Cosmetic surgery Phuket – Breast Surgery Recovery Information Pack

It’s the moment you have been waiting for, almost. Your breast augmentation surgery is over, but you are about to embark on the breast augmentation recovery process. The shape and size of the breasts and chest is different from one woman to another. They are also different between the left and right sides. Sometimes the original shape of the breast or chest and the differences between the left and right sides will not give the usual pleasing looks after breast enlargement. Compromises may have to be made to give the best possible result.

In just about every woman there is a difference in appearance between the left and right breast. This could be due to the difference between the left and right chest wall (rib cage). One side might stick out more than the other side. The breast volume and shape is also different between the left and right sides. The skin tone and muscle tension is also different between the left and right sides. Sometimes after breast enlargement the difference will be even more obvious. If the differences between the left and right sides are very obvious then different size implants may have to be used to try and even out the appearance where possible. Even then the left and right sides may still look different after the surgery. In other words it is impossible to match the left and right sides exactly after a breast augmentation surgery.

The gap between the breasts may be wide before the enlargement. In such cases the gap would remain the same or the gap may be even more noticeable after breast enlargement. Cleavage in such cases is harder to achieve especially if the skin in the area is thin. When implants are placed behind the muscle in such situations the gap may appear even wider and cleavage is even harder to achieve.  This is because the muscle attachments prevent the implants to be placed closer to the middle of the chest.

Some women are very thin. In this circumstance, there is a possibility of being able to feel the edge of the implant or in some cases seeing the wrinkles of the implant.

Waking Up After Breast Augmentation

After you wake up and are brought into the recovery room, a nurse will monitor you until you are ready to be returned to your private room. How long this takes varies, but usually it takes at least two hours. As the anesthesia wears off, you will feel sore and possibly confused. Your vision may be blurry and you may be extremely sleepy. If you feel any pain, ask for a pain reliever. You may also feel very cold and start shivering immediately after your surgery. This is usually from the medications. The shivering can also be due to the temperature of the operating room. Ask for a blanket if you feel uncomfortably cold.

As you will have had general anesthesia, you may feel nauseated. Medication can help. Make sure to tell your surgeon or anesthesiologist if you don’t feel well. Following a Breast Augmentation, the breasts may appear to be placed quite high up. This is also normal. During the first two months postoperatively the breast implants will gradually lower and settle from the effects of gravity into a more natural position. Do not be alarmed if one side settles quicker than the other, as this sometimes occurs

Drains After Your Breast Augmentation Recovery

Your surgeon may have placed one or more drains in your incision to remove excess fluid. (The fluid may be pinkish or brownish.) These thin plastic tubes may be left in place over night after surgery. There may be a little irritation around the edges of the incision due to the drain

Compression Garments ,

The hospital will supply you with one support bra or boon tube style bra upon discharge from the hospital.

Scars

All breast augmentation techniques will leave a permanent scar behind, which is meant to be as inconspicuous as possible after healing. Though uncommon, extensive scarring is a possible complication of breast augmentation. Remember that your scars will get worse before they get better. Your incision will heal, but scars go through a series of changes before they are completely healed and that can take months. Scarring is the result of the body’s attempt to heal the site of a cut, burn, or other wound. When the body heals from injury it produces an overabundance of collagen, which forms a scar. This production of collagen is kept in check by an enzyme aptly named collagenase that melts collagen away. During the initial healing process the interaction of these substances determine the nature and extent of scarring. Avoid direct sunlight.

Caring for Breast Implant Incisions

After the surgery the surgeon will place waterproof plasters over your incision sites. Keep your incisions/suture line dry. If the plaster should get wet or start to peel off we recommend that you contact the PIAC office to make an appointment to have the wounds cleaned and redressed.

Depression

Many patients, experience periods of sadness or anxiety as they recover from cosmetic surgery. We begin to second guess ourselves and wonder if we ever should have had the surgery in the first place. We begin to think we are “ugly” and that the bruising and swelling will never go away. If you are feeling like that, you are not alone. In fact, you’re quite normal! Some people go beyond feeling blue after cosmetic surgery to being seriously depressed. Depression is a serious condition that should be treated seriously. Remember that if depression after surgery does happen to you, it is normal. You can even write down what to expect before your surgery, so you can note it afterwards when you are feeling blue. This can help you keep things in perspective and prepare your mind. It is also remind you that you knew this was going to happen. Keep reminding yourself that you are not crazy, that you’re just going through a low. Your depression should subside. If it does not, speak with your plastic surgeon or GP about it. You might want a referral for a therapist.

