Tissue expanders are an important step in breast reconstruction. While you can return to work and resume other everyday activities with tissue expanders, you may find that they cause discomfort, including disruptions to sleep. Here are our tips for sleeping with tissue expanders and managing discomfort in the tissue expansion phase after a mastectomy.
What are tissue expanders?
Tissue expanders are temporary implants placed above or underneath your chest muscle before placing silicone implants or undergoing flap reconstruction. These implants gently stretch the area over a multi-week or multi-month period to make room for an implant. If you are not undergoing an immediate reconstruction at the same time as your mastectomy, you may need tissue expanders to prepare your breast or breasts for implants later.
Tissue expanders come in different textures and shapes, depending on your desired outcome and your doctor’s recommendation. The tissue expander is composed of an empty implant and a small valve. Using the valve, a medical professional will fill your implant or implants with saline on a semi-regular basis, until your skin is stretched enough to accommodate the permanent silicone implant. How long you need tissue expanders depends on the size of the implant, your body, and your doctor’s recommendation.
What do tissue expanders feel like?
Tissue expansion may feel like muscle cramping or tight muscles. These sensations are normal, especially in the hours after a saline injection. You may also experience breast tenderness or soreness if you have scar tissue. Your breast or breasts may also feel unnaturally stiff, as tissue expanders are not as flexible as implants.
If you are unsure if your discomfort is normal, your concern should be brought to the attention of a medical professional. Call your doctor if you are still experiencing pain more than 24 hours after a saline injection.
Tissue expanders vs. implants
Tissue expanders and implants are not interchangeable. Your tissue expanders will come before implants as a necessary step to prepare your body for implant placement. Before an implant is placed or flap reconstruction occurs, the tissue expanders are removed from your chest.
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Do you need to wear a bra with tissue expanders?
Choosing the right bra to wear with tissue expanders can be difficult, as your breast size is changing and the breast area is tender after surgery. While wearing a bra with tissue expanders is a personal choice, you may be more comfortable wearing one or find that a supportive bra helps relieve discomfort. If you opt to wear a bra while your tissue expanders are in, look for these qualities:
- Choose comfort. Breathable fabrics and adjustable straps can be easily changed as your needs evolve.
- Avoid underwire. Wire-free bras are much more forgiving for changing breast sizes. Underwires can also sit uncomfortably against sensitive skin and a tender chest as you heal.
- Skip cup sizes. Molded cups will feel restrictive as your breast size changes. Forgiving, stretchy fabric accommodates changing breasts.
- Consider a bra you can wear after tissue expanders. Bras like this lacey post-mastectomy bra are versatile, beautiful, and can be worn long after your reconstruction.
Tips for coping with tissue expander discomfort
Discomfort, soreness, and achiness are all normal while tissue expanders are making room for your implant or flap reconstruction. Understandably, these sensations can be distracting and unpleasant. Try these tips to help mitigate that discomfort:
- Ice your breast. A cold compress can help reduce swelling. Ask your medical team before applying ice, as the cold may not be good for sensitive skin due to radiation.
- Meditate. Pain management meditation guides can help you divert attention away from the pain you are experiencing.
- Use pillows. Breast pillows support sensitive areas as you cough, change positions, or undergo any other sudden movement.
- Try gentle stretches. Slowly and gently stretching your arms can help prevent stiffness and alleviate soreness in the chest area. Ask your medical team for some safe stretches and instructions on how to do them.
- Distract yourself. Watching your favorite show or listening to good music can help take your mind off tissue expander discomfort.
- Speak with your surgeon about removing some saline. Your surgeon may remove some saline if the sensations are too much. However, less saline means the expansion process may be prolonged.
- Use over-the-counter pain relief when needed. Acetaminophen or NSAIDs may be useful if other techniques do not help.
Tips for sleeping with tissue expanders
Tissue expander discomfort can keep you awake at night and affect your sleeping routine. This is especially impactful if you are a stomach sleeper and find sleeping on your back – the recommended position for the first few weeks of tissue expansion — to be unpleasant. If you are struggling sleeping with tissue expanders, try these tips:
- Try meditation for sleep. Just like there are meditation guides for pain management, you can try a meditation guide to help you sleep. This guide can help you alleviate worry and promote calm so you can more easily fall asleep and stay asleep.
- Use a body pillow to support your position. Body pillows can prop you up and hold you in a position that puts less pressure on your chest while sleeping. Look for a body pillow filled with kapok, a vegan fiber that feels just like down feathers. You can also place regular pillows underneath your head and knees.
- Explore devices that can help you unwind. A sleep meditation light projects a halo of light onto the ceiling without disrupting your partner. Synchronize your breath to the light to help lull you into a more restful state.
Tips from our founder
“Prior to getting expanders put it, I had extensive pain from radiation damage. Bikram yoga was one of the reliable ways I was able to relax my chest wall for pain relief. Maintaining compression with tight-fitting sports bras also helped tremendously. As soon as I was able, I slept on my side with a moon pillow under the breast mounds with additional pillows as arm supports—I still sleep like this! After the drains came out and my incisions were healed enough, I found epsom salt baths in combination with yoga, compression, and pillow supports really helped me managed my discomfort and made sleeping with tissue expanders easier.” – Lisa Lefebvre, Mend Together Founder/2x cancer “endure-er”
As you prepare for breast surgery, tissue expansion, and reconstruction, Mend Together is here to help. Learn more about our free resources for people going through cancer and their loved ones. Our Community Journal, Volunteer Calendar, and Gift & Donation Registry make it easy to give and receive support when it’s needed most.
Stella Morrison is an award-winning journalist who partners with mission-driven companies to share their stories. She is based in New York City.
Information provided here is not a substitute for medical advice. Please consult your healthcare team for advice tailored to your personal diagnosis and treatment.