What does the evidence say about pain relief after breast augmentation?

Breast augmentation pain can come from several tissues and mechanisms, including the incision, pocket dissection and, when an implant is placed beneath the pectoral muscle, muscle involvement. Multimodal analgesia combines methods such as non-opioid medicines and regional anaesthesia. A pectoral nerve block is one possible component; its effect depends on the technique, timing and the rest of the anaesthetic plan. The trials below do not establish one regimen for everyone.

These names describe different injection planes. PECS I places local anaesthetic between pectoralis major and minor and is intended chiefly to affect the medial and lateral pectoral nerves. PECS II adds a deeper plane between pectoralis minor and serratus anterior, which may extend coverage towards lateral intercostal branches and the chest wall; S-PECS in the cited trial combined PECS II with a serratus anterior plane block. This anatomy helps explain why a block aimed at muscle-related pain may not cover every source of discomfort from skin, breast tissue or a surgical pocket. The exact spread and clinical effect vary, and these descriptions explain the research rather than recommend a technique. Multimodal care coordinates complementary approaches, with the aim of treating different pain pathways while limiting reliance on any single medicine class. [2]

What the augmentation trials found

In a two-centre, prospective, randomised, double-blind trial, Aarab and colleagues analysed 73 women having aesthetic implant breast augmentation under general anaesthesia: 35 received a pre-incision PECS I and II block and 38 did not. Both groups received protocolised multimodal analgesia, including paracetamol and a non-steroidal anti-inflammatory drug. The highest 0–10 numerical rating scale (NRS) pain score in the first six hours after extubation averaged 3.9 (SD 2.5) with the block and 5.2 (SD 2.2) without it; the reported difference was −1.2 points (95% CI −2.3 to −0.1; P=0.036). Maximum scores over postoperative days 1–5 were 2.2 (SD 1.9) and 3.2 (SD 1.7), respectively (P=0.032). An NRS is a patient rating from 0 (no pain) to 10 (worst pain); a one-point group difference describes an average contrast and does not predict an individual score. The confidence interval gives a range of effects compatible with the trial data; here it excludes zero, but the estimate remains modest and comes from one study. [1]

The same trial found lower cumulative opioid use, converted to oral morphine equivalents, in the block group: median 0 mg [0–21] versus 21 mg [0–31.5] from hour 6 to day 1 (P=0.006), and 0 mg [0–21] versus 21 mg [0–51] over days 1–5 (P=0.002). The abstract does not define the bracketed intervals, so they should not be labelled as confidence intervals or interquartile ranges. A lower group median does not mean every participant avoided opioids. [1]

A much smaller placebo-controlled split-body trial tested PECS I alone in 14 women having bilateral subpectoral implant augmentation. Each participant received bupivacaine on one side and saline on the other, serving as her own control. The primary outcome was resting pain 30 minutes after arrival in recovery: mean NRS was 3.75 (95% CI 3.13–4.37) on the bupivacaine side and 4.00 (3.50–4.49) on the saline side. At 24 hours, both sides averaged 2.29 (95% CI 1.56–3.01). Six participants reported less recovery-room pain on the active side, five on the placebo side and three no side-to-side difference. The authors found no clear benefit from this PECS I method. The 95% confidence intervals overlap substantially; they show uncertainty around each side’s mean rather than proving equivalence. In practical terms, this small trial did not demonstrate a clear additional reduction from PECS I. [2]

A separate single-centre randomised trial enrolled 30 women having silicone-implant breast augmentation. Fifteen received a combined serratus anterior plane and PECS II block (S-PECS), while 15 received saline; all were followed in recovery and at 4, 6 and 12 hours. The authors reported lower pain scores at every recorded time point and said the S-PECS group was 74% less likely to request pain medicine (P<0.05). The abstract does not give event counts, an absolute difference or a confidence interval. A relative reduction in requests is not a quantified reduction in opioid dose, and observation ended at 12 hours. [4]

A study whose procedure mix needs caution

Ciftci and colleagues randomised 90 patients into preoperative PECS I, postoperative PECS I or control groups (30 per group). Although the title and stated purpose refer to augmentation, the full-text Table 1 reports both reduction and augmentation procedures: 12, 17 and 10 augmentations in the respective groups. Outcomes are not presented separately by operation. The paper reports lower VAS pain scores and opioid use in the preoperative group, but those results cannot be attributed to augmentation patients alone. Its primary outcome was opioid consumption during the first 24 hours; pain was assessed on a 0–10 visual analogue scale (VAS) at 1, 2, 4, 8, 16 and 24 hours. The table lists opioid values without a unit, so they cannot be interpreted as a dose here. [3]

