Breast Augmentation: How Painful is it?

If you are thinking about breast augmentation, you probably have questions about recovery.  How long will I be out of commission? What are my limitations? When will I feel like myself again? How much will I hurt afterward? Thinking about recovery is important, especially with this surgery.  It has some special considerations and pain and swelling is one of them. There is no question that your breast will feel swollen, sore, and even painful, days after surgery. But the belief that breast augmentation is extremely painful is just not reality with our patients. Intense pain after breast augmentation is rare.  When present, it is very short lived and almost always limited to the first few days.  After that, pain improves quickly and is very manageable. Therefore, to get you some answers, this article breaks down what to expect for post-op pain and swelling.  It also gives you some tips to get back on your feet as quickly as possible.

Day-to-day pain expectations 

While the first 2-3 days will be the most uncomfortable, pain levels decrease quickly afterward. On a scale of 1-10, with 10 being the worst possible pain, most patients rate their pain between a 5 to 7 in the first few days. Interestingly, non breast post-op pain, primarily in the back and shoulder region, is a common complaint. Keeping your arms in a guarded position can cause a compensatory strain on muscles in these areas. Here is the breakdown:

  • Days 1-3: Moderate pain (7/10 at most) is managed with prescription pain and muscle-relaxing medications.  Your breasts will look and feel very swollen.
  • Days 4-7: Sharper pain is replaced by soreness around your breasts, nipples and along your incisions.  Swelling still persists and may worsen. 
  • Weeks 2+: You will have very little sharp breast pain, if any.  Soreness can persist, especially with activity.  Swelling will start to decrease but often fluctuates day to day.

A few important factors to consider 

Since pain tolerance differs from person to person so will your experience after surgery.  For this reason, it can be hard to predict how you will feel. There are some key factors during and after surgery that can affect your post-op pain score. In our office, we address each one of these, ensuring that your recovery is manageable:

  • Surgical technique:  A traumatic, lengthy surgery often increases pain. An efficient, less-aggressive surgery will minimize pain and make your recovery shorter.  This is why it is so important for you to select a board-certified plastic surgeon who has expertise in this surgery.  
  • Local anesthetics: These are injected at the time of surgery and will be helpful for the first 24 to 48 hours post op. You may also have the option of longer lasting regional blocks. Once you are at home, muscle relaxants and pain medications will manage pain for the first week of recovery.
  • Implant placement: Depending on whether your implant is placed over or under your chest muscle, postoperative discomfort and soreness will vary. In general, above-the-muscle placement usually has less overall discomfort and swelling. 
  • Activity restrictions: Not being able to use your arms fully after surgery can be frustrating but it helps reduce post-op discomfort.The secondary effect of these limitations is soreness and even muscle spasms around your shoulder,  upper back and even neck. This is usually short-lived and can be managed with muscle relaxants. 
  • Recovery boosters: Ice, head elevation, positional sleeping pillows, slow walking, nutritional supplementation, cryotherapy and even hyperbaric oxygen treatments can all reduce post operative pain and swelling.  We will include some or all of these options in your recovery plan. 

More on the secondary shoulder, neck, and back discomfort 

As we noted, discomfort of your upper back, shoulders, and neck are common after surgery. Since your arm range of motion is limited (think T-Rex arms), you tend to compensate by unnaturally lifting your shoulders. Also, with breast pain, you tend to roll your shoulders forward and inward, in a guarding motion. These reflexive movements lead to secondary muscle tightness and in some cases spasms. Massage and muscle relaxants are helpful here.  Focusing on proper movement mechanics and body posture is also key. Just FYI, your activity will be restricted, especially with arm usage, for the first 4 weeks:

  • Weeks 1-2: Arm mobility and lifting will be limited.  Specifically, you will not be able to put your elbows over your shoulders or lift greater than 8 lbs. This is when you should focus on rest, recovery, and easy walks. 
  • Weeks 3-4: You may resume light activity but there will still be limitations on lifting anything heavy. Longer walks are encouraged.
  • Weeks 5-6: You will gradually increase arm use, and mobility.  You will also be cleared to increase the intensity of your workouts with some limitations on lifting.  A comfortable weight depends on your progress.
  • Week 6-7+: At this point, you will likely be cleared for full activity without restrictions. The time it takes you to get to this point depends on how quickly you reach your recovery milestones.

Swelling is an issue for everyone

You should expect a lot of swelling in the first 24-72 hours after surgery, especially when your implant is placed under the chest muscle. For the first week, it will fluctuate and may worsen with activity or as the day progresses. You will start to turn the corner by the 2nd week and from there swelling will resolve quickly. Patience is key and it can take up to 3-6 months for the swelling to fully resolve. Here is what to expect:

  • Weeks 1-2: Significant swelling and possibly some bruising
  • Weeks 3-4: Noticeably less swelling with little bruising 
  • Weeks 6-8: Continued slow improvements to baseline

Swelling itself can cause your breast to feel sore and achy. Therefore, managing it efficiently is an easy way to speed up your recovery. There are some really helpful ways to reduce swelling.  At Least a few of these should be incorporated into your recovery plan:

  • Cold therapy including ice packs offers the easiest way to reduce swelling in the first week
  • Gentle mobility and walking helps prevent stiffness and encourages lymphatic drainage
  • Sleep with your head elevated and slightly propped up on pillows to encourage drainage of the swelling fluid while you sleep
  • After a week, cryotherapy and hyperbaric oxygen offer more advanced methods of reducing swelling.  You must be cleared for these treatments.

A quick note on the emotional recovery

Many of our patients report feeling a little emotionally drained and frustrated around the 3rd and 4th weeks of recovery. Once you are starting to feel better you naturally want to get back to your normal routine.  But you can’t.  Even 3 to 4 weeks after surgery, you still have some limitations on your movements, especially if your implant was placed under your chest muscle. It is important to focus on a positive mindset to counteract the feelings of frustration and even remorse that are common at this time. Trust the healing process and give yourself space to fully heal.  Good things are yet to come!

Manage the pain, discomfort, soreness, and achiness like an expert

You now have been fully versed in the important recovery milestones following breast augmentation. As we discussed, the pain, discomfort, soreness, swelling and achiness are all manageable.  They are primarily limited to the first few weeks after surgery and then quickly resolve. We also gave you a few good tips to make your recovery easier.  It is important that you keep communication open with our office and please don’t hesitate to ask questions. Breast augmentation is a doable surgery that relies on preparation.  So start planning!