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After Breast Surgery

Beverly Hills Plastic Surgeon Dr. Lisa Cassileth Explains What to Expect after Breast Surgery

Whether you are having breast augmentation at our surgical center, a breast implant revision procedure, or breast reconstruction after cancer, you can be confident that you have chosen one of the top plastic surgeons in the country. You will be closely monitored by the Cassileth Plastic Surgery staff through the whole recovery process starting from immediately after surgery through your final office visit. We are here to assist you through every step and answer any questions you have.

Below are the main areas that most patients have questions and concerns about. Your initial consultation with one of our doctors will also provide an opportunity to ask additional questions that you may have before your surgery.

Day of Breast Surgery

During your procedure, a doctor will administer a long-acting anesthetic that greatly reduces the pain that was formerly associated with breast surgery. This anesthetic lasts for 3 days and, along with an oral pain medication, will see most people through the first few days very comfortably. After the first 3 days, most people switch to an anti-inflammatory medication such as Ibuprofen.

Immediately following your procedure, you will be settled in the recovery area where you will be monitored until you are fully awake and alert. Once you are cleared to leave by our anesthesiologist, you will be given the oral pain medication prescribed for you and you can be driven home or to the recovery retreat. If you go home, you will need to have someone with you for the first 24 to 48 hours to assist you. This can be an adult family member, friend or if you wish, a home nurse can be arranged.

In most cases, you will be placed in a surgical bra which provides gentle compression. This greatly reduces swelling and discomfort. In cases involving fat grafting and many times with breast reconstruction, you will not have a post-operative bra, as maximum blood flow to the area is more important than compression in these cases.

Breast Surgery – First Week

Most patients will have drains placed to avoid fluid buildup. These must stay in place until the output amount has dropped to a specific volume, typically, 3 to 7 days. These drains ensure that infection won’t develop and while they are a nuisance, they will greatly aid your recovery. Infection can be difficult to treat and can ruin your result so it is important to leave them in place. Our doctors are known for their expertise in repairing breast surgery gone wrong. Drains are part of the recovery process and are worth the extra nuisance they create. Once the fluid output has dropped to 30cc per day, they can be removed by one of our medical staff in our office.

Dressings and Showering after Breast Surgery

You will have dressings placed on your incisions which should remain in place until you see one of our doctors for your first visit. We want the incision to remain sterile until it is completely sealed. Avoid getting the area soaked. When showering, you should turn the shower head so the water hits your back.

The dressings are waterproof but should water seep beneath them while showering, you will need to come in to have us replace the dressings. Leaving the incisions covered with a wet dressing could lead to an infection. Otherwise we will change them at your first visit, usually between day 5 and day 7 following your surgery.

Underneath the dressing there will be “steri strips,” which are butterfly bandages. They can get wet and should stay on for two weeks. You can come in and have us remove them or, as most people do, receive instructions on how to remove them. Most sutures will be absorbable.

First Few Weeks after Breast Surgery

Swelling will start to diminish over the next few weeks and most patients will discontinue the use of any narcotic pain medication and switch to anti-inflammatory medication such as Ibuprofen.

As with all surgical procedures, inflammation is part of the healing process and, in some cases, may increase between weeks 4 and 6. This is completely normal and is the body’s response to healing.

This can be particularly alarming for patients who have had a breast revision procedure for capsular contracture, as it seems as if the condition is reappearing. This, however, isn’t the case and over the next few weeks, the tissue will soften up after the initial tightening at the 4 to 6 week mark.

Patients will have a one-month checkup to ensure the healing is progressing normally, and after that it is just a matter of following instructions, ensuring proper bra choice, activity level, and recommended post-operative treatments if necessary.

Swelling and Inflammation after Breast Surgery

It is worth repeating that around 4 to 6 weeks after surgery many patients will experience an increase in inflammation and swelling as the body goes through the healing process. This natural healing process can’t be sped up or avoided – everyone experiences the same process, although the timing does vary from patient to patient.

Timing depends greatly on the procedure that was performed. Breast revisions take longer to heal than simple breast augmentation as there is more manipulation of tissue required to correct the problems. The swelling and inflammation will diminish over the first few weeks, and then increase around the 4-6 week mark. After that the swelling and inflammation will continue to decrease over the next 6 weeks.

After 6 to 8 weeks, patients usually resume their normal activities. Breast reconstruction will take about 12 weeks before patients feel normal and their energy starts to come back.

Physical Activity after Breast Surgery

It is normal to want to remain immobile after surgery, but the best way to ensure a great result is to move. Immediately following surgery, patients are encouraged to use their full range of motion by doing usual activities such as brushing hair, opening cabinets, reaching for things. It will feel uncomfortable at first but it is important to move. Not only will it help with circulation, but moving will ensure you don’t form internal scar tissue.

You will be restricted from lifting heavy objects for a period of 6 weeks. Don’t lift anything heavier than a gallon of milk during the initial healing period. Exercise should be gentle. Walking is always beneficial. If you have any questions about activity, our staff will be available to help determine what is safe for you.

Breast Surgery Scars

Scar tissue will undergo changes for a year following surgery. You will experience the most change during the first 3 months. The scar will stay bright red for the first 6 weeks, and then will start to fade around the 3 month mark. Depending on the color of your skin, the scar may be red, pink or brown. In most cases, regardless of color, the scar will fade significantly over several months. If the color is bothersome to you, there are laser treatments and scar healing gels that can be recommended to improve the color.

We offer laser treatment to speed up the process if you don’t want to wait a year to see your scars fade completely. Since the doctor expertly places her incisions where they are least likely to be seen, this might not be a bother for many people. If you are concerned about this, call the office to schedule an evaluation appointment to see if you are a good candidate for laser scar treatments.

Summary

Day 1

  • Placement in surgical bra
  • Approval from anesthesiologist to go home
  • Supervised care for 24 to 48 hours by a family member, friend or nurse

Week 1

  • Keep all dressings dry and sterile. In the event that you soak your dressings, return to the office for dressing replacement.
  • Leave drains in place until fluid output has dropped to 30 cc per day. Once this happens, return to our offices for drain removal.
  • Help reduce swelling by taking an anti-inflammatory medicine such as ibuprofen.
  • Maintain basic physical activities such as opening cabinets, reaching for things, etc., to encourage healing. Do not lift anything heavier than a gallon of milk for the next 6 weeks.

Weeks 4 to 6

  • Swelling may increase, which is normal. Maintain anti-inflammatory medication regimen.
  • Scar will remain bright red.
  • Continue to limit heavy lifting and strenuous physical activity.

Weeks 6 to 8

  • Patients resume normal activities in most cases after consultation with the doctor.

Month 3

  • Most patients will feel normal around this time and their energy will return.
  • Scar will begin to fade. Laser treatments and scar healing gels can be recommended to improve color.

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