This is a very common question in breast augmentation. As most Board Certified Plastic Surgeons, including myself, recommend placement of the implants below the pectoral muscle, if no measures are taken, the breast implant surgery could be very uncomfortable. This is because we have to lift the muscle and actually detach it from the rib cage near the breast bone in order to accommodate the implant. This can cause significant postoperative discomfort. However, there are remedies. I personally like the On-Q pain pump, which is a tiny, little tube that we place at the time of surgery and this will drip Novocain local anesthetic (not narcotic) right onto the muscle and keep the patient quite comfortable. That way, there is less need for oral pain medication, especially narcotics, which, I believe, should be avoided whenever possible. The On-Q pain pump has been incredibly successful in relieving postoperative pain in my practice. Others prefer to use the infiltration of local anesthetic blocks, with great success as well. The important thing is to find a Board Certified Plastic Surgeon who is sensitive to these issues.