Aesthetic Breast Surgery Research Articles

Enhanced Recovery After Aesthetic Breast Surgery Under Sedation, Intercostal Block and Tumescent Anaesthesia: A Prospective Cohort Study of the Early Postoperative Phase.

Comfort and recovery are major concerns of patients seeking aesthetic surgery. This study aimed to assess postoperative pain and recovery after outpatient breast surgery under sedation, intercostal block, and local anaesthesia. This prospective cohort study included all consecutive patients who underwent aesthetic breast surgery between April 2021 and August 2022. Epidemiological data, anaesthesia, pain, and patients' satisfaction were systematically assessed with standardized self-assessment questionnaires. Altogether, 48 patients [median (IQR) age: 30 (36-25)] were included. The most frequent surgery was mastopexy. 69% of surgeries involved additional procedures. The mean intercostal block and local anaesthesia time was 15min. Patients received a median (IQR) of 19 (34-2) mg/kg lidocaine and 2.3 (2.5-2.0) mg/kg ropivacaine. The median (IQR) consumption of propofol and alfentanil was, respectively, 4.89 (5.48-4.26) mg/kg/h and 0.27 (0.39-0.19) µg/kg/min. No conversion to general anaesthesia or unplanned hospital admission occurred. Patients were discharged after a median (IQR) of 2:40 (3:43-1:58) hours. Within the first 24 postoperative hours, 17% required once an antiemetic medication and 38% an opioid. Patients were very satisfied with the anaesthesia and 90% of the patients had not wished more analgesia in the first 24h. Aesthetic breast surgery under sedation, intercostal block, and tumescent anaesthesia can safely be performed as an ambulatory procedure and is associated with minimal intra- and postoperative opioid consumption and high patient satisfaction. These data may be used to inform patients and clinicians and improve the overall quality of care. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Modified Delphi Technique to Identify Management of Aesthetic Breast Augmentation: Will We Reach a Consensus?

Breast augmentation is a common operation. Evidence has grown with experience and long-term studies, but variation in practice exists. The authors detail the existing practices of a group of surgeons for primary and secondary aesthetic breast augmentation. Seventy-two plastic surgeons with a specialist interest in aesthetic breast surgery were asked to participate in the survey about aesthetic breast augmentation. A 54-point online survey was given, covering demographics about the surgeon and practice, implant choice and perioperative technique, use of emerging evidence and surgical techniques, preferences about secondary surgery, and opinions about topics of controversy. All 72 surgeons completed the survey. Their mean age was 57.6 years, 56.9% had been in surgical practice for over 20 years, and 88.9% were performing more than 50 primary breast augmentations per year. The most commonly used measurement for implant selection was breast width, the most common implant type was silicone (81.9%), and volume range was 250 to 350 cc (86.1%). A total of 36.1% of surgeons use anatomic implants in more than half of their cases. Opinions were divided about postoperative return to work, use of insertion funnel, and acellular dermal matrix. Multiple factors affect clinical outcome in primary and secondary aesthetic breast surgery. A few well-established techniques have gained common acceptance, but opinions are more diverse for difficult, complicated, or challenging scenarios. This survey helps clarify the decision-making process of expert surgeons with an interest in aesthetic breast surgery.

Capsular Contracture in Aesthetic Breast Surgery. An Overview of a Common Procedure

Complications following reconstructive or aesthetic breast surgery are important considerations for women pursuing these options. Common complications of breast reconstruction using implants and expanders include capsular contracture. Knowing this pathology is necessary due to its prevalence in patients undergoing breast interventions. Preventive actions must be taken, as well as optimizing some techniques and knowing risk factors in patients to reduce the incidence as much as possible.

Capsular Contracture in Aesthetic Breast Surgery. An Overview of a Common Procedure

Capsular Contracture in Aesthetic Breast Surgery. An Overview of a Common Procedure

Conduite à tenir devant un sérome tardif péri-prothétique

The widespread use of silicone implants in reconstructive and aesthetic breast surgery led to an increase in the incidence of breast implant associated anaplastic large cell lymphoma, BIA-ALCL, mainly associated with the use of macro-textured breast implants. BIA-ALCL is a serious complication presenting clinically as a late onset periprosthetic seroma. Thus, its occurrence became an alarming sign feared by most plastic surgeons. Therefore, a good knowledge with respect to early diagnosis, subsequent workup, and treatment is crucial in the management of periprosthetic seroma. The diagnosis of late onset seroma is clinically evident. Although idiopathic seroma is the most common cause, BIA-ALCL should be always eliminated. A complete workup is usually necessary. An ultrasound performed by a radiologist specialized in breast imaging followed by an ultrasound guided puncture is imperative. Consequently, the cytological and the bacteriological analysis will orient us toward the etiology (infectious, neoplastic or mechanical). A standardized management of late periprosthetic seroma does not exist, with various factors are to be taken into consideration. These include the surgeon's experience, the diagnosis, and the medical institution facilities. Although idiopathic seroma is managed by a simple puncture and drainage, other causes may require a surgical procedure with implant removal, capsulotomies, and/or total capsulectomies.

