Breast surgery recovery guide

Bleeding is normal with any procedure and is usually minimal. However, if there is excessive bleeding, it can create major complications. If this occurs during surgery, your plastic surgeon and anesthesiologist will be aware of by pooling blood or by a blood pressure drop. If bleeding occurs after surgery, it can accumulate under the skin causing bruising and may require additional surgery. You should follow your surgeon’s instructions following surgery to minimize the possibility of postoperative bleeding.

• Rest, but not bed rest : While rest is important in the early stages of healing, equally important is that you are ambulatory, meaning that you are walking under your own strength. Spend 10 minutes every 2 hours engaged in light walking indoors as you recover.

• Recline with your head and chest slightly elevated above your lower body.

• Good nutrition : Fluids are critical following surgery. Stick to non-carbonated, non-alcoholic, caffeine-free, and green tea-free beverages including fruit juices and water, milk, and yogurt drinks. You must consume at least 1 big glass of fluid every 2 hours. Stick with soft, bland, nutritious food for the first 24 hours.

• Take all medication, exactly as prescribed : Use oral pain medication and muscle relaxants as needed. Take the entire course of antibiotics.

• Change your incision dressings : Your incisions will seep fluid and some blood for a short time after surgery. Keep dressings clean and dry.

• Wear a support surgical garment around the clock. Ensure that you wear this garment at all times.

• Do not smoke. Smoking can greatly impair your safety prior to surgery and your ability to heal following surgery. While incisions may have sealed, smoking deprives your body of necessary oxygen that can result in poorly healed, wide, raised scars.

• Do not drink alcohol. Alcohol consumption whilst taking the antibiotics may diminish the effect the antibiotics have on your body.

• Relax. Do not engage in any stressful activities. Do not lift anything heavier than 5Kg. During this time you will progress with each day that passes. Ease into your daily activities. Continue to wear a proper support bra. You may sleep flat. However do not sleep on your stomach. If you are a side sleeper, a soft pillow under your mid-back and shoulders may offer more comfort and support than a single pillow under your head.

• Practice good sun protection. Do not expose your breasts to direct sunlight. If you are outdoors, apply at least an SPF 30 to the chest area at least 30 minutes prior to sun exposure. Your chest region and breast skin are highly susceptible to sunburn or the formation of irregular, darkened pigmentation. You may start to use scar treatments after sutures are removed.

• Do not engage in activities that cause your breasts to bounce or move up and down. This includes speed boat tours, elephant trekking, parasailing, and similar activities, as this can cause excess stretching of the skin.

Follow your surgeon’s instructions regarding massage of your implants. In some cases the recommendation may be light massage or no massage at all. When doing massage, remember to move your implant in all the four quadrants using a slow steady movement.

• Position your palms on the outer quadrants of your breasts and press slowly inward. You can feel and see the implants bulge toward the inner quadrants of the breast. Press and hold for 20 to 30 seconds. Repeat according to the instructions from your surgeon.
• Press the breasts slowly outward such that a bulge on the outward quadrants of the breast will be noted. Press and hold for 20 to 30 seconds, repeat.
• Position your palms on the lower quadrants of the breast and push slowly upward. Bulging of the implant on the upper quadrants of the breast should be noted. Press and hold for 20 to 30 seconds. Repeat. Do the same for the downward movement.

All plastic surgery procedures carry some risk including breast implant or breast reconstruction surgery. Having your procedure done in an accredited hospital minimises your risk during a procedure. The best way to categorize risks is to divide them into the risks of having a general anaesthetic, things that can go wrong during the procedure, things that might happen in the first few weeks and things that might happen further down the track. Generally speaking, patients undergoing elective surgery have very minimal risk, provided due care and attention is attended to by your clinical care team and by you as a patient. When you are admitted to the hospital you will be provided with a consent package that details these risks, but the following is a quick list. The following is not meant to frighten you but to make you aware of the possibilities.

