On a scale from 1-10, how would most women rate the pain of gummy bear Breast Implants with sub-muscular placement? I will be doing this with stomach and thigh PAL Liposuction.
How Painful Was Your Breast Augmentation with Under the Muscle Placement?
Doctor Answers 19
Breast pain with under muscle placement
1) Injectable numbing done at the time of surgery (some can last for several days)
2) Muscle relaxants so your muscle is not as tense
3) Narcotics to help address pain. Usually more effective if you stay ahead of it
4) Non-narcotic medications (e.g. anti-inflammatories such as Advil)
You often find that discomfort does correlate with size of the implant and the degree of stretching of the soft tissue of the breast.
Depends on your pain tolerance
How Painful is breast augmentation surgery? - Not Painful!
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.
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How Painful Was Your Breast Augmentation with Under the Muscle Placement?
Things to to consider during your consultation, which your surgeon will discuss with you, include implant type (saline vs silicone), shape/texturing of implant (round vs shaped/textured vs non-textured), implant position (sub pectoral, subglandular, or subfascial), incision (inframammary fold, periareolar, axillary, or TUBA), and size of implant. This can be performed with/out a breast lift, which would serve to obtain symmetry in breast size or nipple position as well as improve shape. Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory. I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width. Too large of implants for the woman often destroys the breast pocket and breast shape, thus creating an oft seen uncorrectable problem later. Very slightly less tissue may be visualized with subglandular implants, but not very significant. You will likely have more discomfort from the liposuction that the augmentation.
Implants may be placed either in the subpectoral (beneath muscle) or subglandular/subfascial (above muscle). Both locations are excellent and you can choose either one - your surgeon will discuss the pros and cons of each. In general, while a placement above the muscle is a more natural position for an implant to augment the actual breast, I find that it is not desirable for very petite women or women with a paucity of breast tissue - as the visibility and potential rippling seen/thinning of tissue may give a suboptimal outcome. A subpectoral pocket adds additional coverage of the implant, but causes slightly more and longer postoperative pain/swelling as well as the potential for animation deformity with flexing of the muscles. Today, there is no virtually no difference in rupture rate, capsular contracture rate (slightly higher with subglandular as well as certain incisions), and infection with the positions. As you see, there are a few factors to decide upon for incision, placement, and implant type/size. Consult with a plastic surgeon who should go over each of the options as well as the risks/benefits.
Hope that this helps! Best wishes for a wonderful result!
Pain after breast augmentation
When using properly sized implants (implants that are not excessively large) many experienced surgeons are able to deliver a breast augmentation using a pocket under the muscle with minimal pain. By minimal pain I mean pain that is controlled by ibuprofen and pain that allows a return to routine activities within 1-2 days.
Pain After Breast Augmentation
What to Expect for Breast Augmentation
It’s not unusual for patients to experience pain following breast augmentation surgery. This pain is usually related to elevation of the muscles during submuscular breast pocket formation. In addition, spasm of these muscles can contribute to postoperative discomfort as well.
The pain associated with breast augmentation is severe in the first 24 to 48 hours following surgery, but rapidly diminishes with time. We typically use a synthetic codeine derivative called hydrocodone, which has a decreased incidence of nausea compared to codeine. We replace narcotic pain relievers with double strength Tylenol as soon as possible following surgery to avoid the potential for drug problems. We also use muscle relaxants in the immediate postoperative period.
Pain intolerance varies from patient to patient following breast augmentation. If you’re considering this procedure, it’s important to discuss pain management with your surgeon prior to surgery.
Post operative pain
Less pain with Breast Implant surgery
A breakthrough medication, Exparel, is now being used for Breast Implant surgery. This medication is placed at the time of surgery and provides for 3-4 days of pain relief. Recovery is now quicker and time back to work is shorter!
Post-operative pain after breast augmentation
Most patients have mild discomfort for 1-2 days after submuscular breast augmentation. I agree with Dr. Aldea that it is really dependent upon the surgical technique used. If we as surgeons are gentle with your tissues during surgery, you should have no more than minor discomfort and be back to regular activity within several days. Traditionally patients were told that submuscular augmentation was much more painful than subglandular, but that is not necessarily the case. Good luck, /nsn.