Breast augmentation has come a long way. Years ago, when I started doing breast augmentations 40 years ago, patients often described the first few days after surgery as extremely uncomfortable—many said it felt like “an elephant sitting on their chest.” Recovery could be slow, and reliance on narcotic pain medication was common.
Today, the experience is dramatically different.
Many patients now undergo surgery on a Friday and are back to deskwork by Monday. This transformation is the result of multiple advances over the past four decades—improvements in implant design, surgical technique, and, importantly, pain management.
Modern implants are more durable than ever, with cohesive gel technology. This means that even in the rare event of a rupture, the silicone maintains its shape and does not leak freely. This has improved both safety and peace of mind.
Pain control has seen some of the most significant progress. Years ago, we utilized pain pumps—small catheters placed during surgery that delivered local anesthetic over several days. These were highly effective in reducing discomfort and minimizing the need for oral narcotics.
In recent years, we have transitioned to using a long-acting local anesthetic called Exparel. This medication is carefully infused into the pectoralis muscle during surgery, often combined with a targeted nerve block. The result is sustained pain relief for the first few days after surgery—the period when discomfort used to be most intense. Many patients now find they need little to no narcotic medication.
