RESEARCH: Decreasing Pain in Submuscular Breast Augmentation Surgery

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Posted on March 14, 2019 under Breast Augmentation

By Dean Jabs, MD, PhD; Bryson G. Richards, MD; and Franklin D. Richards, MD


In submuscular breast augmentation, the muscle is transected along its inferior and medial border to allow the implant to rest beneath the breast mound and supply adequate cleavage. This leads to significant pain in the postoperative period. Objective: This study was undertaken to quantitatively document the effectiveness of tumescent infiltration and bupivacaine with epinephrine injection in controlling postoperative pain in primary submuscular breast augmentation and its effect on operating time, narcotic use, and complications.


A retrospective chart review of 150 primary submuscular augmentation mammaplasties performed by 2 surgeons was conducted. Seventy-five consecutive augmentations performed by each physician during the same time period were studied. One surgeon used tumescent infiltration, using a syringe and a blunt infiltration cannula, placing 50 mL of standard tumescent solution in the planned pocket area of each breast before dissection. In addition, all cut muscle ends were injected with 0.25% bupivacaine with epinephrine (1:100,000, 40 mL per patient) under direct vision. The other surgeon omitted these steps. Patients evaluated pain subjectively using a 0 to 10 numeric pain intensity scale reported to the recovery room staff at specific times in the postanesthetic care unit.

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pain level

If you would like to learn more about plastic surgery procedures performed by Plastic Surgeons Franklin D. Richards, M.D. , A. Dean Jabs, M.D.  and Dr. Keshav Magge please visit or Serving patients in and around Northern Virginia, Maryland, Washington DC, McLean, Bethesda, Fairfax County, Rockville, Alexandria, Chevy Chase an, Potomac, Montgomery County, and Londoun County.

Our Plastic Surgery Associates team includes Dr. Franklin Richards, Dr. A. Dean Jabs, and Dr. Keshav Magge. Each of our plastic surgeons is board-certified, and together they have over 60 years of combined experience. Drs. Richards, Jabs, and Magge are all highly qualified in procedures for the face, breast, and body, and pride themselves in providing excellent results through our state-of-the-art, Quad A certified operating centers