Typical Post-Surgery Instructions

This document presents the instructions I typically provide to patients based on time after surgery as opposed to specific procedures. These instructions are often very similar and apply to commonly performed procedures such as breast reduction, breast lift, explant and tummy tuck. I understand there is a lot of detail here, but I am known and appreciated for being meticulous,and I suspect that is why you are my patient! Please take time to read this as I think you will find it helpful as you research and prepare for your procedure, and as a helpful reference after surgery.

Regarding incision care, the basic principle is to use healing ointments (as long as you are not sensitive or allergic) until the incisions become scars. That will look like smooth pink red lines. For activity, the concept is to be as active as possible, balanced against a need to protect the incisions from too much movement or pulling, and the muscles in the immediate area from too much pulling. I know that might seem too subjective and vague, but usually common sense and pain will guide you. If in doubt, don’t do it until you can confirm with us.

One Week: Incisions, Drains, Activity, Pain Management and Compression Garments

I routinely use strips of yellow gauze on the incisions. These will be removed at your first visit. At that point, I recommend that you start to apply ointments to the incisions twice a day. Usually, Aquaphor ointment (readily available over-the-counter) will suffice. If there are areas of crusting or mild redness, I might ask you to use the prescription ointment mupirocin and/or an over–the-counter antibiotic ointment such as Neosporin to those areas. Keep the incisions covered at least one more week, or until a smooth durable looking scar starts to develop.

Most of the time, drains meet criteria for removal at about one week. This parameter is 30 cc of output from each separate drain two days in a row. Occasionally, drains need to be in place a few days or a week longer. Continue careful drain area care with antibiotic ointments and a cover gauze until removal. Once your drain is removed, apply antibiotic ointment and keep the area covered until a dry scab or smooth scar develops, whichever occurs first.

In terms of activity, I usually allow lifting of 15 pounds at this time. If lifting is uncomfortable for you, however, maintain the 10-pound limit. Walking is still highly encouraged as an excellent way to promote healing and reduce pain. You can start to resume light to moderate exercise, again listening to pain signals from your body. This includes using light weights for arm muscle exercise and gentle arm and shoulder stretches. Try to avoid a tense shoulder posture, and practice fairly deep full breaths to help expand the rib cage. Leg exercises are also permitted. This might include “spin” type cycle, elliptical with no arm use, and the use of light weights. Aerobic workouts are fine, but limit your heart rate to about 80 percent of your usual max. Body-weighted exercises can be performed as long as you aren’t engaging muscles in the area of surgery (e.g. avoid using your pectoral muscles after breast procedures). The goal is to resume activity to promote healing and recovery while avoiding strain that might split incisions or pressure that might cause bleeding and fluid collections. You can exercise, but avoid doing so much that your pain and swelling increase.

In terms of garments, I usually discontinue ace wraps in favor of a gently compressive sports bra. Make sure the bra doesn’t pinch. I would favor a little loose over too tight. Torso and extremity garments used for tummy tucks and liposuction can be changed to over-the-counter support such as panty girdles or exercise wear. The idea is to continue to compress, support and mold the treatment areas. Once again, avoid anything that is pinching, as this can create lines in the healing fat.

At this time, I really encourage transitioning pain management from opioids to Acetaminophen (Tylenol) and NSAIDs such as ibuprofen (Advil) and naproxen (Alleve). I realize pain is subjective and multifactorial and is experienced by individuals in different ways. The goal is to reduce opioid use to reduce side effects associated with those medications. Abuse potential increases the longer these medications are taken. Anxiety and stress do contribute to pain. Explore stress management techniques. Lavender essential oil is calming for many people.

Office workers can usually return to work at one to two weeks. Patients with strenuous jobs such as factory workers usually require 6 weeks to return.

Three Weeks: Scar Care, Incisions and Nerve Pain

At this point, most of you will have the smooth pink red lines. Understand that some redness in early scars is normal. It reflects increased blood vessel growth and will fade with time. Stiffness is also very common both in the scar and in the surrounding soft tissues. You might feel ridges or lumps. A lot of collagen has been laid down by this phase of healing, and the skin and tissues will feel firm and stiff. This is a good time to start scar care.

