I'm sure you’ve heard women who have had breast augmentations describing their painful recoveries in graphic detail. "I felt like a truck backed over me." "It feels like an elephant sitting on my chest.” We hear these same comments when we're consulting with new patients about breast implants. "My friend had implants, and she couldn't get out of bed for a week, and her breasts were black and blue and purple." It makes you wonder how many women who would want and benefit from breast augmentation have balked because of stories like these. Probably a lot. Maybe you’re one of them. It’s sad because recovery from breast augmentation surgery doesn’t have to be particularly painful.
Our typical breast implant patient describes her pain the first few days after surgery as "It feels like I worked out too hard yesterday." Ok, not a pleasant sensation. Tight, sore, uncomfortable. But nothing like an elephant, truck, or bowling ball crushing your chest. A discomfort that most of us have experienced and made it through just fine.
Why do some breast augmentation patients have so much more pain than others? What are the sources of pain after breast augmentation? How much pain can you expect during your recovery period? What can be done during implant placement and post-surgery to reduce breast augmentation pain and speed the healing process? In this article, we will answer all of these questions to help you decide if breast augmentation surgery makes sense for you.
What Causes Pain After Breast Augmentation
The pain you experience after a breast augmentation comes from several sources.
The Incision
Every breast augmentation surgery starts with an incision. This is usually located in the fold under the breast, around the lower edge of the areola, or in the armpit. Like any cut to your skin, the incision will feel sore but it's rare for it to cause significant discomfort during recovery. The pain from the incision tends to be mild regardless of which incision location is chosen. But incision choice can affect post-op pain in other ways as we will soon see.
Making the Breast Implant Pocket
To create a space for your breast implants, your plastic surgeon needs to either separate the backside of your breast from the underlying pec muscle (subglandular implant placement) or raise the chest muscle off of your rib cage (subpectoral implant placement). Either of these maneuvers is likely to be the source of most of your pain after breast augmentation surgery.
Muscle and Breast Tissue Stretch
Inserting a breast implant immediately forces the pectoral muscle and the breast itself to stretch and curve in a way they had never done even moments earlier. This will cause a sensation of tightness and contributes to postoperative pain though it is rarely the major source.
Pain from pec muscle stretching feels like workout soreness and tissue stretching feels like the swelling from breast engorgement during lactation.
This type of pain tends to subside in the first few days but may linger for several weeks with larger breast implants.
Inflammation and Swelling
Inflammation is your body's natural response to any surgery and most patients can expect some post-op swelling in the breast area after augmentation. This is a completely normal response to any plastic surgery. The associated discomfort is usually mild.
Nerve Irritation
The nerves that supply sensation to the breast and nipples can get stretched and compressed like other surrounding tissue. Irritated nerves often cause areas of numbness immediately after a breast augmentation. As the nerves recover, some patients experience shooting pains in the breasts. These usually resolve several weeks into the recovery period.
Surgical Techniques to Reduce Pain
Now that we've covered the causes of breast augmentation pain, let's explore what can be done during your surgery to ease your recovery and get you back to normal activities quicker.
Anesthesia
The first step in breast augmentation pain management is proper general anesthesia during surgery. Breast augmentation can be performed under local anesthesia with you awake. This is rarely a good idea. First, it’s extremely difficult to numb the entire breast area. In most cases, you will be in pain for at least part of the procedure. Aside from compromising the precision of the breast augmentation surgery, severe pain during the procedure sets you up to experience a lower pain threshold afterward. This lower threshold can cause patients to have more pain and require more prescription pain medications during recovery.
General anesthesia delivered by an experienced anesthesiologist eliminates pain during the surgery, reduces the need for narcotic pain medication, and actually sets you up for a more comfortable recovery. When you choose your surgeon, pay attention also to who is providing the anesthesia and what methods they’re using.
Incision Choice
The incision your surgeon chooses contributes little to the pain in and of itself. But its location can affect how much pain you experience for weeks.
An incision in the fold under the breast (inframammary incision) provides your surgeon with the shortest, most direct route for creating the breast implant pocket. Not surprisingly, the inframammary incision causes the least post-op pain for most patients.
Placing the incision at the lower edge of the areola (periareolar incision) is almost as good in terms of post-op pain management. But to make the implant pocket with this approach, plastic surgeons need to cut down through all the breast tissue. This increases discomfort during recovery.
But, for limiting pain from breast implants, the underarm incision (transaxillary incision) is the worst of all. This approach forces your surgeon to dissect under the pectoral muscle at the sensitive area where it narrows to cross your shoulder. Irritation and inflammation of the muscle here cause much more severe pain that will last for weeks in most patients.
To speed the recovery from your new breasts, we recommend avoiding the underarm incision.
More information on breast implant incisions can be found here.
Pocket Location
Breast implants can be placed either above or below your pectoralis major muscle. Placing the implants under the pec stretches the muscle and causes somewhat more discomfort in most women. In our experience, the difference in pain compared with over-the-muscle placement is minor and only lasts several days and we recommend that you get your breast implants placed under the muscle.
The advantages of under-the-muscle placement include a more natural appearance, stronger implant support, and more accurate mammograms. These are compelling advantages and are worth a few days of increased discomfort.
