Pain studies or medication for pain from expanders?

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Question from PamT: Have there been any pain studies on women who have bilateral mastectomies with expander placement? I'm 11 days post my third expansion. My doctor never offered to do smaller increments of saline. He doesn't think I need anything stronger than over-the-counter meds, but I'm still in pain. What can I do? And do women whose chest muscles are more toned have more pain?
Answers - Beth Baughman DuPree, M.D., F.A.C.S. It's very common for women to complain about chest tightness and pain during the expansion process. In addition to anti-inflammatories, I recommend the use of a muscle relaxant for my patients, specifically Skelaxin (chemical name: metaxalone), as this medication can help with the pain from the stretching of the muscle that occurs in the expansion process. I do not believe that there have been any studies that show that women whose chest muscles are more toned are prone to more pain. After surgery with bilateral tissue expanders having been placed under the pectoral muscle, I use the analogy and explain to my patients that it's as if they did 1,000 chest presses without taking a break. The combination of Motrin and Skelaxin, although it has not been scientifically proven in a randomized trial, has become our standard postoperative pain regimen for patients undergoing mastectomy and immediate reconstruction with either expanders or implants. I also recommend for my patients that during the expansion process they premedicate with Skelaxin the night before they are due to see the surgeon for expansion, and follow through for 24-36 hours afterwards. This has become a popular regimen in my practice with my partners and all of our plastic surgeons. The patients have discussed this at the breast cancer support group and said to make sure for the patients to ask for the expansion cocktail if it is not pre-written for them. There are many muscle relaxants on the market, and we have found that this one in particular has less central nervous system effects and the best benefit for the patient overall.

The Ask-the-Expert Online Conference called Updates From the 2009 ASCO Annual Meeting featured Nick Robert, M.D. and Beth Baughman Dupree, M.D., F.A.C.S. answering your questions about the newest findings on risk, screening, treatment, and more.

Editor's Note: This conference took place in June 2009.

The materials presented in these conferences do not necessarily reflect the views of A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Copyright 2010. All rights reserved.

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