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

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.

Doctor Answers 17

How Painful is breast augmentation surgery? - Not Painful!

The most important aspect of postoperative pain control following subpectoral breast augmentation is the surgical technique.  Local anesthetic infiltration prior to incision and meticulous, gentle, minimally traumatic surgical technique, in combination with highly effective non-narcotic, anti-inflammatory pain medications - both preoperatively and postoperatively - will allow many patients to have a 24-hour return to routine, non-strenuous activities of daily living without any need for postoperative narcotic pain medications like Vicodin and Percocet.
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.  

Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 86 reviews

Breast Augmentation and Pain

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.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 62 reviews

Breast pain with under 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 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.

Pain after breast augmentation

Pain after breast augmentation is influenced by several things including the patient's natural pain tolerance, the soft tissue trauma caused by the surgeon (generally more experienced surgeons are able to cause less tissue trauma), the relationship between the size of the implant and the tightness of the pocket, and, the pocket location (above or below the muscle). 

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. 

Exparel Makes A Big Difference in Managing Pain

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.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 89 reviews

Depends on your pain tolerance

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!

Post operative pain

Pain varies from patient to patient and with size of implant. You will be uncomfortable for a few days, but it's nothing you can't handle. Best of luck.

Grant Stevens, MD
Los Angeles Plastic Surgeon
4.5 out of 5 stars 98 reviews

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!

David Finkle, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 62 reviews

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.

Nina S. Naidu, MD, FACS
New York Plastic Surgeon
4.5 out of 5 stars 6 reviews

Postoperative pain following Breast Augmentation with Implants

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.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 64 reviews

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.