Breast Augmentation/Implants Recovery
Youthful, full-breasts are a sign of health, vitality, and hold a unique place in our society. The breast is a psycho-social-sexual organ that has a significant impact on your sense of self, and your self-esteem. Breasts impact everything from the types of clothes you wear, to how you feel. Studies from the 1980s-1990s found women with breast implants were found to be more confident, hold higher professional positions, and make more money than women without breast implants. While this may not hold true for all regions or countries, I know many women that have had a very positive change in their level of self-love and quality of life following breast surgery.
The modern-day breast implant is a much better and safer product than we have ever had before. All implants we use are “gummy bear” type implants in the sense that they are no longer filled with liquid silicone. Even if you were to cut open the implant, nothing leaks out. There are a multitude of implants that allow for fine-tuning of size in order to create unique beautiful breasts for you, that fits you well, and are not obnoxious or overdone. During your consultation, I like to focus on your goals and make sure that we not only identify a size that meets your goals, but I believe it is also critical that the placement of the implant is relative to the muscle, and the location of the incision match your lifestyle. I do not believe in a “one size fits all” approach to Breast Augmentations.
Surgery is typically performed at one of our surgery centers that create a safe, patient-centric, convenient experience. You will meet your Anesthesiologist the morning of surgery, along with the nursing staff that will care for you. I use general anesthesia in order to ensure your comfort and a long-acting pain block, Exparel, that lasts about 3 days in order to keep you comfortable. If this is your first breast surgery, you will experience some pressure as your muscles and chest become familiar with your new implants. If this is not your first breast surgery, then recovery is even easier.
the Procedure
What is inside the implant?
Saline or Silicone, the two options for breast implants in the USA. The exterior shell of the breast implant is the same regardless of what fills the implant. Although saline implants tend to be less expensive than silicone (only a couple hundred $$), they do not hold their shape as well as silicone implants would. Saline implants tend to have more rippling and feel less natural particularly when used in a thin patient.
What incision did we use?
Incision Types: Armpit, Peri-Areolar (Board of the Areola) or Inferior Mammary Fold (IMF)
If this is your first breast surgery, then your incision will be in your armpit or under the breast. If you already have an incision along the areola, we can certainly use the same incision. If you are having a lift done at the same time, this is also a good choice.
Where is the implant relative to your pectoralis major (push-up muscle)?
Most implants in the USA are placed behind the push-up muscle to help create a natural contour to the upper part of the implant. Because I am very focused on how the implant fits your life, I don’t think that all patients should necessarily have an implant behind the muscle. If you enjoy heavy lifting with your chest (bench press, burpees, inverted yoga positions, etc.) and you do not want to see your implants move, then placing the implant in the front of the muscle may be ideal for you.
What other procedures were used during surgery?
Fat Transfer (Composite Augmentation): This is a wonderful way to get more natural, full cleavage even if you are very thin and fit. I use the fat to help contour the upper and inner aspects of the breast to ensure that there is a beautiful, natural contour. This also helps to avoid the appearance of ripples and is also a great option if you like heavy-lifting with your chest, are very fit, and do not want animation (the appearance of implants moving when you flex your chest).
Breast Lift (Mastopexy): A Breast Lift will help to ensure that your areola is the right size, shape, and in a youthful position relative to your implant. We want the implant and your natural breast to move together. A Circle Lift allows for small movements of the areola and the incision is limited to a circle just around the areola. The incision hides well since there is a natural transition from your normal skin tone to the areola.
Capsulorrhaphy: If you have implants but the implants have slid closer to your armpit and don’t give you the same cleavage they used to, then tightening the capsule (the normal scar tissue around the implant) will help to get back that “hand in glove” fit that you had right after surgery. This is commonly performed with a lift.
Learn more About
the Procedure
The Day of Surgery
We will meet at the surgery center where you will have the chance to be introduced to your team including the Anesthesiologist. The Anesthesiologist will review all necessary documentation provided to ensure accuracy and that we deliver a smooth, safe anesthetic and recovery.
Minimizing the risk of post-operative nausea and wooziness starts in the pre-operative area; you will be given an IV to remain well hydrated and the Anesthesiologist can provide medications during the procedure.
To keep you safe during surgery, you will have a breathing tube or an LMA during the operation. This may cause scratchiness and discomfort for the first couple of days post-surgery. Chloraseptic or a nice throat-coat tea can help with the discomfort.
So that you have very little discomfort after, I like to use long-acting local anesthetics during your surgery. Even with the block, you will still feel some pressure but most patients have pain scores between 1-5 after breast surgery.
When your surgery is complete, the nurse will contact your family member to let them know your procedure is done and the time for pickup. If the surgery runs longer than anticipated this is not a bad thing, though, it can cause some anxiety in your family. Your breasts are unique, and we must take our time to ensure that every little detail is accounted for as the work done during your surgery must last for the rest of your life.
Evening After Surgery
During your first evening, please ask for assistance from your loved one since you may not feel as stable as you would normally. I recommend getting up and moving around at home. Surgery can increase your risk for blood clots in the legs and we want to ensure the blood is kept flowing.
If you are a stomach or side sleeper, I recommend getting some wedge pillows and/or place a pillow behind your knees to help simplify sleeping on your back. In order to resist the temptation to roll over, it is encouraged to sleep flat on your back or slightly reclined with a few pillows – you can also place pillows in a recliner chair.
