeable, and a 10 being the worst pain you can imagine. In one study, it was found that women ranked their pain, on average, between 0.4 and 2.5 out of 10. Pain was also usually limited to the first 24 hours after a fill. Therefore, if you pain is significant, or is lasting longer than a day, it's important to see your doctor.

When to Call Your Doctor

Pain and other symptoms can be caused by infection rather than muscular pain from expanders. Call your doctor right away if you have a fever, or redness, warmth, or swelling in the breast area.

Whatever method you use for pain relief, it's important to take care of your skin. The skin above your expander is at risk for breakdown (necrosis) and, as noted, infection.

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

A Word From Verywell

Pain from tissue expanders used in breast reconstruction is very common, but thankfully, temporary. Permanent implants are more flexible and easier to tolerate than tissue expanders. Most women report having far less pain once the implants are in place.

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  1. Breastcancer.org. Implant Reconstruction: What to Expect. Updated August 29, 2019.

  2. Le NK, et al. Pain and anxiety levels of patients undergoing tissue expansion after mastectomies: A case series studyCancer Control. 2017 Nov;24(4). doi:10.1177/1073274817729893

  3. Regan JP, Schaffner AD. Breast Reconstruction Expander Implant. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Updated April 10, 2019.

  4. Kim KH, Yeo SM, Cheong IY. Early rehabilitation after total mastectomy and immediate reconstruction with tissue expander insertion in breast cancer patients: A retrospective case-control study. Journal of Breast Cancer. 2019;22(3):472-483. doi:10.4048/jbc.2019.22.e40

  5. Strazisar B. How to relieve pain after immediate breast reconstruction with sub muscular tissue expanderJ Anesth Clin Res. 2016;7:665. doi:10.4172/2155-6148.1000665

  6. Sue G, Long, C, Lee G. Mangement of mastectomy skin necrosis in implant based breast reconstructionAnnals of Plastic Surgery. 2017;78(5 Suppl 4):S208-S211. doi:10.1097/SAP.0000000000001045