How can the pain and recovery time after getting breast implants be minimized?

I routinely use pain pumps for both breast augmentation procedures and tummy tuck procedures in my Raleigh, North Carolina Plastic Surgery Practice.

During the surgery a tiny tube is set to supply the local anesthetic continually into the surgical area for three to five days of time. Marcaine, a long lasting local anesthetic  is administered  through tiny tube. This medication significantly reduces discomfort around the surgical area with no side effects like nausea, drowsiness or constipation. This small Pain Relief Pump is removed  2-3 days after surgery when the medication is over.  Unlike the other pain relief medications, this technique does not affect the other parts of the body except the surgical area.

I do prescribe pain medication to patients receiving breast augmentation surgery , however most report that the discomfort is fairly minimal and rarely do patients feel the need for pain medications since the introduction of pain pumps.

I have also heard women complain of severe pain after breast augmentation, and I find it puzzling.  My patients don't complain of significant pain.  There will be some more discomfort if the implants are put under the muscle.

Some of the tricks to  minimize pain:

1) MOST IMPORTANT, is GENTLE SHARP  dissection to create the implant pocket (instead of  "blunt dissection" which means ripping the tissues with the finger).

2) Stop absolutely all the bleeding.

3) Don't use  an excessively large implant for the particular patient's anatomy.

4) Put the patient in a comfortable elastic bra immediately.

5) The patient should keep her elbows close to her body for a week.

6) Don't massage or manipulate the breasts in any way.

Postoperative pain from breast augmentation is dependent on many factors, some of which have been touched on by other respondents.  One significant factor is the position that the implant is placed in, above the muscle or below the muscle.  Below the muscle is a much more painful procedure.  So, if its pain that you fear, consultation with your board certified plastic surgeon will determine if this is an option for your body characteristics.  If it is not, then other methods of pain management are available, such as the pain pump, or injecting long acting local anesthestic at the completion of your procedure.  Good luck!

The reality is, breast augmentation, when done with subpectoral (under the muscle) implants can be a very painful procedure. I've been using pain pumps consistently for the last several years in my breast augmentation patients and the pain relief can be dramatic. Yes, you'll still need some narcotic pain killers after surgery, but not nearly to the degree that you would without the pain pump. This also means that you're risk of post-op nausea and vomiting will be less. That alone is a great reason to seek a surgeon who uses pain pumps!

Pain pumps are safe, typically delivering bupivicaine (a non-narcotic, long lasting local anesthetic) directly to the pockets around the implants. The tube is tiny, and usually removed in the office or by the patient at home, when the pump is empty (2-3 days).

Future pain control methods are being investigated that include instillation of an even longer lasting local anesthetic around the implants at the time of surgery, avoiding the need for pain pumps.

lil,

This is a great question. I have found that the recovery from breast implant surgery depends mostly on patient motivation and patient response to previous surgery. For highly motivated patients, who are informed and who play an active role in there pre- and post-op tend to do better. Additionally, people who normally hit the alarm clock repeatedly every morning tend to have longer recoveries. Likewise, people who get out of bed as soon as the alarm clock goes off tend to recover faster. Another useful gauge is people who call in sick to work frequently will likely have a longer recover while patients who have never missed a day of work will most likely recover faster. Whoever does your surgery should also give you pain medications and muscle relaxers to help get over the initial hump of surgery. After that, most patients tend to do very well.

Good luck with your surgery.

David Shafer, MD
Shafer Plastic Surgery - Manhattan

I have used pain pumps for the past 5 years and feel the difference it makes is well worth the $250. It is a device that delivers numbing medication to the area without making you sick to your stomach. It runs automatically, for 2 to 3 days, when you need it most. Many patients take over the counter pain medication with the pain pump, avoid the side affects of prescription pain medications. Ultimately, the most important variable is going to a board certified plastic surgeon, certified by the American Board of Plastic Surgery, to get the most appropriate treatment.

Breast augmentation can be quite painful for the first 48-72 hours. The discomfort is usually pressure from the muscle distention. If the implants is placed above the muscle, the discomfort is significantly less. This however may cause you to have a worse long term result. Most physicians will place the implant under the muscle to reduce scarring, drooping and rippling.

Many Plastic Surgeons will utilize a pain pump during the first 48 hours after surgery. It is a very simple process to have a pump. It is placed at the time of surgery. The pump is connected to a small tube the is inserted near the armpit. It automatically drips numbing medication under the muscle to reduce the pressure and pain. Most of our patients use almost no oral pain medication when also getting the pain pump.

Check with your Plastic Surgeon to see if they utilize the pump.

There are several aspects of the procedure that affect the postop pain. As has been mentioned, large implants where the tissue has to stretch will usually be more of an ordeal. However, surgical technique matters; if it is done gently and precisely, there is less injury to the tissues which may mean less swelling and discomfort. Some surgeons also use a "pain pump" which slowly infuses numbing medication into the surgical site over the first few days. In any case, most patients have "turned the corner" and are feeling better after the first 3-5 days.

The perception of pain can be much different between any number of individuals experiencing the Breast Augmentation, even when the same surgeon employs the same technique. Without question, there is some pain associated with Breast Augmentation, more so when the implants are placed under the pectoral muscle. Unfortunately, there is also the "anticipatory" pain that patients may experience because they have been told to expect that Breast Augmentation is painful. Some patients may be more susceptible to this "anticipatory" pain, which then magnifies the actual pain they feel.

As a surgeon, I try to control the factors that may create real pain following Breast Augmentation. This includes delicate handling of the tissues during the creation of the pocket for the implants; minimizing bleeding; utilizing local anesthetic nerve blocks and irrigation of the pockets around the breast implants; liberal use of pain medication, muscle relaxing medications, and anti-anxiety medications in the immediate post-operative period; and, encouraging early return to normal physical activities by the patient. I have found that for most patients, the "pain" is similar to the muscle soreness and discomfort one may experience after lifting too much weight during a session in the gym. In any case, the actual pain is generally at its worst in the first 24-48 hours after surgery, and quickly diminishes thereafter.

In nearly 20 years of experience, I have never had a patient tell me that she was in so much pain that she wished she had never chosen to have Breast Augmentation. More commonly, the expectation of pain has been worse than the actual pain experienced.

Anticipate happiness with your Breast Augmentation, not pain!