Breast Augmentation Recovery
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Breast augmentation typically requires that patients minimize physical activity for 3 to 7 days before slowly resuming more strenuous tasks. The amount of downtime required, and the amount of time needed to make a full recovery that allows you to resume all normal activity, is largely dependent upon where the incision was placed, the size of the implant, and whether the breast implant was placed above or below the pectoral muscle.
Breast augmentation is the world's most popular cosmetic surgery procedure, and techniques are being constantly refined in order to allow women to undergo surgery, recover, and resume their daily routines in the shortest timeframe possible. While the surgery and its results are the common focal points among those considering surgery, it is important to understand that recovery is a relatively brief, but crucial step in achieving the maximum benefits.
If you are considering breast augmentation, you are probably spending considerable time deciding which surgeon to choose and how to budget for the cost of surgery. These are two very important aspects to consider, but it is equally important to budget for time you can spend away from work and other obligations, healing in a calm and relaxing environment and avoiding physical strain. Meanwhile, patients should understand that they will not have to spend their recovery lying in bed for a week; rather, they just have to take care to keep physical activity minimized, and take certain measures to ensure they heal properly.
I encourage anyone considering breast enhancement to spend ample time learning about all aspects of surgery, including the recovery period. By knowing what to expect, and preparing to follow your surgeon's instructions closely, you can maximize the likelihood of a successful surgery that provides you with many years of boosted confidence and satisfaction with your appearance.
Submuscular versus Subglandular Placement
Breast implants are placed either above or below the pectoral muscle, according to the patient's lifestyle, aesthetic goals, and other factors. Submuscular placement is the more invasive of the two surgeries, because in addition to requiring an incision in the skin, this method requires separating a portion of the pectoral muscle to create room for the implant. This is often the recommended placement option for women who desire the most natural-looking results, and who do not regularly engage in activity that requires a great deal of upper body strain.
Because it is more invasive, submuscular placement usually requires about a week of downtime away from work and avoiding aerobic exercise, and can require about two to four weeks before doing any lifting. On the other hand, patients who choose subglandular placement are usually able to return to work within two to three days.
Healing garments are an important part of recovery, and they also differ according to implant placement. For submuscular placement, I recommend that patients wear a two-inch wrap-style bandage just above the breast. After surgery, the implant will eventually drop to a small degree as it achieves harmony with your muscle and breast tissues, resulting in a natural appearance.
My colleague James Landeed, M.D., a fellow San Antonio plastic surgeon, explains that this stage of recovery requires patience.
"When breast augmentation involves submuscular placement, the muscle can trap the implant and keep it high until the muscle releases enough to let it fall into the pocket," he said. "I always tell my patients not to be surprised if it looks high. This can take two to three months or more."
If a patient chooses subglandular placement, she can wear a conventional bra, but I recommend wearing one without an underwire, which can hinder the process of the implant dropping into place. The location of the incision is another very important factor determining how much time a patient must wait before resuming normal exercise and other activity.
Location of the Incision
Incisions created in the bottom crease of the breast, where the lower protrusion of the breast meets the chest wall, are called inframammary incisions. If this is determined to be the best method of placing your implant, you will probably be advised to wait two to four weeks before resuming any upper body exercise. Meanwhile, it is very important to avoid lifting your arms above your head. By avoiding placing any strain on this area of your body, you can facilitate healthy healing resulting in a discreet, easily concealed scar.
However, there are other incision techniques that can require less downtime. For example, in some cases, the implant is placed through an incision around the nipple, an area that experiences little, if any strain during activities that require upper body movement. The method that results in the least scarring is called transumbilical (TUBA) placement. This involves using an endoscope - a special surgical tool that consists of camera attached to the end of a thin pliable tube - to place a deflated saline implant through a small incision in the navel. The implant is subsequently filled with saline solution to achieve the desired size.
Transaxillary placement involves using an endoscope to place a deflated saline implant through an incision in the armpit, and this usually does not require any restriction of upper body activity after a week's time.
Size of Implant
Breast implants are available in a wide range of sizes to accommodate women who desire a moderate enlargement, women who wish to achieve a voluptuous bust line, and every patient in between. The size of implant you choose, along with the placement method, can have an effect on the duration of your recovery. For example, larger implants place greater pressure under the pectoral muscle, and result in more stretching of the overlying skin. This can cause recovery to take a bit longer.
Smoking and Healing Do Not Mix
By now, everyone understands that tobacco use of all kinds is detrimental to your health. However, it is important to understand that smoking and other forms of tobacco use have an especially adverse affect on the ability of your body to heal following surgery. Nicotine causes blood vessels to shrink, compromises the function of red blood cells, and lowers oxygen levels in the blood. Cells must divide and grow in order for wounds to heal, and without adequate oxygen, this process can be delayed considerably.
Nicotine causes blood vessels to shrink, compromises the function of red blood cells, and lowers oxygen levels in the blood
Nicotine also compromises the function of white blood cells, which fight infection and foreign entities in the body. When white blood cells cannot properly consume any bacteria present in a wound, it can greatly increase your risk of infection.
If you are a smoker, you must stop smoking at least three months before surgery, and continue to abstain during recovery. Perhaps it goes without saying, but patients are well advised to stop smoking altogether once they have stopped long enough to undergo surgery.
Quitting tobacco use is especially important for patients who wish to combine their breast augmentation with a breast lift. In addition to the techniques performed as part of breast augmentation, a breast lift can involve more incisions, as well as the removal of excess skin, fat, and breast tissue. This combination is more invasive than breast augmentation alone, and it becomes even more important that you facilitate the ability of your body to heal properly.
