I'm 5 ft, 115lbs, and had 305 cc under the muscle 10 days ago. How Long is Pain to Be Expected After Breast Augmentation?
Doctor Answers 6
Pain after breast augmenation
There are many, many , many different factors that influence the amount and longevity of pain after augmentation and relate to tolerance, motivation, implant size, over/under, extent of surgery, muscle mass, soft tissue compliance, size of existing breast, chest wall antamy, medication history and tolerance, etc. TYpcially patients experience the most pain for the first 4 days, diminishing by 7-10 days, with nearly all medications stopped by 3 weeks but some persistent aches for up to 3 months.
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Medication Can help
Postoperative expectations following breast implants
Pain is a very subjective thing, and so it is going to be very hard for your plastic surgeon to guarantee a particular amount of time at which you will be pain free. Although my patients usually say that the pain associated with breast implants is easy to control with medications, some discomfort can last for several days. I have had one or tow very sensitive patients continue to complain of pain for up to two weeks, but I must say that this is the exception. At 10 days out, you should still feel that there is some discomfort, particularly with motion, but this should be relatively easy to control with Tylenol. If this is not the case, you may be one of those sensitive patients that may take a bit more time. If your doctor says everything looks good, don't worry- it will get better!
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Pain following Breast Augmentation
Pain is very difficult to measure and varies a good bit among patients. It is not unusual to have pain 10 days following a submuscular augmentation. You do almost always have more pain when the implants are placed below the muscle, but the result is usually worth it.
Pain after breast augmentation
Postoperative local anesthetic administration is also effective in reducing postop discomfort and speeding the return to routine activities of daily living, and some plastic surgeons have incorporated this into the care of breast augmentation patients. For many years I used the On-Q ‘pain buster’ which is a closed system that delivers a long-acting local anesthetic medication through catheters placed into the implant pockets during the breast augmentation surgery. The On-Q (and others like it such as the GoPump etc) allows continuous infusion of bupivacaine (Marcaine) into the breast implant pockets for 2-3 days postop, and makes the recovery narcotic-free for most patients. The major downside of the On-Q and other similar devices is the balloon reservoir and catheter system that patients would have to manage (i.e. carry around in a pouch and attempt to conceal under clothing) for the first two to three days.
A sustained-release form of bupivacaine called Exparel has recently been developed (FDA approved in 2011) which eliminates the need for pain pumps following breast augmentation. Exparel is injected around the base of the breast prior to implant placement, and provides about 48 hours of local anesthesia following surgery. Not only are the catheters and reservoirs eliminated, but also the effectiveness of bupivacaine appears to be higher when infiltrated directly into the periphery of the breast (where sensory nerves pass through) compared to infusion of bupivacaine into the implant pocket around the implant through a catheter system. Which makes sense, as it’s not the breast implants that need the local anesthetic, it’s the surrounding breast tissue.
With this approach to postoperative pain control, patients are usually pain-free in the recovery room, and report a sensation of pressure or ‘tightness’ over their sternum. When I call patients in the evening later that day, they in most cases are not in pain and have enjoyed a normal dinner. Arm range-of-motion exercises can begin immediately, including locking the fingers of both hands together with arms extended fully overhead, and with arms extended fully behind the back. Patients usually report some soreness but no severe pain when seen in the office two or three days after surgery. The goal truly is a 24-hour return to non-strenuous activities of daily living.
This kind of outcome is achievable in some patients without the administration of Exparel intraoperatively, but it is impossible to identify who those patients are preoperatively. So our practice is to administer Exparel to all breast augmentation and augmentation mastopexy patients to ensure the highest possible level of postoperative pain control and the lowest likelihood of need for oral narcotic pain medication at home.