There are many options to manage pain after breast augmentation
This is an excellent question and I'm glad you asked it. There are so many considerations here, and I think they involve much more than just "what pills to take after surgery." Pain is a very complex thing, and not only do different people experience pain differently and to different degrees, but there are different "components" to what we as humans call "pain." If these are broken down and each one considered and managed the best way, postoperative pain can be a very small part of your overall recovery process. Fortunately, breast augmentation is by and large not a terribly painful procedure anyhow, and the pain is usually short lived for most patients. However, as I said, pain is experienced differently by different people. Generally speaking, I think most people consider pain to be divided into two major components: so-called "suffering," which is the conscious, or psychological part of the pain that we experience when we know we're in pain, and the "organic" or physical part of the pain that we actually feel. These are closely related, and one affects the other, but they have been shown to be distinctly different and therefore susceptible to different management strategies. For me, I consider the suffering component to be more "experiential," that is, it has more to do with how you are feeling in general around the time of your surgery or afterward. Are you comfortable? Are you scared and anxious? Cold? Hungry? Thirsty? Nauseated? All of these things, believe it or not, have been shown to have a significant effect on the experience of postoperative pain. Thus, not only can we influence the suffering component of pain by attending to these things, but if we plan for it properly, we can start to do it before a surgeon even lays the scalpel on your skin to begin the surgery. Additionally, we find that if patients wake up comfortably with excellent pain management from the beginning in the operating room, this starts things off on the right foot, and we have a much easier time managing pain over the course of the rest of the recovery. It is always easier to maintain pain control than to obtain pain control late, and suffering is a big reason for this. Many of the management strategies that we have employed in my practice center around this part of pain management, and they have been highly successful at either decreasing, or eliminating, the need for narcotic pain pills postoperatively in most patients. I still prescribe narcotics to most people just to be safe, but we find that they don't need as many. One of the major advancements along these lines takes a page from the playbook of our colleagues in Europe, where ERAS, or Enhanced Recovery After Surgery, is a growing paradigm. In this model, the entire medical care team is involved in a very specific process aimed solely at speeding up a patient's overall recovery after surgery and getting discharged to home sooner if they are in the hospital. There are a number of things that they do for some of their general surgery patients that we wouldn't necessarily do for our outpatient plastic surgery patients, but we have "stolen" many of the good ideas from them that apply to our patients. For instance, one example of this is a specially formulated preoperative carbohydrate/amino acid/electrolyte loading beverage (not just Gatorade) that we give to people 2 hours before surgery. Gone are the days of "nothing to eat after midnight" in my practice. Extensive research has shown that preoperative fasting like this is detrimental, and this preoperative clear liquid not only is safe, but it significantly decreases the incidence of preoperative anxiety, thirst, and hunger, postoperative nausea and vomiting, and as a result of all of that, pain management becomes much easier. It sounds crazy that a simple drink 2 hours before surgery would do all of this, but it does. Other things including proper preoperative warming, and then another one of the beverages in the recovery room, instead of the usual soda or water that most people get, also help. For the "organic," or physical component of pain, this is where medication use is most prevalent, as it is this component of pain that is most likely to be helped directly by medications. But, the question here is which medications? Most of us normally default to narcotic pain medications because that is the simple answer and what we have all learned through the years. These drugs including Percocet, or oxycodone/acetominophen (Tylenol), Norco and Vicodin, which are hydrocodone/acetominophen, Dilaudid, and codeine (think Tylenol 3), all share the same constellation of side effects including nausea, drowsiness, constipation, urinary retention, respiratory depression, and even death in large amounts. Unfortunately, I had a colleague once whose patient died from Oxycontin (slow release oxycodone) overdose postoperatively. Overdose is not something to take lightly, as many times patients become anxious because of uncontrolled pain, and they keep taking more and more medication hoping it will work, not appreciating the danger, and ultimately overdosing. For a variety of reasons, narcotic medications may not be preferable for postoperative pain relief, or if they are, we should at least minimize their use as much as possible. Fortunately, there are still a number of ways we can manage postoperative pain without relying so heavily on narcotics. I'll just list a number of the ones I've used. Each surgeon will have his or her own experience with pain management and his or her own preferred protocols. Another oral medication that has been mentioned here, that I also find very useful is valium. Also added to this category are other muscle relaxers like Flexeril, Robaxin, and Soma. All of these medications relax tight and spasming muscles, and when we have put implants under the muscles, it is very often muscle tightness and spasm that hurts. In addition, these medications are all sedating and to some degree anxiolytic, meaning they decrease anxiety, and they will also help decrease nausea. Thus, one of these medications might be more beneficial in instances like this than a narcotic. Something that I always use in the operating room to control early postoperative pain, at least for the first several hours after surgery, is local anesthesia. I put a small IV catheter into the pocket before I place the implants and leave it. Then after the implants are inserted and the pocket is completely closed, I