You often ask us in consultation how much it hurts to have breast augmentation surgery and the answer is always the same, very variable depending on each person. However, we can identify which patients are most likely to suffer the most postoperatively.
- Nulliparous, that is, patients who have not had pregnancies, will possibly experience more pain since it is the first time they undergo a volume change in their breasts.
- Severe breast hypoplasias, that is, those patients that are very flat. The less breast we have, the greater the probability of experiencing pain.
- Large prostheses, especially the most projected ones.
- Prostheses placed below the pectoralis major muscle: Our preference is to place subpectoral implants but strain of the pectoralis muscle causes more pain. In fact, patients who undergo surgery in the subglandular plane experience almost no pain.
The pain is produced by a nociceptive mechanism secondary to the distension of the sensory nerves that innervate the costal wall, especially the third and fourth intercostal nerves. The best way to mitigate this pain is to perform a sensory block with local anesthesia. Our favorite is bupivacaine diluted to 0.25%, which gives us around 12 hours of anesthesia.
We also use anti-inflammatory and analgesic drugs during the first postoperative week. Normally, ibuprofen of 600 mg every 8 hours is usually sufficient, but it can be accompanied by nolotil or paracetamol, alternating it every 4 hours.
Sports bra: A sports bra that supports the chest well but does not exert excessive pressure also helps reduce discomfort in the first postoperative days.
With all these measures, anesthetic block, anti-inflammatory/analgesic medications and sports bra , most of our patients do not experience pain beyond the 4th postoperative day. Some patients even tell us that the sensation they have experienced is much more like severe soreness than the pain of surgery.