Is Exparel Worth the Extra $300 for my Breast Augmentation?

Ibuprofen is usually not allowed as it increases your changes of excessive bruising and bleeding.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 augmentation 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).  I have not had any problems with patients hurting themselves or "ripping sutures" on this medication

Hello! Thank you for your question! Exparel is an excellent form of delivery of a local anesthetic, Marcaine. It is delivered within a liposomes form, which is slowly released over a 72 hour period. The injectable form lasts approximately 6 hours. It has significantly reduced postoperative pain as well as the need for postoperative narcotics following surgical procedures. Sometimes a small additional fee is required for it's use, but it's benefits have been great. The pain pumps are excellent as well as they continuously drip the anesthetic within the pocket. Typically, Exparel is either injected into the surrounding soft tissue/underlying muscle layer or just simply released into the pocket itself. If injected between the ribs, there certainly is a theoretical, and higher, risk of puncturing of the lung. the former methods are more common. Hope that this helps! Best wishes!

The company that makes Exparel has been trying to convince plastic surgeons to use this on their patients.  Personally, I have never used it and don't think it's worth the cost or if it even works.  You can't use ibuprofen because of the risk of bleeding.  There are many different meds for post op pain relief and I am sure your surgeon and anesthesiologist can figure out something that will work for you.

I haven't seen anything in the literature about the use of this drug specifically in breast augmentation. I don't see much of a downside to it but I wonder if it will be worth $300.

That is a great question an I think the answer depends on the technique that your doctor uses for breast augmentation.  The standard technique involves blunt dissection (tearing the tissues) with a finger or dissector and if that is the technique that your doctor uses then yes, the Exparel would be helpful.  However, my preferred technique it that originally pioneered by Dr. Tebbetts where a precisely tailored pocket is dissected with cautery dissection- Dr. Tebbetts was able to show that most patients (98%) are off of narcotics after 24 hours with this technique and 20% didn't require narcotics at all!  This is my experience as well.  I would ask your doctor what they recommend, but you shouldn't need a local anesthetic that lasts for 3 days for a technique where most patients are feeling pretty good by 24 hours.