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Managing Post-Augmentation Pain

Effective strategies for post-augmentation pain management.
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Pain management is a key component of surgical care. Not only are patients more comfortable when their pain is properly managed, they are more likely to resume limited activities and take an active role in postprocedure care. For an elective procedure, such as breast augmentation, making the experience as painless as possible is an effective way to increase patient satisfaction and ensure good surgical outcomes.

Pain following surgery can lead to complications, such as pneumonia, which can develop if patients aren’t taking deep enough breaths. It raises blood pressure, increases the heart rate and interferes with sound sleep. It can also increase the risk of blood clots if patients are unwilling or unable to get up and move around. “The person is exposed to a lot of risks if they’re not able to manage their pain,” says Julius Few, MD, of the Few Institute for Aesthetic Plastic Surgery in Chicago and New York.
Pre-Operative Pain Management

For the breast augmentation patient, pain management begins before the surgery, during the consultation. This is an opportunity for the surgeon to not only make sure the patient knows what to expect during and after her surgery, but to discover the patient’s attitude toward pain, and her previous experiences with surgical pain.

“You can get into trouble with the patient who will tell you ahead of time that she has a very poor pain tolerance,” notes Dr. Few. “In those cases you have to work extra hard, and I tend to be even more aggressive in terms of putting in local anesthesia around the time of surgery and coming up with a protocol that often involves multiple medications such as Motrin and a narcotic and then muscle relaxers. In those cases I’ll typically use agents such as Valium or Flexeril to relax the muscle response.”

“I believe there are different pain tolerances in people and many patients will let you know that they always experience more pain after any procedure,” says Edward Miranda, MD, of Pacific Plastic Surgery Group in San Francisco. “Then you have to dissect whether they are just fearful, or they are truly pain sensitive. Many of those patients are just fearful, because they or a friend had a bad experience. We always give them a narcotics prescription. We tell them to fill it, we encourage them to take it if they need it, but we ask them to please try our protocol first.”

The type of procedure will also determine the amount of pain the patient can expect. Augmentation in which the implant is placed under the muscle tends to be more painful than those in which the implant sits just beneath the breast tissue. Larger implants can cause more post-surgical discomfort than smaller ones.

Image copyright Ian Hooton/Science Source