Can Anyone Reassure Me About Getting Under Muscle Implants and Lift ?

I'm concerned pain wise about under muscle implants and lift I'm going from a/b cup to a DD I have a 21 month old whom will be at grandmas for two weeks but after that I will have to look after him.  Will this be ok as I won't have anyone else who can?  I'm very concerned regarding pain as pain relief never works for me and I still feel everything Thanks

Doctor Answers 6

Under Muscle Breast Implants

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The first couple of days are a bit tougher with implants under the muscle rather than over, but it is well worth it! About 99% of my patients have their implants placed under the muscle. Typically they get by after surgery mostly with ibuprofen. I give them a prescription for Percocet®, but it is rare for anyone to ask for a refill. Childbirth is much more difficult, according to my patients. I hope that helps reassure you. You should be fine with 2 weeks of childcare for your 21-month-old. Best of luck!

Long Island Plastic Surgeon
4.4 out of 5 stars 25 reviews

Pain after breast augmentation with lift

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I usually tell my patients that with a breast augmentation with lift they can return to work in 5 days.  That being said at 2 weeks post op you should be fine to take care of your baby.  Best of luck.

Pain after submuscular implants and breast lift need not be severe!

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First, submuscular implants are necessary when performing a breast lift, as skin flaps are created that do not allow implants above the muscle. Secondly, you want below the muscle for the capsular contracture-reducing benefits of avoiding bacterial biofilm formation from implants beneath only the breast (all the ductal bacteria "bathe" and multiply on the surface of the implants and increase your risk of CC).

Third, careful and precise surgical technique make submuscular "more pain" not so much any more! Avoidance of bleeding by extremely precise hemostasis at the time of surgery reduces bleeding, bruising, "culture broth" for those pesky biofilm-producing bacteria, not to mention swelling and pain!

Aside from precise technique (not all surgeons do this; some still use blunt dissection with "hockey stick" type instruments and "pack the wounds" with gauze while creating the opposite pocket), there are a few other things to consider to get the most pain-free experience--swelling, muscle spasm, and inflammation while healing from the trauma of elective surgery.

Blunt dissection and rough technique means bleeding control is much less accurate, not to mention the exposure of your sterile implants to cotton fibers (the gauze packs) that can act like grains of sand in an oyster--except in you there won't be a pearl, you may develop a capsular contracture!

So, careful surgery (obviously no drain, since you don't need one if you don't have bleeding, and don't leave that superhighway for bacteria into your breasts) is critical, as well as proper post-op management of muscle spasm, inflammation, and swelling.

NOT just narcotic trying to "cover up" these issues, and potentially failing in your case.

I utilize oral Celebrex pre-operatively to reduce inflammation and swelling before it even starts, and continue this post-op for a week or so. Intravenous Decadron is given immediately upon entering my operating room--this helps reduce swelling, inflammation, and post-op nausea, while stabilizing cellular membranes and making them physiologically less "leaky." Less swelling and inflammation reduces muscle stretch and resultant discomfort (or pain).

Which brings me to the next thing: oral non-narcotic muscle relaxants are given for 10 days post-op (longer if needed), as this is actually more of a cause of post-op pain than "raw" nerve endings.

And, before I close the incisions, I put 15cc of long-acting local anesthetic right into the submuscular pocket with the implants, anesthetizing those nerve endings for hours to longer, making the ride home and the emergence from anesthesia truly comfortable! Don't get me wrong, I don't want my patients going dancing the night after surgery (or even going out for pizza). Even if they feel they CAN, go home and take it easy; start with chicken soup and liquids! Pizza and salads can wait til the next day.

And ice bags to the protected skin are OK too!

If all this is insufficient to make you absolutely comfortable, you still have pain medication available, but avoiding (or reducing) it can minimize nausea and vomiting from your narcotic on top of your anesthetic (that's another thing--we utilize only TIVA [total VI anesthesia] and avoid inhalation anesthetics that cause much higher rates of nausea). Avoiding throwing up reduces bleeding, bruising, and swelling that can cause more pain and even lead to re-operation for hematoma, so this is just as important as precise surgical technique!

You'd be surprised how much this entire surgical/anesthetic/medication regimen actually works to minimize pain after submuscular augmentation (with or without lift, but the additional hours of lift surgery make the anesthesia choices that much more pertinent here as well)! I see all of my breast patients the next day, and ask each one of them what their pain level on a scale of 1-10 they experienced. Most say 3-4, but a surprising number actually say ZERO! They typically have had one or more children such as you, and say they feel discomfort or "engorgement," but they actually tell me that our pain and muscle spasm and inflammation and anesthetic regimen gave them a "pain-free" experience. Of course there are those that say 7 or 8, but they usually have not had children and look absolutely comfortable as they say it! Go figure!

So get the proper surgery (below the muscle implants), but more improtantly, choose the "right" surgeon--an ABPS-certified plastic surgeon who does lots of breast surgery and has done so for years (experience makes good surgeons better, and bad surgeons repetitive).

Best wishes and speedy recovery! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Can Anyone Reassure Me About Getting Under Muscle Implants and Lift?

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In general, there is more pain associated with implants under the muscle and with larger implants.  In order to go from an A/B to a DD you would need relatively large implants, so your concerns (of being able to take care of a 21 month old after two weeks) are justified.  If the healing goes well that may be enough time...but you should revisit with your surgeon whether such large implants at the time of a lift are the best choice.  The combined procedure (of a breast lift with implants) is associated with an increased risk of complications versus either procedure alone; selecting relatively large implants increases those risks accordingly.  For that reason, it may be a good idea to go over the entire surgical plan again with your surgeon, after which you may have a better idea of what your recovery will be like.

I hope that this helps and good luck,

Dr. E

Easier than childbirth or C-Section!

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Most of my patients who have had other major surgery, or children report that the recovery from their sub-muscular breast augmentation +/- lift is far easier than the surgery or childbirth. If you have a 21month old I'm sure you'll do just fine with the proper pain medicine. Express your concern about the medication with your surgeon and see if he has alternative medication you can try if the first one doesn't work.

Can Anyone Reassure Me About Getting Under Muscle Implants and Lift ?

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Everyone's recovery is unique. Most women are functional long before two weeks, but pain meds work for most. 

Larger implants as you seem to be getting are more likely to cause more and prolongued discomfort. 

Your question is better discussed with your surgeon, who knows the specifics of what is planned. All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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.