Causes and Management of Tissue Expander Pain

The most common type of breast reconstruction is done with tissue expanders and breast implants. Even though this type of breast reconstruction can create good results, when you have tissue expanders, they may temporarily cause pain. There are many ways to cope with tissue expander pain—some of which you can do for yourself, and some of which require a doctor's help.

Let's talk about how to deal with tissue expander pain and why it occurs.

What is a Tissue Expander?

Tissue expansion is a common breast reconstruction technique that involves expanding breast skin and muscle using a temporary tissue expander. The temporary expander ends up being removed later and you will receive either permanent breast implant or a microvascular flap reconstruction

The breast tissue expander is basically an inflatable breast implant designed to stretch skin and muscle in order to make room for a more permanent implant. The tissue expander is usually put in at same during the mastectomy surgery. During that surgery, the expander is inserted between the skin and chest muscle. It is essentially acts as a pouch expanded by the injection of saline. When it is first placed, saline is injected through a fill port. The fill port allows for periodic injection of salt water solution to gradually fill the expander over the next few weeks of months.

Implantation the expander is not painful but there may be some stretching and pressure in the breast. There might be some discomfort during the procedure, but most women do not find the implantation uncomfortable.

Subsequent injections of the saline solution start a few weeks after the mastectomy once the drains have been removed. After the skin over the breast area is stretched enough, the expander is removed in second surgery where the flap reconstruction or permanent implant is placed. Getting the expander placed requires an overnight hospitalization and recovery may take a few weeks. 

Tissue Expander Pain

Many women hesitate to complain about tissue expander pain. After all, when compared with the pain of a mastectomy, possibly a lymph node dissection, and chemotherapy, it's not usually as bad. Plus, many women are thankful to be alive and have the option of having breast reconstruction with breast cancer!

Yet it's important to talk to your doctor and share your discomfort with your loved ones. Tissue expander pain is very common. Thankfully, if you talk to other women who have been through this procedure, you'll probably hear remarks about how much more comfortable they were after the expanders were removed and the permanent implants placed.

Causes of Tissue Expander Pain

Tissue expanders can feel very hard and unnatural because their shells are thicker and less flexible than implant shells. The muscle that is being stretched is the source of the pain—breast skin and nerves are most often numb after a mastectomy. Pain from tissue expanders will feel similar to muscle spasms, cramps, or muscular tightness

It is normal for tissue expanders to be uncomfortable, but sometimes it 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. If you are also having radiation treatments, some radiation fibrosis may cause pain around your tissue expanders as well. Increased pain may also result if you develop an infection.

Self Help for Tissue Expander Pain

There are many things that you can do on your own to improve your comfort while you have your expander or expanders in place. This will be especially noticeable when you have had a recent saline fill. Try some of these tips if you are feeling pain:

  • Chill It: Try applying a cold gel pack on the painful area for about 20 minutes, keeping a light cloth or towel against your skin. If you don't have a cold gel pack, you might try a package of frozen corn or peas, or even put ice cubes or crushed ice in a small bag. The cloth against your skin will increase your comfort and help to prevent damage (and subsequently the risk of infection) to your skin. If you are receiving radiation therapy, icing may not be a good idea as your skin may be red and sore already. But there are other things you can try instead.
  • Tune Out: Use relaxation tapes and other distractions to take your mind away from the pain. Meditation and guided imagery can be helpful and appears to have other benefits for people with cancer as well. Music therapy, or even just listening to your favorite tunes, is a great way to take your mind away from the discomfort. In addition, music may have some "hidden" benefits for people with cancer, such as increasing the number and activity of T-cells in your body; cells in our immune systems which fight cancer.
  • Move Around: Try some slow and gentle arm exercises to stretch those 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.
  • Do Less: Ask for smaller fills of saline during expansion treatments or more time between fills. You don't need to try and be a hero and "tolerate" larger fills. Smaller fills will accomplish the same purpose often with more comfort. In addition, larger fills, especially if you are having radiation therapy, increase the risk of your skin breaking down and possibly becoming infected.
  • Take an Advil: If you are able to take Advil (ibuprofen,) you may want to try "pre-medicating" before each fill (at least 30 minutes beforehand) and again a few hours after your fill.

Professional Help for Tissue Expander Pain

If your self-help strategies just aren't doing it, there are some things your doctor can do to help relieve your pain. Your job is to speak up, describe your pain or discomfort, and ask for a prescription or other assistance.

  • Ask for It: Consider asking your doctor for a prescription for pain. This might be a prescription for anti-inflammatory medications, such as ibuprofen or prescription-strength naproxen. Use these drugs exactly as prescribed. If your pain is severe, your doctor may recommend a muscle relaxant or a narcotic pain medication. These medications, however, should be used sparingly, and only for pain directly after a fill.
  • Calm the Pain: Applying a lidocaine skin patch may be used to moderate tissue expander pain. Lidocaine patches are now available over the counter, though it's a good idea to talk to your doctor first. Some people may develop skin irritation with lidocaine patches which could increase the risk of infection, especially for those going through radiation therapy. If you go this route, make sure to read the directions carefully and do not leave the patch in place longer than the recommended duration.
  • Back Out: You may need to ask your plastic surgeon for the temporary removal of some saline solution, to give you some relief. Don't be afraid to ask and don't feel like you are failing to do so. Our bodies tell us many things. If you are feeling too uncomfortable, you are likely asking your muscles to stretch too fast. Listen to your body and be comfortable.

    Exchanging Tissue Expanders for Permanent Implants

    Most women report having far less pain with their breast implants than with tissue expanders. After your exchange surgery, any post-op pain you have should diminish fairly quickly. If it does not, see your surgeon or doctor for help.

    Implants are typically smaller, more flexible, and easier to tolerate than tissue expanders. Once your skin and muscle settle over your permanent breast implants, your appearance and comfort should improve.

    A Word From Verywell

    Pain secondary to tissue expanders used in breast reconstruction is very common, but thankfully, temporary. There are a number of things you can do yourself to decrease your pain, and you may also ask your doctor for help with management. Whatever method you use it's important to take care of your skin. The skin above your expander is often numb from surgery, but at the same time, at greater risk for breakdown (necrosis) and infection. If your tissue expanders are very uncomfortable, visit your doctor to make sure that your pain isn't due to an underlying infection or another process, especially if you are also receiving radiation therapy.

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