Breast augmentation is a very exciting and emotional experience for those women who choose to undergo it. But the immediate after effects of the procedure is that, although the breasts are bigger, it is one that is associated with pain. While there is no such thing as a painless breast augmentation, there are a variety of strategies to make it as comfortable as possible through the early recovery period.
While every woman has their own level of pain tolerance, and no two patients are exactly alike, there are several components of the breast augmentation procedures that make it more painful. If the breast implants is placed under the muscle (which it is in my practice 99% of the time), it is going to be more painful than of the implant is placed on top of the muscle beneath the breast tissue. Larger implants cause more discomfort than smaller sizes due to the stretch on the muscle under which they lay.
During surgery, the best strategy to lessen after surgery pain is to inject long-acting local anesthetics into the incision site and pectoralis muscle. The most common local anesthetic used is Marcaine which can provide pain relief for 18 to 24 hours after surgery. Some plastic surgeons use an indwelling pain pump, which will be effective for days longer, but always raises concern about being a potential pathway for bacteria to track into the implant. The newest long acting local anesthetic for injection around the breast site is Exparel. It is Marcaine that is suspended in liposomes which naturally degrade and release the anesthetic agent over the next three days. The use of Exparel works as long as a pain pump but without the external tubing.
Since the use of narcotic pain medication is needed in most patients, at least for a few days, it should be started immediately when one gets home. Once started it should be used regularly for two or three days after surgery and then its use should be tapered. There are some patients that prefer to try Ibuprofen first and then use narcotics for any breakthrough pain. With this pain management approach, take 800mg of Ibuprofen three a day and take it regularly. Anti-inflammatory medications are not like narcotics, they have to have a stable and high blood level to be effective and it takes more than a day to get a therapeutic level going.
A less effective but potential useful pain management technique is the use of cold compresses (not ice) for the first 24 hours after surgery. After the first day, one can switch to warm compresses. (but not a heating pad) Just like any muscle strain, the initial use of cold and then switching to heat helps with muscle injury recovery.
Early physical therapy, although initally unappealing, can be a really good strategy for a quicker breast augmentation recovery and to reach a more comfortable state sooner. Because breast augmentation is largely a big pulled muscle, early range of motion is very helpful. Once one gets the muscle moving, it does not hurt as much. Starting arm range of motion exercises within hours after surgery and continuing to do it as a ritual for a few days after surgery will really help the muscle feel better sooner.
Between local anesthetic injections, Ibuprofen and selective narcotic use, hot and cold compresses and early physical therapy, most women after breast augmentation should be doing many normal activities (short of strenuous exercise) within a few days.
Dr. Barry Eppley
Indianapolis, Indiana