Rapid return helps minimize pain after breast augmentation with implants

There are several excellent points made here regarding pain and recovery after breast augmentation. Factors which can influence postoperative pain and recovery include:

• Under the muscle is more painful than over
• Larger implants tend to cause more breast expansion and pain
• Meticulous and precise dissection of the muscle are important aspects of minimizing injury and pain
• Intraoperative use of local anesthetics
• Use of  Pain pumps
• Use of Celebrex as an anitinflammatory agent
• Use of  Valum or other muscle relaxants
• Immediate institution of range of motion exercises: we institute the following regimen:

Rapid Return Exercises Following Breast Augmentation

Perform these exercises immediately in the recovery room and at least once circuit each hour while awake until your first post-operative visit. Although these are illustrated in the sitting position they can be performed in the standing position as well. Our goal is to progressively stretch the pectoralis muscle. If the exercises are not performed, the muscle tends to contract and shorten which may cause more discomfort (as is seen with a hamstring pull.) Remember: NO HEAVY LIFTING or SUDDEN MOVEMENTS.
 

Shoulder Roll

With your arms hanging straight down at your sides, pull your shoulders up toward your ears and roll your shoulders back slowly in a circular motion. Maintain an upright posture and sit at the front of the seat. Roll your shoulders for 10 to 15 repetitions in one direction before reversing direction for an additional 10 to 15 repetitions.  

Arm Circles

While seated upright at the front of your seat, hold your arms straight out to each side and slowly rotate your hands in a small circular motion. Complete at least 10-15 revolutions in each direction, rotating forward, then backward.

Arm Stretch

This places the pectoralis muscle on full stretch. Place your arm over the head with your forearm resting on the top of your head while your hand reaches for the opposite ear. Avoid tilting your head. With the other hand, slowly pull on the elbow and hold it as you take a few slow breaths. Hold this position for 10 to 15 seconds with each arm.

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.

There are many methods available and each surgeon will have their own routine and preferences. Generally, however, the immediate recovery period is only about 2-3 days for most patients before you return to your daily activities and have minimal need for pain medication. There are pain pumps available that use local anaesthetic, some surgeons inject local anaesthetic into the surgical site, some use anti-inflammatory medications and/or muscle relaxers as well as the usual narcotic pain medication. The two most important factors, however, are choosing the correct implant size and meticulous dissection at the time of surgery. The bigger the implant, the more discomfort you will have due to increased stretching of your tissues. During surgery the less the tissues are traumatized and the less bleeding there is, the better your postop pain level will be. Going under the muscle has somewhat more discomfort but not a significant difference that I have noticed.  Moms who have been through childbirth and breast engorgement tend to recover faster than patients who have not had children yet. Overall, the pain level is very well managed and lasts for only a short period of time.  Pain levels are very subjective and each patient is different and needs different methods of pain control that works best for them - so review your pain tolerance with your surgeon and choose from the different techniques available that suits you best. The most important factor is your breast implant size compared to your body type and tissue characteristics.

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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.

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