Why the results differ

The trials ask related but distinct questions. The largest direct study added PECS I and II to a standard medicine protocol and followed outcomes for five days. The split-body study isolated PECS I against saline in a very small sample. The S-PECS study tested two block planes together but reported only a relative medicine-request result in its abstract. The Ciftci study compared block timing but mixed reduction and augmentation cases. Their outcomes and populations should not be pooled informally into one estimate.

Multimodal analgesia means coordinating more than one pain-relief method; it does not mean that every patient needs a nerve block or that opioids can always be avoided. These studies mainly measured short-term pain scores and medicine use. They do not establish that a block improves arm function, discharge timing, wound healing, return to work, exercise clearance or readiness to travel. The 14-person trial reported no block-related complications, but that sample is far too small to establish safety or rule out uncommon harms. Individual decisions belong with the treating anaesthesia and surgical team.

Questions to discuss with the clinical team

Ask how the planned pocket and incision relate to the pain plan, and whether the expected costs and the quoted breast augmentation cost in Turkey cover the same scope of care. Clarify separately whether accommodation, transfers, medicines or follow-up are included in any breast augmentation package; inclusion labels do not establish clinical suitability.

• Which tissues and implant pocket are involved in the planned operation, and how might that affect expected pain?
• What medicines and regional techniques are included in the proposed pain plan, and what evidence supports that particular combination?
• What are the expected benefits, risks and alternatives of the proposed block for this patient?
• How will pain be assessed and treated if the initial plan is insufficient, including after discharge?
• Which warning symptoms require urgent clinical advice, and whom should the patient contact?

Access and disclosures

Full text was available for the Desroches and Ciftci studies. This review relies on abstracts for Aarab and Sforza, so details absent from those abstracts are not supplied. The Desroches authors reported departmental support but no external funding and disclosed that one author had received a fee for a 2017 Allergan conference. Ciftci and colleagues stated that the study had no funding and declared no conflicts of interest. Funding and conflict disclosures were not verifiable from the Aarab and Sforza abstracts consulted. PubMed/PMC records checked on 18 October 2026 displayed no correction or retraction notice; that record check is not independent proof that none exists.

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References

1. Aarab Y, Ramin S, Odonnat T, Garnier O, Boissin A, Molinari N, Marin G, Perrigault P-F, Cuvillon P, Chanques G. “Pectoral Nerve Blocks for Breast Augmentation Surgery: A Randomized, Double-blind, Dual-centered Controlled Trial.” Anesthesiology. 2021;135(3):442–453 (issue 1 September 2021); published online 28 June 2021. DOI: 10.1097/ALN.0000000000003855; PMID: 34195767.
2. Desroches J, Roy M, Belliveau M, Leblanc B, Beaulieu P. “PECS I block for postoperative analgesia in patients undergoing breast augmentation surgery: a randomized double-blind placebo-controlled study.” Brazilian Journal of Anesthesiology. 2020;70(4):333–342 (July–August issue); published online 12 July 2020. DOI: 10.1016/j.bjane.2020.07.004; PMID: 32792131; full text: PMC9373589.
3. Ciftci B, Ekinci M, Celik EC, Karaaslan P, Tukac IC. “Ultrasound-guided pectoral nerve block for pain control after breast augmentation: a randomized clinical study.” Brazilian Journal of Anesthesiology. 2021;71(1):44–49 (January–February issue); published online 25 December 2020. DOI: 10.1016/j.bjane.2020.12.004; PMID: 33712252; full text: PMC9373212.
4. Sforza M, Saghir R, Saghir N, Husein R, Okhiria R, Okhiria T, Sidhu M, Poojary M. “Assessing the Efficacy of the S-PECS Block in Breast Augmentation Surgery: A Randomized, Double-Blind, Controlled Trial.” Plastic and Reconstructive Surgery. 2024;153(1):1e–9e (January 2024 issue); published online 4 April 2023. DOI: 10.1097/PRS.0000000000010492; PMID: 37010475.