Recovery
Typical downtime from a Breast Augmentation is within 1 week (3-7 days). Our post-operative dressings are very minimal. There will be some bruising and swelling, but you will be able to enjoy your new breasts immediately after surgery.
Incision Care
During your first week post-operative, you do not need to apply anything. Once the skin glue or steri-strips fall off, apply Vitamin E oil to the area twice, daily. Once you get to 1-month post-surgery, you will switch to a Silicone gel.
Your incisions will be at maximum strength about 6 weeks after surgery. Out of an abundance of caution, you will be able to return to full activity/sleeping on your stomach, etc until 8 weeks post-surgery.
Multi-Modal Therapy Medications
Tylenol Extra Strength (500mg) take 2 every 6 hours for 5 days
- Do not wait for pain. Tylenol makes up the foundation of your pain management and will decrease the number of narcotics needed.
Ibuprofen (600mg) take 1 every 6 hours scheduled for 3 days
- Do not wait for pain. Ibuprofen makes up the foundation of your pain management and will decrease the number of narcotics needed.
Gabapentin (100mg) take 1 every 8 hours for 14 days
- Do not wait for pain. Gabapentin makes up the foundation of your pain management and will decrease the number of narcotics needed.
Tramadol (50mg) take 1 every 6 hours as needed for pain. If you use antidepressants, this will be exchanged for Oxycodone (5mg).
- It is okay to wait until you have pain. Tramadol is a long-acting narcotic that will begin to work in about 30 minutes and can last up to 6 hours. Oxycodone is a fast acting, strong medication that can exacerbate nausea and or make patients feel “loopy”.
Zofran (Ondansetron, 4mg) take 1 every 8 hrs
- The dissolvable tabs can be placed under your tongue if you are feeling nauseous from the anesthesia.
Medications For Other
Scopolamine Patch (Transderm-Scop, 1mg)
- This patch is a preventative for nausea prior to surgery. You will place this patch behind your ear the night before surgery.
Singulair (Capsular Contracture, 10mg) take 1 daily for 90 days
- A study was performed that showed a reduction in the already low-rate of capsular contracture in women that took Singulair daily for the first 90 days after surgery.
Doxycycline or Bactrium (Antibiotic, 100mg) take 1 twice a day for 7 days
- You will take an antibiotic for the first week after surgery.
Cyclobenzaprine (Muscle Relaxant, 10mg) take 1 every 8 hours PRN
- It is okay to wait until you have pain. The pressure you feel after surgery is due to the Pec Major muscle getting tight/stretched. This can lead to spasms and pain. A muscle relaxant will help to break that spasm and can help you sleep better.
Medication Schedule
A proposed schedule has been supplied in order to simplify the scheduling of medication. We understand there are a lot of medications to follow, but rest assured, we believe Multi-Modal therapy provides the greatest comfort and decreases post-operative nausea, drowsiness, and constipation. If your pain has become severe or additional recommendations are needed, do not hesitate to contact our office.
| Medication | Multi-Modal Therapy Schedule |
|---|---|
| Tylenol (1000mg) | 4AM, 10AM, 4PM, 10 PM |
| Ibuprofen (600mg) | 4AM, 10AM, 4PM, 10 PM |
| Gabapentin (100mg) | 6AM, 2PM, 10PM |
| Tramadol (50mg) / Oxycodone (5mg) | 4AM, 8AM, 12PM, 4PM, 8PM, 12AM |
| Singulair (10mg) | 8AM |
| Cyclobenzaprine (10mg) | 4AM, 12PM, 8PM |
| Doxycycline (100mg) | 10AM, 10PM |
| Zofran (4mg, optional) | 6AM, 2PM, 10PM |
Follow Up Schedule
1 Week
Some bruising will be present as it fades to a yellow color tone from the original purple – not everyone bruises. I want to make sure you are comfortable, progressing well, are showing no signs of infection, and are having bowel movements. Nothing more frustrating than being sore from surgery and constipated, trust me!
1 Month
Your incisions are healing well but will still appear redder around the surrounding skin. Overall, you will be feeling great!
3 Months
You will be enjoying the results of your surgery! The incisions are fading and will continue to improve all the way until one year after surgery. Buy new bras…or don’t wear bras, totally up to you!
6 Months
Feeling good, looking good! There are small nuances that we want to make sure are still progressing well.
1 Year
“Why do I have to see the doctor?” I want to ensure you have healed well and we have improved your quality of life. It is at this point your incisions will appear faint.
1 Week
Some bruising will be present as it fades to a yellow color tone from the original purple – not everyone bruises. I want to make sure you are comfortable, progressing well, are showing no signs of infection, and are having bowel movements. Nothing more frustrating than being sore from surgery and constipated, trust me!
1 Month
Your incisions are healing well but will still appear redder around the surrounding skin. Overall, you will be feeling great!
3 Months
You will be enjoying the results of your surgery! The incisions are fading and will continue to improve all the way until one year after surgery. Buy new bras…or don’t wear bras, totally up to you!
6 Months
Feeling good, looking good! There are small nuances that we want to make sure are still progressing well.
1 Year
“Why do I have to see the doctor?” I want to ensure you have healed well and we have improved your quality of life. It is at this point your incisions will appear faint.
Questions & Concerns
I am overjoyed and grateful to be part of your journey. I do not take this responsibility lightly. As questions and concerns arise, I expect you to contact me and my staff under any circumstances (925) 966-3920. This is a journey that is best done together. I look forward to caring for you and your family.