Preventing Soft Tissue Complications in Secondary Aesthetic Breast Surgery Using Indocyanin Green Angiography.

Secondary cosmetic breast surgery after primary augmentation with implant can be associated with an increased risk of adverse events. Partial/complete nipple-areola complex necrosis is particularly feared. In this preliminary study, the authors propose the utilization of indocyanine green (ICG) angiography to assess the blood supply of breast tissue after implant removal. The main objective was to prevent skin and gland necrosis in revision breast surgery. The authors performed a retrospective comparative analysis of 33 patients who underwent secondary breast surgery between 2018 and 2021 by a single surgeon (M.S.). Breast tissue perfusion was assessed in 16 patients by intraoperative ICG angiography at the end of implant removal and possible capsulectomy. Non-stained/non-fluorescent areas were judged to be low perfusion areas and were excised with short scar mastopexy. In the ICG angiography group, 7 patients (44%) showed an area of poor perfusion along the inferior pole; all of these patients underwent subglandular breast augmentation. Resection of the poor perfusion areas allowed an uneventful postoperative course. In the non--- ICG angiography group (17 patients), 5 patients experienced vertical-scar dehiscence/necrosis. We found a statistically significant association between the non-ICG angiography group and vertical scar dehiscence/necrosis, and also between vertical scar dehiscence/necrosis and subglandular implant placement (P = 0.04). Safer secondary surgery can be offered to patients undergoing secondary aesthetic breast procedures, especially when the first augmentation surgery is unknown-for example, implant plane, type of pedicle employed, if the implant is large and subglandular, and if capsulectomy is performed.

Surgical site infection in reconstructive and aesthetic breast surgery: A single center retrospective analysis of the association between healthcare workers and infections

Reconstructive and aesthetic breast surgeries are frequently performed procedures, and the consequences of a postoperative infection are devastating both for the patient and the healthcare (HC) system. Over the years, there has been heightened interest in the physical and mental well-being of physicians and HC workers. Little is known about the relationship between HC workers and surgical site infections (SSI), and whether HC workers are at an increased risk for SSI. The aim of this study was to investigate whether women working in the HC system have an increased risk for SSI following reconstructive and aesthetic breast surgery. We conducted a retrospective analysis of all patients who underwent aesthetic and reconstructive breast surgery at our institution between the years 2013-2020. Women who were recognized as HC workers were analyzed in a separate group and compared to those who were not. Records of 378 patients were reviewed, of whom 53 (14%) were identified as HC workers. The overall infection rate was 17.4%. HC workers manifested a higher infection rate than the other group (32% vs. 15.1%, p<0.05) and a significantly higher relative risk for SSI (RR 2.12, p<0.01). Women working in the HC system may have an increased risk of developing postoperative infectious complications following aesthetic and reconstructive breast-related surgery. Further research is needed to corroborate these findings and elucidate the causes.

Risk Factors for Postoperative Complications Following Aesthetic Breast Surgery: A Retrospective Cohort Study of 4973 Patients in China.