Because breast enlargement is a totally elective operation, you must be in good health before going ahead with the procedure. Eat healthily with plenty of fruits and vegetables, keep fit and have plenty of rest. Should you have some illness (eg the flu) before the date of the surgery, our surgeons may postpone the procedure until you have recovered fully.

Smoking: Smoking increases the risks of all potential complications. This includes chest infections and poor wound healing. You should stop smoking 4 weeks before and 4 weeks after the surgery.

• Areas of lung collapse and pneumonia
• Clots in the legs (DVT) which can move to the lungs (Pulmonary Embolism)
• Allergies
• Awareness
• Death (risk in about one in a million, you are at more risk driving to and from the hospital)

• Bleeding
• Damage to surrounding structures

• Collections of fluid or blood within your abdomen
• Sensation changes to the breast or nipple
• Firmness
• Delayed healing
• Bruising and swelling
• Irritation from dressings
• Nipple Sensation
• Nerve injury

• Poor scars
• Asymmetry
• Skin contour irregularities (stretch marks, rippling and wrinkles
• Changes in size and shape with age & weight fluctuations
• Capsular contracture

During your consultation, your specialist plastic surgeon will explain all these risks, what they do to avoid and treat them, and the rates at which they occur.

All surgeries have risks, and breast augmentation is no exception. Capsular contracture occurs when scar tissue forms around the implant, resulting in painful breast stiffness and possible leakage of the fluid inside the implant. Women often fear this common complication because it is difficult to predict when it will occur and who will develop it. Most women start having symptoms around three months after their breast implant surgery, but you can develop capsular contracture at any time, and it can recur after it is treated. Capsular contracture occurs in less than 5 percent of women, and while there is no way of telling who is going to develop it, several factors may increase your risk. They include:

• Autoimmune disorders
• Smoking
• Radiation therapy
• Severe trauma to the breast
• Hematoma (a break in blood vessel, causing localized bruising or blood clot)
• Seroma (a collection of fluid under the skin)
• Bacterial infections
• Silicone molecules leaching into the pocket around the implant

Warning signs of capsular contracture include deformed, misshapen, and painful breasts, or breasts that are firmer than when they were first implanted. There are four levels of capsular contracture. They include:

• Grade I : the breast is soft and looks natural
• Grade II : the breast is slightly firm, but looks normal
• Grade III : the breast is firm and looks abnormal
• Grade IV : the breast is hard, painful, and looks abnormal

The recommended screening guidelines for women who have had breast augmentation with breast implants solely for cosmetic reasons are the same as those for women who do not have breast implants. Cosmetic breast augmentation with implants may make screening for breast cancer a bit more challenging, but this is not an excuse to avoid regular screening. A mammogram (breast X-ray) or magnetic resonance imaging (MRI) can save your life, so follow your doctor’s advice regarding breast cancer detection.

Implants do not interfere with breast-feeding, but many women have had concerns about passing silicone gel into breast milk if their implants were to rupture. These fears have been allayed by science. In the early 1990s, there were reports of silicone gel leaking from implants into the body, and some women claimed that their autoimmune and connective tissue disorders were related to their implants. As a result, silicone implants were removed from the market in 1992. At the same time, fear arose that breast-feeding with silicone implants could endanger the infant. Studies have since shown that silicone molecules are too large to pass into the milk ducts and breast gland tissue. In addition, the FDA conducted numerous studies which served to exonerate silicone gel implants as a cause of disease. As a result, they returned to market in 2006. That said, there are no guarantees that you will be able to breastfeed, regardless of whether you undergo breast augmentation.

implant placement may make a difference in terms of your ability to breast-feed. For example, in rare cases a periareolar incision (around the edge of the nipple) may interrupt or disturb the milk ducts. Placing implants below the pectoral (chest) muscle is least likely to disturb the milk duct

Discuss your plans to breast-feed with your surgeon. Your surgeon will be able to work with you to achieve the best possible aesthetic results without compromising your plans to breast-feed.

These instructions are not meant to be comprehensive or all-inclusive, any additional instructions will be given to you by your Surgeon as needed.