Scar care is usually applied twice a day for three to four months, or until the scars are soft and pale. Stiffer areas can be massaged to help flatten and smooth. Take care to avoid being too vigorous, as you can make yourself inflamed and tender if you rub too hard. Scar care does not guarantee a pleasing outcome for everyone, as genetics play a significant role here. Most people, however, do well.

Conventional scar care consists of topical silicone. Over-the-counter options vary in price point and availability. Scar Zone is a good value-based product that is usually found at Kroger and Meijer for about $12. Most retailers and drugstores carry products in the $25 to 30 range. Typical brands are ScarFade and ScarAway. Mederma is in this price range but I have not been impressed with its effects. We do sell quality scar products at the office that contain 100% silicone. These products are the most expensive. Patients do like these formulations, but I realize cost can be a consideration. Scar care will be most effective when the scar is biologically most effective, or from shortly after injury to up to 6 months after surgery. Topical scar creams are not likely to show significant improvement on old scars. Thick, red scars are an exception and may require treatment for 12 months or more.

For explant patients or others who prefer a more natural approach, I have observed nice results from natural oils. Most commonly, essential oils such as frankincense, lavender, and helichrysum are added to a carrier oil such as coconut (liquid or solid depending on your preference), jojoba, and almond. The essential oil manufacturer will often provide guidance on dilution ratios, but 10 to 15 drops to one ounce of carrier is common. Even natural oils can be sensitizing. Discontinue for rash or other symptoms.

Breast lift and breast reduction patients may have knots near the areola and T area. These can be clipped at the skin surface, or can be allowed to break off. Sometimes they do become inflamed, though. In that case, apply antibiotic ointment, and get the knots removed, either at home or with us.

Some patients, especially after breast lift and reduction, may develop small incision openings about this time. This is often due to unique mechanical forces at 90-degree incision junctions that lead to small separations, or dissolvable stitch knot migration to the surface. Do not apply scar care there. Treat with antiseptics or antibiotic ointments and keep covered until dry and healed.

A common experience is nerve pain. First, numbness in skin and structures like the areola is very common after these procedures. As the nerves come back on line, you will often experience stinging, burning, tingling or zaps. This is common and will resolve over a period of a few weeks to a couple of months. Liposuction patients are particularly prone. Very soft massage similar to cat kneading can help.

Despite the fact that nerve pain can develop around this time, I really encourage you to be off of opioids by now. Narcotics may mask the pain but don’t address the nerve inflammation. Use NSAIDs or Tylenol. If you are really struggling, ask us about using gabapentin specifically for nerve relief.

One Month: Returning to Normal Activities, Lifting Restrictions

This is a time when I believe you can largely normalize activity without harm and start returning to normal. I do recommend avoiding intense muscle use at the surgical sites for two more weeks, e.g. pectoral muscles for the chest and rectus muscles in the abdomen as a precaution. Limit lifting to 25 pounds for those two weeks, although moms are usually fine to lift infant and toddler children. Do continue to listen to your body and avoid anything that causes you pain. Reassess every week or so.

You can start to wear a regular bra at this time if it is comfortable for you. Usually, underwires are not comfortable for another month or so. I do ask reduction and lift patients to wear a sleep bra for 3 months. I think this helps the scars, especially in the breast folds.

Tummy tuck and liposuction patients can stop wearing compression at this time, although many feel more comfortable using their garments for another 2 to 4 weeks.

Six Weeks: Healing Is Complete

This is the time when healing after surgery or trauma is complete. This does not mean you are completely free of discomfort or swelling, but you should be feeling a lot more like your usual self.

Resuming unrestricted activity is safe at this time. Swelling and discomfort often come and go depending on your activity level. Discomfort usually does not indicate you have caused damage. Perform activities according to your own tolerance.

Garment use is also largely according to your preference, although I do favor a nightly bra for 3 months for most breast patients. Explant patients without a lift don’t need to use a night bra.

Three Months: Enjoy Your Surgery Results!

By now, discomfort usually occurs only mildly or briefly (infrequent, less intense zaps and tenderness can occur for many months).

Scars are starting to become softer with less color. Discontinue scar care now, or in another month or two, depending on how your scars are behaving.

Swelling is gone or mildly intermittent for most procedures.

Hopefully you are really enjoying your results! If you are seeing issues that concern you, these often resolve by six to twelve months. Usually I recommend delaying revision until six months or more have passed.