The popularity of aesthetic breast surgery in China results in greater demand for assessing risk factors for complications and mortality. To determine the incidence and independent risk factors for postoperative complications following aesthetic breast surgery in China. A retrospective cohort study on 4973 patients who had aesthetic breast surgery between 2012 and 2021 was performed. Postoperative complications include minor complications (incision healing impaired, hematoma, or fat liquefaction) and surgical site infection (SSI), which were recorded within 30 days after surgery. The follow-up time was expanded to 1year only after prosthesis implantation procedures. Potential risk factors including age, weight, length of hospital stay, operation time, volume resection, incision location, and other clinical profile information were evaluated. Among 4973 patients who underwent aesthetic breast surgery, the minor complication rate was 0.54%, and SSI was 0.68%. Augmentation with prosthesis implantation had the highest SSI rate (4.23%), which was significantly associated with increasing age (relative risk [RR] 1.12; P < 0.01) and periareolar incision (RR 5.87, P < 0.01). After augmentation with autologous fat transplantation, postoperative antibiotic use (RR 6.65, P < 0.01) was an independent risk factor for SSI. After adjusting for weight, volume resection over 1500 g (RR 14.7, P < 0.01) was an independent risk factor for SSI of reduction-mastopexy surgery. The complication rate of reduction mammaplasty (1.01%) and gynecomastia correction was lower (0.75%), and there was no record of complication in mastopexy procedures (n = 161). The incidence of postoperative complications following aesthetic breast surgery is low. Risk factors for complications mainly include increasing age, perioperative antibiotic use, periareolar incision, and extensive volume resection. Much more attention should be focused on those high-risk patients in clinical practice to decrease breast infection. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Experience and Indications for the Use of the P4HB Scaffold (GalaFLEX) in Aesthetic Breast Surgery: A 100-Case Experience.

The popularity of utilizing mesh in the breast has varied over the years. It is well described, and yet there has been poor uptake of its utilization in aesthetic breast surgery. Poly-4-huydroxybutarate (P4HB; GalaFLEX, Galatea, Lexington, MA) has recently been described as a useful adjunct in supporting poor tissue quality with positive early outcomes and low complication rates. The authors sought to determine the outcome and range of indications of PH4B in aesthetic breast surgery to document its effectiveness in assisting with long-term outcomes in mastopexy. Firstly, an observational study was undertaken standardizing mastopexy techniques with P4HB included in the procedure. Photographic measurements were taken to determine the extent of lower pole descent and lower pole stretch at 3 months and 1 year postoperative to observe change over time. Secondly, other indications were explored, including the correction of secondary defects such as inferior malposition and symmastia. The results of the mastopexy study were highly encouraging and comparable with those previously published in the literature, confirming sustained stability of the lower pole over time for mastopexies and implant mastopexies. In addition, the GalaFLEX was successfully employed in correcting many secondary defects. P4HB is extremely versatile and easy to utilize and has low complication rates. The results have led to a change in practice, with routine incorporation of GalaFLEX for all routine mastopexies. It has also replaced the utilization of acellular dermal matrices in aesthetic breast surgery.

A New Technique for Breast Pocket Adjustment: Argon Beam Thermal Capsulorrhaphy.

Summary:Implant malposition remains one of the main complications of aesthetic breast augmentation and alloplastic breast reconstruction with expanders and implants. Many capsulorrhaphy techniques have been described to adjust the breast pocket and correct the malposition. In this study, we tested the efficacy of the argon beam coagulator (ABC) for lateral capsulorrhaphy on breast reconstruction patients at the time of expander replacement with a permanent implant. We also experimentally compared the effects of the ABC and the standard electrocautery on fragments of healthy breast capsule. We noted a 69.5% capsule shrinkage with the ABC versus 46.8% with the standard electrocautery. We concluded that breast capsulorrhaphy using the ABC is a safe and efficient technique for the correction of breast implant malposition in both reconstructive and aesthetic breast surgery.

Commentary on: Experience and Indications for the Use of the P4HB Scaffold (GalaFLEX) in Aesthetic Breast Surgery: A 100-Case Experience.

Commentary on: Experience and Indications for the Use of the P4HB Scaffold (GalaFLEX) in Aesthetic Breast Surgery: A 100-Case Experience.

A Novel Application of the Hemostatic Net in Aesthetic Breast Surgery: A Preliminary Report.

Obtaining optimum breast aesthetics can be challenging in secondary aesthetic breast surgery, particularly with poor-quality skin, when downsizing implants, and in cases where patients will not accept additional mastopexy scars. Most techniques described in these cases rely on internal suturing and capsulorrhaphy, which can lack precision in tailoring the skin over the internal pocket. The aim of this study was to present the authors' experience with utilizing the hemostatic net to help address a range of challenging breast cases in their practices. A multicentre retrospective analysis of patients undergoing aesthetic and reconstructive breast surgery between 2019 and 2021 was conducted. A database was established to record patient demographics, indications for surgery, surgical technique, and complications. Following capsulorrhaphy, the hemostatic net was applied in as many rows as required with monofilament sutures and removed 3 to 7 days postoperatively. Twenty-four women (aged 23-67 years) underwent aesthetic or reconstructive breast surgery with the hemostatic net. This approach optimized stabilization of the inframammary fold and redraping of lax skin or irregularities in the skin envelope. At follow-up review, only 1 instance of the net failing to successfully redrape the skin was seen. The application of the hemostatic net is an option for patients who might otherwise require mastopexy but refuse to accept the scars. The technique has now been extended to primary cases where implant malposition or skin tailoring issues are anticipated, thus securing its place as a part of the surgical armamentarium.