Pocket Dissection
To create space to insert the breast implant, a plastic surgeon needs to either lift your breast tissue off of the underlying pec muscle (over the muscle) or raise your pec muscle from your rib cage (under the muscle).
There are two techniques for making the implant pocket:
Blunt Dissection
With blunt dissection, the plastic surgeon uses a metal rod or spatula to tear the tissue layers apart. This is how all breast augmentations were originally done and is still a popular method. But tearing apart tissue bluntly hurts. When you read stories of women describing severe chest pain and pressure, the vast majority will have had pockets made by blunt dissection.
Electrosurgery Dissection
An electrosurgery device (Bovie) acts like an electronic scalpel. It uses high frequency electrical current to simultaneously cut and cauterize (stop bleeding) tissue. An experienced surgeon can use it to lift the pectoralis muscle off the rib cage very precisely and with little blood loss (often less than a tablespoon). Because it dissects the pocket without force or tearing, electrosurgery is much less painful. It's the only method we recommend.
Breast Implant Choice
We've seen that one of the sources of breast augmentation pain is muscle and breast tissue stretch. Very large breast implants require more stretch and so, on average, hurt a bit more. The difference isn't, in our experience, significant and we feel there are much more important factors than post-op recovery that should go into choosing breast implant size.
Exparel
Exparel is a slow-release version of the local anesthetic Bupivicaine. Injecting Exparel will make an area numb for two to three days. Unlike pain medications or muscle relaxers, Exparel relieves pain without drowsiness, nausea, or any other side effects. With Exparel, the recovery from many cosmetic surgeries is easier and most patients require less pain medicine even after the Exparel wears off.
We use Exparel routinely after all our tummy tucks and offer it to our breast augmentation patients who want it.
Suture Choice
Sutures are used to close all breast augmentation incisions. Your surgeon's choice of suture is unlikely to change your pain level after surgery. But meticulous suturing technique will prevent additional discomfort from too-tight stitches that pinch your skin. Also, if your plastic surgeon uses dissolving sutures, you will eliminate the pain of suture removal (which is mild but still nice to avoid) and your incision care will be easier.
Post-Op Tips for Reducing Breast Augmentation Pain
Your postoperative pain level is mostly determined by your surgeon's technique and your own pain tolerance. But there are several post-operative dos and don'ts that can make your life more pleasant during the first few weeks after breast augmentation.
Pain Medication
Your pain medication is prescribed for a reason. Always take your pain medications according to your doctor's instructions but, if you need them, do take them.
That said, not all pain medications are created equal. We've already discussed how Exparel can relieve pain without side effects by numbing the surgical area. We are happy to offer Exparel to our patients who want it.
Since most of our patients experience only mild to moderate pain after breast augmentation, Exparel isn't usually necessary. In fact, we've found that virtually none of our patients even need opioid pain medications.
We usually prescribe a combination of an antiinflammatory analgesic and a medication that blocks nerve pain. This combination relieves pain and reduces swelling without the side effects and risks of narcotic pain medicine.
We do prescribe opioid pain medication for patients who need it or can't take the non-narcotic medications. But currently, less than 5% of our breast augmentations require the opioids.
Activity
In the last few years, it's become fashionable for plastic surgeons to promote 24 hour breast augmentation recovery. This is more a marketing gimmick than smart surgical care. But there are some elements of truth to it so let's explore it further.
Twenty-four hour breast implant recovery does not come from a proprietary or unique surgical technique. Low postoperative pain levels come from the surgical choices and methods we've already described which are available to - but not necessarily practiced by - every plastic surgeon. Most of our patients have low to moderate pain even on the day they have their augmentation. Still, we don't recommend immediate resumption of all activity and here's our thinking on it:
We first ask ourselves, "what's the upside of telling our patients to stretch, exercise, dance, dine out, or whatever right after surgery?" The answer is nothing. Almost no one wants to do that and certainly, no one needs to do that.
Now what's the downside? Well, it's considerable. Because doing too much too soon will increase your risks of bleeding, infections, implant malposition (healing in the wrong place), capsular contracture, and other complications.
Even if you don't develop an unnecessary complication, increasing your activity too soon will increase your post-op pain. A breast augmentation, like any plastic surgery, is a controlled injury. And like any injury, it is more painful and heals more slowly if you don't rest it. The same way you don't run on a sprained ankle, you don't want to stress your new breasts.
Massage
Many surgeons recommend that their augmentation patients massage their new implants often starting on the day of surgery. Massage is supposed to decrease the chance of capsular contracture (scar tissue buildup). There’s no evidence to support that and there never has been.
As you can imagine, squeezing your newly augmented, tender breasts hurts. It might be worth the pain if there was any proven benefit but there isn't. If anything, massage increases your risk of bleeding, implant malposition, and actually raises your risk of capsular contracture. We don't recommend it.
Conclusion
We hope this article has given you a better understanding of breast augmentation recovery. At our practice, we think that low pain levels and minimal downtime are important goals for every patient. Our goal is to get you back to living your life as quickly and safely as possible. To achieve this, we focus on meticulous surgical skill and technique, as well as carefully planned postoperative care to minimize your pain and simplify your healing.
If you have questions about breast augmentation or breast implant revision, please call or text us at 972-498-4385.
