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 19

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.

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!

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.  
 

Michael Law, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 107 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 68 reviews

Pain After Breast Augmentation

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. 


Stanley Castor, MD
Tampa Plastic Surgeon
5.0 out of 5 stars 97 reviews

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

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!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 20 reviews

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.

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. 

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
5.0 out of 5 stars 116 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 66 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.