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Plastic Surgery

Post Operative Care

General Comfort

It is important for you to get up, move around the house, and take some deep breaths 4-6 times a day.

Plan to sleep on your back with your head elevated, if possible. Sleeping on your side will cause swelling on the side you are laying on. Making yourself a nest with pillows can be very helpful.

Some people experience a slight sore throat or mild cough for 2-3 days after surgery. This is a side effect of anesthesia and should resolve in 48-72 hours.

Pain Management

The first night and day after surgery will be your most uncomfortable. The pain will then stabilize over the next 24-48 hours and then decrease day by day. Most people will not need prescription pain relievers by the end of the first week. Some people only take a few doses and then use Tylenol®. Listen to your body and take your medication, as you need it. You will heal faster if you are not tense and tired from pain. Pain is also your body’s way of asking you to slow down. Plan to rest the first week after surgery.

You will be offered a prescription pain reliever for use after surgery. It is usually a combination of acetaminophen (Tylenol®) and a narcotic. To avoid nausea, take the pills with food in your stomach. Constipation can be a side effect; double your fiber and fluid intake while taking these pills. A stool softener may be helpful for some patients. You can progress to regular strength acetaminophen as your pain subsides. You may take non-steroidal pain relievers, such as ibuprofen (Motrin®, Advil®) or naproxen (Aleve®, Naprosyn®), 5-7 days after surgery but not before your drains are removed.

Narcotics will interact with alcohol so do not drink at the same time you are taking them. The medication will also make you drowsy so do not drive while you are taking it. After the first few days, if you have stopped taking pain medication, you may drink.

Drains

Drains are used in 80% to 90% of our surgeries to prevent post-operative swelling and fluid buildup. You will be instructed in drain care before leaving the hospital. Please check them periodically when you are awake. You will need to empty them when they are a third to one-half full. It is important not to get the drains wet because of the risk of infection.

The initial drainage will be bloody, changing to clear red then to clear yellow over the next 3-5 days. If blood clots in the tube, it can be cleared by applying pressure and “milking” the tube toward the bulb. Be careful not to put tension on the tube where it enters the wound.

You should wash your hands before and after handling the drains. Record the amount of drainage and empty the bulb into the toilet. The bulb will need to be squeezed when sealed in order to create suction. If you have less than 30cc of drainage in 24 hours before your first post-op appointment you may call the office to make an appointment to have them removed. Keeping your upper body quiet in the first few days after surgery will reduce your drainage.

Wound Care

There is no need to change a clean, dry dressing for the first 2-3 days after surgery. If you have drains, your first dressing change will take place in our clinic. If you do not have drains you may remove your dressings at home 2-3 days after surgery. Remove the outside adhesive and the gauze padding. It is normal to have some dark brown drainage on the gauze. You will probably see paper tapes (Steri-Strips®) directly on the suture line and a scab along the Steri-Strip®. You will have some bruising as well. Do not remove the Steri-Strips®.

You may shower after the original dressings and drains have been removed. Lather up with a mild soap on your chest above the incisions and Steri-Strips®. Allow the suds to wash over the breasts (do not scrub at the area; be gentle with yourself), rinse and pat dry. Place gauze padding or rectangles of clean, soft cotton material (such as old tee shirts) over each breast and hold in place with a front-closing, sports bra.

Your doctor will give any other wound care instructions to you at the time of your surgery.

Complications

Please call or come into the clinic or the Emergency Department when the clinic is closed as soon as possible if you have:

  • Increasing swelling, redness, or pain in the breasts.
  • Pus drainage from the breasts.
  • Excessive bleeding post-op (i.e., bandages become soaked with blood).
  • Shortness of breath.
  • Fever greater than 100 degrees orally.

Activity Limitations After Surgery

  • There should be no reaching above your shoulders, twisting or lifting more than 5 pounds for three weeks.
  • No heavy activity or exercise for three weeks. Any activity that makes your face flush or makes you sweat can make you swell.
  • No soaking your incisions (bathing or hot tubs) until your Steri-Strips® are removed, your sutures have been removed, and all scabs are healed.
  • After three weeks, you may resume normal activities.
  • Do not wear under wire bras for 4 to 6 weeks after surgery, and then it is a matter of personal choice.

Scar Care

Scar development is a process that lasts up to a year or more after surgery. Scarring can be significant, but with a little care the appearance of the scars can improve. It is also common to have areas of numbness in your breasts. This may be permanent but some patients experience improvement with time.

As healing progresses, itching can become significant. Remember, itching = healing. Sometimes the itching will come from deep inside where no amount of scratching will help, or the nipple can itch a great deal. Be very careful not to damage tender, new skin. Cooling the breasts can soothe them. This can be done with cool air, a cool shower, or ice packs (the blue gel ones are very good because they conform to the breast nicely, are light weight, and can be reused). When using the ice packs you can lay a thin towel over the breasts, then the packs, fold the towel over the packs and gently hug them to your body. Generally, it is a good idea to use the ice packs no more than 15 minutes at a time.

For the first year avoid sunlight on your scars to keep the areas from pigmenting darker than your surrounding skin. Use clothing and sunscreen to protect the scars.

Scar tissue does not have the same lubrication glands as regular skin. After three weeks you can help your scars by keeping them moisturized with lotion or ointment. Massage the length of the scar with firm circular motion 2-3 times a day. This will help organize the scar tissue and help it to be more mobile and soft. You may notice increased redness in your scars between 3-6 months after surgery. This is normal.

If your scars are growing thick, rope-like, outside their original boundaries, or are itchy, burning and painful, please call the clinic. If you have a history of keloids or hypertrophic scars, please discuss this with your plastic surgeon.

Body Image

It may take a few weeks for you to become comfortable with your new figure. Your stomach will seem more prominent than before the surgery. It is not uncommon to question the decision to have breast surgery and have temporary regrets in the immediate post-operative period. Usually by 6-8 weeks after surgery, things will have settled down and you have become comfortable with your size, as well as enjoying the benefits of your smaller breasts.