Supplements and Medication
Supplements and certain medications are a part of most of our daily lives, providing many benefits. However, they can actually complicate surgery, and you should expect your surgeon to review your intake of supplements and medications in great detail.
It is essential that patients stop using any medications or supplements that can cause bleeding
When creating the "pocket" that will contain the breast implant, it is of absolute importance that the tissue is "dry," or not bleeding. This not only helps to maintain your safety, but also reduces your risk of developing capsular contracture, a condition in which scar tissue surrounding the implant begins to tighten, distorting the shape of the implant. It is essential that patients stop using any medications or supplements that can cause bleeding. This includes fish oil, herbal supplements, aspirin, and others. In fact, the American Society of Plastic Surgeons requires that patients sign a consent form confirming that they have ceased intake of all supplements prior to surgery. Patients should not resume taking supplements and other medications until two weeks after surgery, or until their surgeon has determined it is safe.
Allowing alcohol consumption during recovery is debatable among surgeons. The bottom line is that pain medication and alcohol do not mix. However, as soon as a patient no longer needs pain medication, I am personally fine with patients enjoying a glass of wine if they wish.
As with any surgical procedure, patients who undergo breast augmentation can expect some soreness and tenderness in the days following surgery, but this can be controlled with medication. The kind of pain medication prescribed following surgery depends on your doctor. At my practice, I often use EXPAREL®, an injectable time-release pain medication that can provide localized relief for three to four days following surgery. This solution not only provides great comfort, but also eliminates the hassle of acquiring and taking oral pain medication.
Breast augmentation, like any other outpatient surgery, should never be a matter of simply having surgery, receiving recovery instructions, and being sent on your way. I always see my patients the next day after surgery. During that time, I check for hematoma, or the localized collection of blood outside the blood vessels. In some cases, patients are fitted with special drainage tubes that prevent hematoma, but the sophisticated techniques we use today usually eliminate the need for tubes following breast augmentation.
During follow-up appointments, I also look for any signs of irritation, which can be indicative of infection or other complications. Before you leave the surgical center following breast augmentation, you will be given an antibiotics prescription to reduce the risk of infection.
I usually ask that women return about a week later to begin discussing a massage regimen to help them experience the greatest possible benefits of surgery and avoid certain complications.
By massaging the breasts, you can facilitate the proper positioning of the breast implants and prevent capsular contracture. Following breast augmentation, a capsule of scar tissue always forms around the breast implant, but an ongoing massage regimen can help your body develop this capsule in a way that will not compromise the aesthetic results of your surgery.
When a patient undergoes transumbilical submuscular placement, I instruct her to massage the breast in a downward projection using the opposite hand to massage the opposite breast. Otherwise, a light massage is sufficient to break up any scar tissue that may develop. For best results, this routine should be performed for 20 minutes twice a day, for as long as you have your breast implants.
When to Contact Your Surgeon
During your recovery, if you start to notice irritation, or if you begin experiencing a fever, it is possible that you have an infection, and it is very important to contact your surgeon as soon as you can. Chest pain and shortness of breath are also signs of a potentially serious complication, and you should meet with your surgeon as soon as possible.
Sharon and Pamela: Two Patients Share Their Recovery Experiences
Pamela is a patient of mine who has undergone multiple procedures with me following recovery from health conditions that had affected her appearance. She had breast cancer at age 17 and underwent a double mastectomy, or the complete surgical removal of both breasts to eradicate all cancerous tissue.
"After my mastectomy, I had undergone reconstructive surgery, and one of my implants eventually ruptured," Pamela said. "The first person I thought to call was Dr. Barone. She replaced both implants and removed the scar tissue."
Pamela's advice for anyone undergoing breast augmentation is to make room in your busy schedule for recovery, and follow the instructions your surgeon provides.
"Recovery is simple: just do what your surgeon tells you to do"
"Recovery is simple: just do what your surgeon tells you to do," Pamela said. "It's like any other outpatient surgery. Even though you're going home that day, you have to do exactly what the doctor tells you. I scheduled a week off of work following my breast augmentation, and took advantage of having the weekend before and after."
Sharon underwent revision of a standard breast augmentation. She had undergone surgery at another practice 9 years earlier, and had grown dissatisfied with the results. Following surgery, which involved subglandular implant placement, she reported experiencing minimal pain, and was actually back at work - albeit with minimized physical activity - three days following surgery.
"There wasn't much pain at all," Sharon said. "For any women who have had children, I would compare the pain during my breast augmentation recovery to being engorged while breastfeeding. It's not quite as painful as engorgement, but it's similar."
Having undergone breast surgery twice, Sharon said some simple, yet careful planning can go a long way in helping you to have a fast and comfortable recovery.
"Before you reach out to a surgeon, you should also do your research beforehand, and make sure they have good reviews," Sharon said. "Make sure it's a doctor you can trust, so you can go in with a good attitude."
Set the Stage for Beautiful, Satisfying Results
For many women, breast augmentation is a considerable investment in terms of time and money. When it is performed correctly, it can provide a tremendous boost in self-esteem and, in turn, quality of life. While your surgeon is largely responsible for the success or failure of the procedure, there is a certain amount of dedication and discipline required on your part to ensure that you get the most out of breast augmentation. Spend plenty of time asking your doctor questions, and take careful note of his or her instructions to make certain that your breast augmentation results bring you the greatest possible satisfaction.
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