A double-blind prospective placebo controlled trial of intraluminal lidocaine for pain relief after tissue expansion was performed in 18 women undergoing breast reconstruction. In contrast to others' claims of effective analgesia, no difference in the incidence of immediate or late pain after expansion could be demonstrated between 100 mg of lidocaine and placebo. The overall incidence of early pain was 8%. This was significantly less frequent than late pain, which occurred after 36% of all expansions. Postexpansion pain (early or late) was reported after nearly one-half of all expansions, most of which was ascribed to late pain. The incidence of pain did not significantly depend on the temporal progression of breast expansion, nor was there a difference in the incidence and prevalence of pain for patients undergoing unilateral versus simultaneous bilateral expansion.