Introduction: Most women choose breast reconstruction at the same time as mastectomy. The most common method of breast reconstruction is with tissue expanders (implementation). The relief from the postoperative pain of mastectomy and reconstruction is of major importance. Not only because post-operative pain can become chronic neuropathic, but also because the post-operative immune suppression it exposes the woman with breast cancer to the risk of metastases. Aim: To investigate the methods of postoperative pain management in mastectomy and immediate breast reconstruction with tissue expander in order to promote the best analgesic approach. Methods: A bibliographic review was carried out on Pubmed, Google and Elsevier internet databases using keywords of the last 10 years. Results: Women undergoing mastectomy and breast reconstruction suffer severe post-operative pain with significant side effects from various systems. The algology aims to reduce the use of opioids, using other analgesics. The ideal analgesic regimen does not exist. Multimodal analgesia provides satisfactory levels of postoperative analgesia, while the use of certain analgesic drugs and techniques provides additional benefit to patients because they protect them against possible metastasis. Conclusions: The best treatment for postoperative pain is achieved by using systemic multimodal analgesia and preventive analgesia prior to surgery. The most important role in the treatment of post-operative pain is the choice of the most appropriate analgesic regimen, personalized and based on the patient's benefits, the means provided, the cost and the culture of the organism. It is recommended to use a multifactorial, systemic and prophylactic analgesia, in combination with a local injection of analgesic to the surgical wound.