Recovery and downtime
The recovery from subpectoral breast augmentation used to routinely be a rather unpleasant experience, but it no longer has to be. Almost all of our patients leave The Plastic Surgery Center with little to no pain, can shower the night of surgery, and experience a 24-hour return to routine, non-strenuous activities of daily living. Out-of-town patients who are travelling with a friend or family member may fly home the day after their breast augmentation surgery. We ask those that are travelling alone to plan on flying home two days after surgery.
During subpectoral augmentation a space for the implants must be developed behind both pectoralis major muscles, and a major portion of each muscle’s inferior origin must be released. Surgery performed directly on a muscle will in most cases produce significant and potentially prolonged postoperative pain, and that is certainly can be true for sub-pectoral breast augmentation – unless a number of preventative measures are taken.
Our protocol includes the following measures that have a synergistic effect that result in the major reduction of, or complete elimination of, postoperative pain:
- Preoperative administration of three non-narcotic oral medications that have been shown in randomized, blinded clinical trials to reduce the need for postop narcotic pain medications
- Pre-incision injection of all incision sites with a combination of local anesthetics
- Minimally-traumatic surgical technique, using low-power electrocautery for surgical dissection and hemostasis (hemostasis is the medical term for the prevention of bleeding from tissue surfaces including the highly vascular pectoralis major muscles)
- Injection of an extra-long-lasting local anesthetic (Exparel) into the inferior margins of the pectoralis major muscles (in the area where they have been divided using electrocautery)
As most of our breast augmentation patients never require postop narcotic pain medication, we do not routinely prescribe it for this surgery. We provide patients with a non-narcotic anti-inflammatory pain medication called Celebrex (generic name celecoxib) to take twice a day for the first five days regardless of symptom level. Most patients report little to no pain in the evening following surgery, and perhaps some mild discomfort on postop day one, two and three. Patients can resume all routine, non-strenuous activities of daily living immediately after surgery, and can begin pec major range of motion exercises (arms above head and behind back) on the evening of their procedure.
Patients are seen in the office on postop day one, two or three. Those who work in an office environment usually return to work two to three days following the surgery. Stay-at-home moms should arrange some help with toddlers for the first two to three days after surgery. Exercise is limited to casual walking only for the first two weeks; in weeks three and four some light exercise is permissible.
Patients can gradually increase their isometric exercise level in the second month (weeks five through eight), however it is a full eight weeks before patients are allowed to return to activities that require forceful, repetitive, sustained pec major contraction – such as pushups and heavy weight lifting. Impact exercise may be resumed at 12 weeks postop, and it is important to ensure that the breasts are well supported in snug-fitting sports bra (or two) when first returning to impact exercise such as running or high-intensity cardio training.