Breast augmentation is the most common cosmetic surgery procedure performed in the United States. The optimal approach to postoperative pain management in these patients, however, has yet to be determined. The objective of this study was to investigate the efficacy of pocket irrigation with bupivacaine and ketorolac in reducing pain, narcotic use, and methocarbamol use following subpectoral breast augmentation. A prospective, double-blinded, randomized trial was performed. Fifty primary breast augmentation patients were randomized to 1 of 2 treatment groups: 1) pocket irrigation with bupivacaine and ketorolac, and 2) no pocket irrigation. Patients who received pocket irrigation had significantly lower Visual Analog Pain Scores in the early postoperative period (1 and 6 hours postoperatively). There was no difference in early postoperative narcotic use in patients who received pocket irrigation and those who did not. Patients who received pocket irrigation, however, reported higher narcotic use at 1–3 days following surgery. There was no difference in postoperative methocarbamol use between patient groups. This study suggests that pocket irrigation with bupivacaine and ketorolac can significantly decrease patient-reported pain in the early postoperative period following subpectoral augmentation. It also demonstrates, however, that there is an increased requirement for narcotics between 1–3 days after surgery. These findings suggest that intraoperative administration of analgesics into the implant pocket may thus facilitate an early postoperative recovery; yet, patients should be advised that they might require more pain medication at home for the first few days.