Some women have said the pain of getting implants is extreme and others say it is only mild. Why is there a difference? Are some doctors using a different method? What can be done to minimize pain and downtime during breast implants recovery?
How to Reduce Pain and Recovery Time After Breast Implants Surgery?
Doctor Answers 48
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.
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.
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 StretchThis 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.
Breast Augmentation and Pain
Several steps may be taken to minimize pain. I prefer that women take very few if any narcotics after surgery. How do we achieve this? Before the surgery ever starts we give them two medications by mouth, Celebrex and gabapentin. This combination has been shown in published studies to decrease the need for narcotic pain medication use after surgery. We also begin blowing warm air over them in the preoperative area; this helps recovery by minimizing shivering and it also helps minimize infections (again, in published reports). During surgery I use a meticulous dissection technique, doing almost all of it with a cautery device, trying not to touch the chest wall and trying to cauterize tiny blood vessels before they are cut. I irrigate the pocket for the breast implants with a solution containing a long-acting local anesthetic. In the recovery area we begin range of motion exercises and we have women begin taking muscle relaxing medication. We have them take ibuprofen three times a day at home for the first week or so.
These techniques result in fairly minimal pain for the vast majority of our patients. As you know, pain is also a very subjective thing. Something that doesn't bother one woman may bother another woman a lot. It is my belief that taking active steps to prevent and minimize pain is a much better option than just dealing with pain that occurs. Each surgeon has different ideas about this. Visit with a few surgeons and ask them about this. If a surgeon hasn't thought much about it or can't describe what he or she does, you might consider visiting with other surgeons as well.
Pain control after breast augmentation
There are many methods available and each surgeon will have their own routine and preferences. Generally, however, the immediate breast implants 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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Recovery is different for different people
This is a great question. I have found that the recovery from breast implants 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.
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.
Anticipate Happiness, Not Pain: Big Gain, A Little Pain
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!
There are some options to help your recovery
This is a great question. I think that most of us would agree that much of the discomfort after a breast augmentation is due to the stretching of the pectoralis major muscle (the muscle that the implant is often placed under) by the implant. So if the surgeon chooses to place the implant under the muscle and the patient wants a fairly dramatic difference with a larger implant, the chance of discomfort after surgery increases. So there are a few things that I find helpful for decreasing the pain after surgery:
1) I will counsel my patients on the advantages and disadvantages of the different types and sizes of implants. One of the disadvantages of a larger implant is the liklihood of more stretching of the muscle and therefore a greater chance at more discomfort. If the patient opts for a slightly smaller implant, it can decrease the chance of significant postop pain.
2) I will routinely perform a nerve block, much like what you get when you go to the dentist, except I'm targeting the nerves that go to the breast. By numbing these up before surgery, I have found that we get a bit of a headstart on the postop pain control.
3) I will also put some numbing medicine inside the pocket where the implant goes right before closing the incision; alternatively, some surgeons will use a "pain pump" that will supply numbing medicine for 48 hrs after the procedure.
4) Finally, while it is certainly not the best choice for many patients, I have found that those patients who have their implants placed above the muscle tend to have significantly less discomfort after surgery, because there is no stretching of the muscle. But I will counsel patients that this is not right for everyone, and placing the implant under the muscle may be the best choice.
I hope that helps-- speak with a Board Certified Plastic Surgeon in your area about your concerns, and just remember that in the end most women do very well with this procedure.
Pain after breast implant surgery.
I think ultimately, the most honest answer to your question is that people are just wired differently.
I can perform the same type of surgery the same way on 10 people and get slightly different
responses . In general, most people are quite pleasantly surprised with a quicker recovery .
Some are average , and will hate me for a day are two after surgery but then progressively get better .
Once in a blue Moon somebody will be extraordinarily sore for weeks which is certainly the exception
rather than the rule .
Most plastic surgeons use some type of post operative pain control after breast implant surgery. This is an addition to oral medication.
In my own practice I leave a long acting local anesthesia in the pocket with the implant after surgery. Some doctors use pain pumps or pain patches but I stay on the side of avoiding extra material around the implant that could become infected.
As a general rule, I find more muscular people tend to be more sore and patients to go with larger implants tend to be more soar as well. There is simply more stretching of the tissues. I find that younger patients tend to be less tolerant of discomfort. Older and postpartum patients I find more tolerant.
To minimize post operative discomfort I recommend that all of my patients avoid pectoral exercises about two weeks before surgery. Wimpier muscles tend to be less sore.
Beyond that, simply discuss your concerns with your plastic surgeon so that here she can do his or her best to minimize your post operative discomfort.
Pain after breast augmentation should be minimal.
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.
It really depends on a few factors. Adequate pain control is likely the most important. Individual pain tolerance differs greatly. I find that women who have had children generally have less post-op pain, as they have a much higher pain tolerance. From a surgical point of view, there are several things the surgeon/anaesthesiologist can do to decrease your post-op pain.
I generally perform breast blocks prior to making any incisions with a mix of short- and long-acting local anaesthetics. I have found this greatly reduces post-op pain. I also encourage patients to take the prescribed pain killers regularly every 4 hours especially for the first 24-48 hours. If you don't stay on top of the pain in the immediate post-operative period, it is extremely difficult to "catch-up". Most of my patients experience very little post-op pain after breast augmentation.
Of course, the type of augmentation you have will also determine your post-operative discomfort. Larger implants, and subpectoral implant placement will also increase post-op discomfort. This doesn't mean you shouldn't get large implants, or place them under the muscle - you simply need to know what to expect. Many women also experience difficulty with sleeping in the first few weeks after augmentation due to the weight of the implants on their chest. This is more significant in back-sleepers.
To answer your question about time off work, my experience has been that there is a huge range. I have patients that go back to work the next day (against my advice), and I have had patients take as much as 2 weeks off of work. It really depends on what you do for work, and how you feel. As for taking care of your kids, if your implant is placed under the muscle, it will be a few weeks before you feel comfortable enough to pick them up.
As for scars, I tell patients it will take a year to see the absolute final result. Practically, however, by 3-6 months the scar will be very close to the final result. I suggest 3M paper taping, and have a specific scar massage protocol I use to help speed scar resolution.
I hope this helps. Good luck!
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.