inject a mixture of long and short acting local anesthetic solutions and remove the catheter, so that the implant pocket remains bathed with local anesthetics. Patients wake up in recovery feeling only mild pressure and no pain at all, and I think this gets them started on the right track for pain management longer term. In some cases a patient may need or want longer than several hours of anesthetic effect as an adjunct to pain management, and in those cases I’ll actually inject a medication called Exparel, which is a longer acting version of Marcaine, the long acting local anesthetic. Injected directly into the tissues around the ribs and muscle inside the breast pocket, it will exert its effects for up to 72 hours and greatly reduce the need for narcotic medications too. In addition to this, we have all of our patients who are not allergic to it receive intravenous acetominophen, or Tylenol, from the anesthesiologist during the procedure too. Again, this is a very potent pain reliever - much more than the oral version as it avoids passage through the liver unlike the oral form, it lasts several hours, improves early pain control, and sets the stage for better long term pain management. I personally am not a fan of intravenous or intramuscular Toradol, as it is a NSAID medication just like aspirin, Motrin, and Aleve, which, while an excellent pain reliever as most NSAID’s are, also affects platelet function and can potentially increase risk of bleeding and hematoma after surgery. Tylenol doesn’t affect platelet function like that, so it is safe to take around surgery. Lastly, there are some alternative oral medications that can be used very effectively instead of narcotic medications. One of those is Ultram, or tramadol. It is sort of a “non-narcotic narcotic,” in that it works on the same pain receptors in the nervous system that narcotics do, but it doesn’t produce the same drowsiness, high feeling, or abuse potential that traditional narcotics do. Another option that I have used frequently with great success is Celebrex, which is a NSAID, but in a different class than Motrin, aspirin, and the others, so it doesn’t affect platelets, and it is safe after surgery. It is a very effective pain reliever, but the down sides are that it is a sulfa drug, so some people will be allergic, and it is expensive, so most insurance plans won’t cover it and many people don’t want to pay the cost out of pocket. One last medical option I will add for completeness, which may be controversial in the minds of many people, and actually illegal in some states, but not California where I practice as well as a number of others, is medical cannabis, commonly referred to as marijuana. Let me first state that I don’t use marijuana myself, I don’t personally prescribe it for patients, and I have no political or personal agenda around marijuana or its legalization, other than noting the very compelling and responsible scientific research that is going on with cannabinoids, cannabinoid receptors in the brain and central nervous system, and the many beneficial medical applications of responsibly dosed and administered cannabis. For some people in states in which medical or recreational marijuana is legal, the use of edible, not smoked, forms of THC, or cannabis, may be a better alternative for pain management than narcotics. I personally wouldn’t recommend smoking, or even vaping it, around the time of surgery as that has been shown to have some negative effects on healing tissues the same as tobacco smoke. Medical cannabis not only alleviates both organic and suffering components of pain, but it can help reduce postoperative nausea and vomiting and anxiety too. The only caveat here is to note that I am discussing medically prescribed cannabis dispensed properly and legitimately from a licensed dispensary and not a “nickel bag scored on the neighborhood street corner” or brownies cooked up by your fraternity brothers. One last thing that shouldn’t be overlooked is the power of ice. That’s right, frozen water. Properly applied to the breasts and chest wall tissues for the first 48 - 72 hours, ice can significantly reduce both pain and swelling. That may be more than you wanted to know about pain management following breast augmentation, but it’s everything that has worked in my own practice over the years. Hopefully there are some options in there that can help you and your surgeon find an acceptable and effective way to manage your postoperative pain without narcotics, if you wish or need to go that route. Best of luck with your upcoming surgery.
You could ask for milder pain medication like Trammadol or Tordol. If you need something stronger, Hydrocodone, or one of its cousins may work well for you. Please discuss any concerns you have about medication with your doctor. Also, muscle relaxers can be very helpful for women whose implants are placed behind the muscle.
Norco + Valium
Hello, and thank you for your question. I encourage you to bring up your concern with your BCPS to see what he/she recommends.In our practice, we routinely prescribe Norco (a mix of the narcotic pain medication "Hydrocodone" + Tylenol) and Valium (muscle relaxer). Many people feel as much relief from the muscle relaxer as they do the narcotic pain pill, because the pain is from the muscle tightness stretching over the new implant.Some patients prefer not to take narcotics, and after 24 hours they will switch from Norco to Extra Strength Tylenol. Too much Tylenol can be toxic to your liver. Since the pain pill already has Tylenol, be sure if you add Tylenol to your regimen it is taking the place of the pain pill, NOT in addition to the pain pill.Best of luck!
Alternatives to narcotics
Thank you for your question. Prescription paid medication is best to be discussed with your plastic surgeon. In my experience, patients generally need pain medication for the first day or two. I wish you the best of luck.
Breast augmentation recovery
Narcotic based pain medication is what is usually prescribed after this procedure. It seems to work well for most patients and is only needed generally for a week or less. Many times the medication prescribed is a mixture of narcotic medication and Tylenol, so you need to be careful when taking any extra Tylenol as it could be too much. In addition, some surgeons also prescribe a muscle relaxer if the implants are going under the muscle. Discuss your concerns with your surgeon and together you can determine which medications will be best for you.