Breast augmentation remains one of the most popular and commonly performed elective body contouring procedures. The most frequent location for breast implants is under the pectoralis major muscle, technically a partial submuscular location known as the dual plane pocket. While this implant pocket location has numerous advantages long-term, the elevation of the muscle does not the short-term drawback immediate discomfort and some restriction of arm movement.
To counter this temporary chest muscle discomfort, rapid recovery breast augmentation protocols have been advocated for over a decade. These protocols largely rely on non-steroidal medications and immediate use of the muscle through early physical therapy. (arm range of motion) While complete muscle recovery does occur fairly quickly, there remains the immediate discomfort due to muscle injury and the pressure of the implant underneath it.
One tremendously effective management technique is to inject the portion of the pectoralis muscle over the implant and its sternal attachments with Exparel. This is the only local anesthetic that works for up to three days (72 hours) after tissue placement by injection. This newer local anesthetic combines bupivacaine (Marcaine) with a lipid-like delivery method known as DepoFoam. A single intraoperativhe injection at the source of the pain with either eliminate the pain completely or result in a decreased need for narcotic medications for up to 72 hours after surgery. This injection can eliminate the need for any other method of adjunctive pain relief like catheters or pumps.
Exparel has been around now for several years and has a significant history of both safety and effectiveness. It has been evaluated in over 21 clinical trials of various surgical procedures consistently demonstrating prolonged pain reduction or elimination for days after the procedure. It is thus no surprise that it works equally well in breast augmentation. It does add a few hundred dollars to the cost of the surgery but the allure of minimal pain on awakening and a return to most activities of daily life al almost immediately after raises the concept of a Rapid Recovery After Breast Augmentation protocol to a whole new level.
Dr. Barry Eppley