How Do You Like Me Now? The Influence of "Likes" and Followers on Social Media in Plastic Surgery.

The number of "likes" and followers on social media is a surrogate marker for peer acceptance and popularity, but the influence of likes and followers on prospective plastic surgery patients has not been studied. The aim of this study was to evaluate whether the number of followers or likes on social media has an impact on perceived surgeon competence or likelihood of recruiting new patients. A fictitious Instagram page was created with different permutations displaying different numbers of followers on the page. Similarly, fictitious Instagram posts were created displaying before-and-after results of ideal and suboptimal breast augmentation and gynecomastia surgery results, with the number of likes being the only variable. Using a crowdsourcing platform, survey responders rated surgeon competence and likelihood of patient recruitment based on the Instagram post. A total of 4284 responses were collected. The number of followers or likes did not impact perceived surgeon competence or patient recruitment scores. Optimal surgical results consistently scored higher than suboptimal results, regardless of the number of likes. Almost half the responders were unable to identify the American Board of Plastic Surgery as the appropriate board certification for performing aesthetic breast or body surgery. A high number of followers or likes, by itself, is unlikely to translate into higher likelihood of recruiting new patients. Overall, aesthetic results seem to be the most important driving force in receiving high competence scores and recruiting new patients, rather than social media presence or board certification.

One-Stage Mastopexy-Lipofilling after Implant Removal in Cosmetic Breast Surgery.

Revising unsatisfactory outcomes in breast augmentation represents one of the most challenging procedures in aesthetic breast surgery. Different techniques for revising unsatisfactory outcomes in breast augmentation have been described, which can be summarized in two options: implant replacement procedures and implant explantation procedures. Implant explantation procedures can be performed alone or in combination with other techniques to restore volume. Depending on the native volume, the shape and the elasticity of the remaining breast tissue, implant removal can be also associated with mastopexy, auto-augmentation mammoplasty or fat graft. This article portrays our series of combined mastopexy and lipofilling after implant explantation for revising unsatisfactory outcomes of breast augmentation. A prospective observational study was performed including all patients underwent cosmetic one-stage mastopexy-lipofilling after implant removal. Collected data included patient's age and BMI, smoking, previous scar location (periareolar, inframammary fold or trans-axillary), implant characteristics (size and location), reason why patient wants to remove the implant (capsular contracture, implant rupture, animation deformity, chronic pain, asymmetry), mean liposuction and fat injection volume, type of capsulectomy, mean operating time and postoperative complications. Cosmetic results and patient satisfaction were evaluated using the 5 points Likert scale and BreastQ reduction/mastopexy module, respectively. A total of 14 patients (28 breasts) were included with a mean follow-up of 11.3 months. Mean liposuction and injection volumes were 980 mL and 295 mL, respectively. Regarding breast volume, a reduction in one-cup size was noted in 100% of cases. Only one patient (7.69%) requested additional breast volume and underwent a second fat grafting session. Regarding aesthetic outcomes, the mean scores for breast volume, shape, symmetry, quality of scars, nipple-areola complex and donor site shape were 4.2, 4.2, 4.9, 4, 4.3 and 4.7, respectively. BreastQ showed an improvement of patients reported satisfaction with a median (Quartile Rank) score increase of 19 points for the "satisfaction with breast" domain (p &lt; .00001) and a decrease of 17 points for the "physical well-being" domain (p &lt; .00001). "Satisfaction with outcomes" median (Quartile Rank) score was 72. Combined mastopexy and lipofilling after implant removal represents a new tool in plastic surgeon armamentarium. This technique is indicated in patients who do not desire anymore breast implant, presenting ptosis of the remaining breast gland and donor site availability. Our article suggested that combined mastopexy and lipofilling achieves satisfactory aesthetic results and excellent patient-reported outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

OPTIMAL ANALGESIA FOR BREAST SURGERY ENHANCED RECOVERY IN DAY SURGERY.

