Pain control is an important concern for both patients and their surgeons. In order to help patients following breast surgery, surgeons will need to know their patients’:

• Medical problems
• Current medications; both prescribed medications and over the counter medications
• Use of alcohol, marijuana and other drugs
• Previous surgical and anesthesia history

Surgeons can work with the anesthesia team to offer their patients a personalized approach to pain control at the time of their surgery. This pain control can also provide pain relief after surgery. Examples include:

• Local anesthetics, where medication to numb the surgical site are injected into the tissue during surgery or delivered to tissue by a tube placed into the surgical site at the time of surgery
• Nerve blocks, such as a paravertebral block, where medication is injected near the nerves that supply sensation to the operative site
• Epidural anesthesia, like what is given to women in labor.

Not every patient is a candidate for each of these approaches, and anesthesiologists with specialized training are required to deliver some of these anesthetics.

After surgery, many patients are able to control their pain with over the counter medications, like Tylenol, Ibuprofen and Aleve. Opioids may be required for a brief period of time. Opioids are more likely to be required following some types of breast reconstruction surgery and axillary dissection.

Opioids are very powerful pain medications but have the potential to lead to addiction. They can also cause significant constipation, which for some patients may be worse than their pain. Using as little opioid medication for as brief a period of time is a guideline that many surgeons provide their patients.

For patients who have used opioids before their surgery, the opioid medications will not be as effective for controlling pain as in a patient who has never used opioids. This is because of opioid tolerance. Use of alcohol and non-prescription drugs, such as barbiturates and anti-anxiety medications,  may also cause tolerance to opioids.

Besides medications, wearing a supportive bra or camisole can help provide pain control. Once a patient’s sterile dressing has been removed, placing a gauze pad, sanitary napkin or sheepskin over the incision so that it does not rub against the bra can provide some extra cushion.

While many surgical patients having orthopedic surgery will be encouraged to use an ice pack, breast surgical patients should first check with their surgeons to see if an ice pack is advisable in their specific case. Patients who have had breast reconstruction will often be advised NOT to use ice, as this may affect the blood flow to their skin flaps and nipples.

The patient experience will be dependent upon the type and extent of surgery, their medical conditions, their medication history and their ability to “feel their pain”. Patients should discuss any concerns or questions with their surgeon.

For more information, the American College of Surgeons has produced an excellent brochure, Safe and Effective Pain Control After Surgery.
https://www.facs.org/~/media/files/education/patient%20ed/managing_your_pain_after_surgery.ashx