I Am on Methadone Maintenance 90 Mg Daily and I Want to Have a Breast Aug. What Do I Do for Pain?

  The responsibility for pain management after the surgery should be carefully monitored by your methadone doctor and plastic surgeon.  The methadone doctor should make recommendations about a protocol to follow for pain after surgery.  Kenneth Hughes, MD Los Angeles, CA

It is best that your surgeon speak with your methadone doctor to assist in management. Make sure your post op meds don't have tylenol, so that if you take more than your doc suggests you won't have tylenol toxicity.

Ask your surgeon about prolonged local anesthetic with Exparel injections or a pain pump, either of which provide  about 3 days of local anesthetic effect.

All the best. 

When I have encountered this situation in the past I have coordinated post op pain relief with the Pain Management Specialist and it worked out well.  Another solution is to use either a pain pump or a long acting local anesthetic such as Exparel.

You should have your plastic surgeon and your pain specialist coordinate your care.  There are many different medications available to treat post-operative pain but, as you indicated, your case is complicated in that you're already developed tolerance to many of them, or to their equivalents.  Hopefully, this is something that can be addressed by your two doctors and, if so, then good luck with the surgery!

Dr. E