Aesthetic breast surgery is the most common body surgery at Bagatin Polyclinic. During 2020 and 2021, altogether 274 cosmetic surgeries were performed on the breasts. This included breast augmentation, breast augmentation and lifting operations, in a ratio of 2 to 1.According to statistics from the American Association of Plastic Surgeons (ASPS), in 2020 breast augmentation with implants was ranked fifth of all cosmetic surgeries performedand the second largest body surgery immediately after liposuction, with 193,073 procedures done. In addition to these procedures, breast augmentation (87,051) and breast reduction (33,574) procedures were also popular. Due to the increased interestin these procedures and their high daily percentage of operating programs, adequate analgesia and recovery of patients, who undergo these cosmetic breast corrections, areimportant. Today, it is no longer enough for an operation to go well and the patients to have good results. It is also important that the procedure itself, from induction of anesthesia to early and late recovery, allows for a quick return to daily activities and work.

Split Inferior Pedicle: The 1-Stage Augmentation Mastopexy for Grade 3 Ptosis.

In this article, the authors describe the 1-stage surgical technique that has been used by the senior author since 1990 for all his primary grade 2 and grade 3 augmentation-mastopexies. The article provides a safe, simple, and reproducible approach to a challenging procedure, one that tends to be the most litigious in aesthetic breast surgery. The key points of this technique are simple preoperative markings; the augmentation is performed with a true submuscular placement of smooth implants; and the mastopexy is performed with an inferior pedicle technique with unlimited skin flap undermining and no limitation of nipple elevation. Seventy-eight consecutive cases of augmentation mastopexy performed since 1999 by a single surgeon (V.S.) using the same technique were reviewed. The age range was 26-62 years old; the range of implant volume was 150-375 cc; and the follow-up time period was from 1 year to 22 years. After an extensive patient case review, the authors enforce true extended submuscular augmentation (TESMA) as a reliable augmentation technique that can be used as the first procedure in any grades 2 and 3 ptosis, 1-stage augmentation-mastopexies including bariatric cases. The authors believe that the split inferior pedicle for the mastopexy in combination with the TESMA is a breakthrough approach that eliminates the second stage for any augmentation mastopexy procedure. No major complications such as nipple necrosis, implant bottoming, malpositioning, or extrusions were observed. It is a safe, simple, and reproducible procedure. Level of Evidence: 4

A Rationale for Micro-textured Breast Implant Augmentation.

BackgroundTextured breast implants have been used in aesthetic breast surgery to decrease rates of malposition and capsular contracture. Recent concerns regarding breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)’s link to textured devices have prompted many physicians to reevaluate their use.ObjectivesThe authors aimed to create an algorithm for when to use smooth vs micro-textured breast implants and provide their rationale for when micro-textured implants may be more beneficial.MethodsIn total, 133 patients received primary augmentations performed by a single surgeon from January 2018 to December 2020; 84 patients received smooth implants and 49 patients received micro-textured implants. All surgeries were performed in the dual plane using an inframammary incision. Implant-related complications and scar malposition were recorded and compared between groups.ResultsNo significant difference in the prevalence of implant-related complications was found (3.57% for smooth devices and 2.04% for micro-textured devices [P-value 0.621257; 95% CI −0.06100 to 0.007467]). There were no cases of BIA-ALCL. A comparison of scar malposition rates between the smooth and micro-textured groups also revealed no statistically significant difference (15.4% for smooth devices and 8.16% for micro-textured devices [P-value 0.226156; 95% CI −0.1200 to 0.007467]). Patients in the micro-textured group proportionately had more anatomical risk factors for malposition.ConclusionsMicro-textured breast implants continue to be a safe and effective choice for patients. Micro-textured implants show a trend toward decreased scar malposition, although not statistically significant. Patients at high risk for malposition with micro-textured breast implants give similar results to patients at average risk for malposition with smooth implants.Level of Evidence: 3

Polydioxanone Internal Support Matrix: A Rationale for Prophylactic Internal Bra Support in Breast Augmentation.

BackgroundTextured breast implants have been used in aesthetic breast surgery to decrease the rates of implant malposition. A recent analysis of a large-volume single-surgeon experience found statistically similar rates of malposition in smooth vs micro-textured breast implants.ObjectivesProphylactic use of a polydioxanone (PDO) internal support matrix in breast augmentation was hypothesized to prevent scar malposition and increase pocket control.MethodsIn total, 200 patients received silicone gel primary augmentations performed by a single surgeon from January 2018 to December 2020; 84 patients received smooth implants alone; 49 patients received micro-textured implants; and 67 patients received smooth implants plus PDO internal support matrix. All surgeries were performed in the dual plane using an inframammary incision. Implant-related complications and scar malposition were recorded and compared.ResultsNo significant difference in implant-related complication rates was found between shell types (3.57% for smooth devices alone and 2.04% for textured devices [P = 0.62; 95% CI −0.06 to 0.01]). There were zero complications in the smooth plus mesh study arm. A comparison of scar malposition rates between the smooth alone and textured groups revealed no significant difference (15.4% for smooth devices and 8.16% for textured devices [P = 0.23; 95% CI −0.12 to 0.01]). The smooth implant group with the prophylactic placement of PDO mesh had the lowest scar malposition rate of 4.48%, a significant difference compared with the smooth devices alone (P = 0.03; 95% CI −0.21 to −0.01).ConclusionsMicro-textured devices show a trend toward decreased scar malposition, although not significant. Prophylactic use of PDO internal support matrix in silicone gel breast augmentation is safe and has the lowest incidence of scar malposition.Level of Evidence: 3

