While it is true that gentle technique results in less pain regardless of the area of the body we are discussing, it is also true that the size of the implant has a lot to do with the body’s pain reaction following breast augmentation surgery.  Physicians who claim to be able to do painless breast augmentation seem to limit the volume of the implant more than other plastic surgeons do.  A 250 cc implant placed by any capable plastic surgeon would probably be less traumatic to the patient than a 500 cc implant.  We are all different in many ways.  As patients some of us have a difficult emotional time, some a difficult physical time, and some of us both or neither.  I believe that the best way to manage the pain of an elective surgery is to deal with the possibility honestly preoperatively and acknowledge that each patient is different.  A positive approach by the patient and physician seems to be a more reliable way to minimize the physical and emotional hurdles that accompany surgery.  My last patient wanted implants of 500 cc in volume.  She and I chose them together based on desires and expectations on her part and based on a physical examination, her body weight, and chest wall dimensions on my part.  After two office visits and discussions, she and I arrived at the proper volume.  Postoperatively, she was moderately sore.  Since that time she has said that she would do it a gain in a heartbeat if necessary.  I find that she looks a bit on the busty side of normal.  My aesthetic sense might have limited my choice of size for her.  However, I am glad that I did not force my opinion on her, but continued to listen and discuss with her.  Saving her pain by putting in half the implant size she wanted would not have been appropriate in her case.