How Painful Was Your Breast Augmentation with Under the Muscle Placement?

Thank you for your question. There are many things that can make your post-operative pain tolerable:1) Injectable numbing done at the time of surgery (some can last for several days)2) Muscle relaxants so your muscle is not as tense3) Narcotics to help address pain. Usually more effective if you stay ahead of it4) 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.

Thank you for your question. After Breast augmentation surgery, patients are often quite sore, but everyone experiences pain differently. The pain from breast augmentation is due to the stretch of the muscle. It is musculoskeletal soreness and is easily controlled with narcotic pain medication. Most patients are off narcotics within 3-4 days after surgery.

Pain after gummy bear (silicone) implants is variable in women and can be affected by things such as a persons natural pain tolerance, the size of the implants, the tightness of the chest muscles and the use of post operative local anesthesia. The larger the implant, the larger the pocket that must be made under the muscle and therefore, the greater the post operative pain. Many women who work out their chest regularly will have really developed pectoralis (chest) muscles. Big pec muscles seems to cause more post op pain. I regularly inject a large amount of local anesthesia into the muscle pocket to give women several hours of pain relief. My patients will then go home and begin taking their post op pain meds and ibuprofen along with ice. Many of them will report that they are off pain meds and just taking ibuprofen by the second day. 

Hello! Thank you for your question! Breast augmentation is a procedure often sought by women to increase size, add upper pole fullness and projection along with improve shape and symmetry of her breasts. Women who have the breast augmentation done report increased self-confidence, self-esteem, and more comfortable with her body. In fact, it has been the most popular procedure in plastic surgery in the US for the past few years. In general, implant size does not correlate with cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size or implant size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance. Your breast width is the most important measurement. 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!

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.

There are some techniques and medications that experienced plastic surgeons use to minimize pain after breast augmentation independent of the implant type. One of these is Exparel. Exparel is extremely safe when used as directed. As it is injected through a small guage needle mostly under direct vision the complications are rare and less than the breast augmention itself. See the below link for more information. In my experience it is more effective than a pain pump (plus you don't have tubes hanging out of you that have to be removed).In summary, Exparel is a very long-acting local anesthetic that has just been released. It lasts approximately 3 or more days following injection. This is the same length of time that a pain pump lasts and will therefore take the place of a pain pump. This means patients can enjoy the same effect of a pain pump, but without any catheters and no pain pump to carry around.Exparel will be available for those concerned about minimizing discomfort after surgeries such as tummy tuck and breast augmentation.Exparel costs the same as a pain pump and produces the same result but with less hassle.

The pain from sub muscular breast augmentation moderate, and can be easily controlled with postoperative pain medicine.  Most patients feel well within the first week.  Some are well within a day!

The varying pain response to this operation is truly amazing to me despite the use of identical techniques and implants.
Some of my patients require nothing more than Tylenol while others have necessitated the use oxycontin for up to 6 weeks.

It really doesnt depend on the type of implant but the size. Also, it depends on the patient and how meticulous the dissection is. To minimize the post op pain and medication requirement, the dissection needs to be meticulous.
Having said that some patients have more pain than others. In general most of my patients take pain medications for 1-2 days.
Hope that helps.

Hi there,
The duration and severity of the pain experienced after breast augmentation under the pectoralis muscle is variable, and will indeed depend on your individual pain tolerance, the technique of the surgeon, and what the surgeon's preferences for managing this discomfort are.
Most of our patients say they do not have actual pain, describing more of a pressure sensation that most like to feeling like they have a heavy book lying on their chest. Most say this lasts 3-4 days and that they feel pretty good after that, with soreness experienced only during certain movements.
Good luck- I hope you love your new body!