Reconstructive and esthetic breast surgery after solid organ transplantation - a systematic review, proposal of a novel protocol and case presentations.

Great advancements in solid organ transplantation (SOT) have allowed patients to have better chances to survive longer and enjoy aquality life after surgery. This increasing number of SOTs and improved long-term survival rates lead to an increasing demand for plastic, esthetic and reconstructive breast procedures. Aliterature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and using searching terms related to esthetic and reconstructive breast surgery was conducted across three databases: PubMed, Scopus and Google Scholar. Included articles were analyzed to extract data points of interest including patient age, type of surgery, organ transplanted, underlying conditions associated with organ transplantation, follow-up, immunosuppressive drugs and their side effects, perioperative management and complications related to the breast plastic procedures in SOT recipients. Atotal of 1,298 articles were retrieved from the mentioned electronic databases. Eight full articles were finally included in this systematic review. In these articles, atotal of 41 cases of breast plastic surgery after solid organ transplantation were reported. Procedures were esthetic in nature in 26.83% of cases (11 of 41 cases) and reconstructive in 73.17% of them (30 of 41 cases). No deaths were reported. Although esthetic and reconstructive breast surgery could be performed safely in SOT recipients, the dosage of immunosuppression and patient&#39;soverall health status with regard to the length and extent of the planned procedure should always be taken into account. From the literature data analysis, it is not possible to draw astatistical conclusion that the complication rate of surgery in immunosuppressed post-transplant patients is the same as in normal, not immunosuppressed population. Further and more valid clinical studies are warranted.

Non-narcotic Pain Management after Primary Aesthetic Breast Surgery

BACKGROUND: The opioid epidemic continues to be a major health issue and major cause of death in the United States. Alternative pain regimens for elective operations are a priority to aid in decreasing complications from opioid use. Aside from simply limiting the quantity of narcotic medications prescribed, the plastic surgery literature has begun to explore alternative options for postoperative pain control by evaluating both effectiveness and safety profiles. The purpose of this study was to evaluate effectiveness and safety of a nonopioid pain regimen for patients after primary aesthetic breast surgery. METHODS: Inclusion criteria captured all consecutive patients over 18 years of age who underwent primary breast surgery, including augmentation or augmentation in combination with mastopexy. They were to use acetaminophen 1000 mg every 8 hours as needed, ibuprofen 800 mg every 8 hours as needed, and cyclobenzaprine 10 mg every 8 hours. All patients also received one dose of 30 mg ketorolac in the recovery unit. The seventy included patients were given a survey regarding pain control and side effects of medications after their operation to evaluate both effectiveness and safety of their non-narcotic regimen. Primary outcomes collected were effectiveness of pain regimen rated on a scale of 1–5 and any side effects from medications. RESULTS: The majority of patients (60.0%) reported the effectiveness of their pain control as 5 out of 5. Ten (14.3%) patients rated 4 out of 5, 11 patients (15.7%) 3 out of 5, one patient (1.4%) 2 out of 5, and six patients (8.6%) 1 out of 5. Only 10 patients (14.3%) reported side effects related to their medication. Seven patients had drowsiness, two had constipation, and one reported upset stomach with ibuprofen. One patient (1.4%) needed evacuation of hematoma on postoperative day #0. Level of postoperative pain control did not appear to correlate with volume of implants placed. CONCLUSIONS: The non-narcotic pain medication regimen using acetaminophen, ibuprofen, and cyclobenzaprine proved to be both safe and effective in this group of primary aesthetic breast surgery patients. The importance of exploring nonopioid therapy cannot be emphasized enough in the face of today’s crisis. Conclusively, no ideal regimen has been determined to date; however, its importance continues to mandate further exploration on this crucial topic.