where to start with cosmetic procedureswhere to start with cosmetic procedures

If you've chosen to have a breast reconstruction after a double mastectomy using tissue expanders, there are a few things that you should know before the surgery. Here are some no-nonsense facts.

Yes, it does hurt.

Everyone's tolerance for pain varies, but you need to keep in mind that this is major surgery. Whether the tissue expanders are installed at the same time the double mastectomy is done or whether it is done at a later date isn't going to change the fact that there will be some pain involved.

Tissue expanders are fairly simple devices. They aren't much more than an empty silicone sack with a little magnetic port inside. However, they cause pain for two different reasons.

• First, they are inserted through the latissimus muscle flaps, which runs along the sides of your chest. These particular flaps of skin are often very noticeable after breasts are removed, so your plastic surgeon will cut and shape the flap when he or she inserts the tissue expander. For a while, that side area will be very sore and delicate.
• Second, the expanders are inserted under the muscle and tissue that remains in your chest, where your breasts were. They are gradually filled with saline, using large syringes that are inserted through the magnetized valves. (The doctor will literally use a small magnet to locate the valve each time he or she adds more saline.) The sensation is very much like "growing" your breasts a few milliliters of fluid at a time over several months. This can pull on nerves and irritate scar tissue.)

Talk to your plastic surgeon about pain control before you have your surgery. It isn't unusual to need Percocet, Vicodin, or another narcotic for several weeks after the initial surgery. After two or three weeks, most people are able to cope with the uncomfortable (but not exactly painful) feeling of the expanders as they are gradually filled each week.

Yes, you will need help.

The first few weeks are the most difficult and you will need help at home. There are a number of activities that you should do until your doctor clears you:

• showering without help

• dressing without assistance

• lifting small children or pets

• lifting groceries, including jugs of milk or water

• pulling wet clothing out of a washing machine

• running the sweeper

• lifting cast-iron cookware to cook or to clean

If you ignore your doctor's instructions and try to do these things yourself, you can pull fragile muscle tissue, creating microscopic tears that will not only hurt worse but will take longer to heal. You also increase your risk of infection.

Yes, you have control over this process.

Tissue expanders aren't the right choice for everyone, but the do have their benefits. Most importantly, they allow you to slowly achieve the look and size that you want for your reconstructed breasts, which means that you can work with your doctor to decide on the size, weight, and shape that you like best. If you've undergone a double mastectomy, the slow, deliberate pace of the tissue expanders can help you regain a sense of control over your body.

They're also less reliant on the flexibility of your skin, since they allow you the time to grow and stretch muscle and skin to cover them - making them ideal if you don't have a lot of excess skin left over once the mastectomy is done or if you're older and your skin is more fragile.

Just be prepared ahead of time for enduring a few weeks of pain (which will pass quickly if you rest like the doctor tells you to) and arrange for as much help around the house as possible until you heal!