Depression can result from the after effects of your anesthesia (anesthesia seems to bring out our “sensitive sides” and makes many emotions feel stronger), medications, postsurgical traumatic stress syndrome, constipation from the medications (Who can be happy when that happens?), and a general sense that your life is in disarray.

Soreness and Pain After Breast Augmentation Surgery

If your breast implants are placed over your chest muscle, your recovery will most likely be shorter and less painful than if your implants are placed under the muscle. If you have combined your breast augmentation surgery with a breast lift, your breast lift recovery will add to your overall recuperation time. Do not take pain relievers with aspirin or ibuprofen until your surgeon says that it is OK to do so, since they can cause excessive bleeding.

Monitor Your Temperature

Take your temperature regularly during cosmetic plastic surgery recovery. An elevated temperature could mean you have an infection.

Antibiotics

Take all the antibiotics that your doctor prescribes for as many days as the prescription says. Not doing so can result in an antibiotic-resistant infection. Avoid alcohol consumption whilst taking the antibiotics as alcohol can diminish the effect the antibiotics have on the body.

Rest

The surgeon will recommend that you get plenty of rest for the first few days following the surgery. ‘

Swelling After Breast Implant Surgery

You may be swollen for three or four months after breast implant surgery. Drinking water, cutting back on salt and engaging in light exercise can help reduce this swelling (edema). Do not take any over-the-counter or herbal diuretics unless advised to do so by your surgeon. If you experience sudden swelling in the days after your surgery, call your surgeon.

Bruising

You will probably have some bruising after your breast implant surgery, but this will fade. Certain herbal remedies such as arnica or bromelain may help. Ask your surgeon what he recommends. If you still have some discolorations after several months, talk to your surgeon.

Sleeping With Your New Breasts

Sleeping is difficult right after your breast implant surgery. You have to sleep on your back with your upper back and head elevated to reduce swelling and pain. Be sure to have someone wake you up to take your meds, eat healthy meals, and drink your fluids.

Bathing

You will be able to shower but not swim until your incisions are closed and your sutures have been removed.

Tip: You may not be able to wash your hair for a week because you should not raise your hands over your head. Wash your hair the night before your surgery and braid it or place it in a ponytail.

Activities During Breast Augmentation Recovery

Walk around as soon as you are able while recovering from breast augmentation surgery. This will help prevent blood clots and can also help relieve swelling. Do not engage in strenuous activities, or exercise, for at least three to four weeks after your surgery. You should plan to avoid activities which require much raising of the arms above the level of the head for 10 days after surgery. With great care, you can drive about 7 days after surgery. Patients can usually return to work in a few days unless their occupation requires any particularly strenuous movements and lifting. In such cases, 3-4 weeks should be allowed.

• Walking can commence within days,
• Light jogging within 2 weeks,
• Gym and Pilates after 4 weeks and
• Upper body weights 6 weeks.

Are They All You Dreamed They Would Be?

In the days and weeks right after your surgery, your breasts will be quite firm and will sit high up on your chest. Don’t worry. They will soften up and will drop. Remember, the breast on your dominant side (your right side, if you are right-handed) may not drop as fast as the breast on your non-dominant side. In the weeks and months following your breast augmentation procedure, your breasts may appear “off” in shape or position. They also may feel itchy or sensitive. This is because your skin has been stretched over the implants, making your breasts very firm and high. The full results of your breast augmentation won’t be seen completely for many weeks, so be patient.

Loss of Sensitivity

You may lose some sensitivity in the nipple or the surrounding skin after breast augmentation surgery. This usually subsides within a few weeks. In rare cases, however, loss of sensation can be permanent. As sensation returns to your nipples and breasts, you may experience sharp pains, itchiness, heat, tingling and prickling. These temporary sensations occur because nerve function is returning.

Nipple Over sensitivity

Many women complain of very erect and sensitive nipples after breast implant surgery. You can protect your nipples by using a Band-Aid (especially the large round ones), large corn pads, or nursing pads. These pads will protect your overly sensitive nipples from the abrasiveness of your clothing and shield your erect nipples.

Breast Noises: Squeaks and Gurgles

Do not be alarmed if you hear gurgling, buzzing, or crackling noises coming from your augmented breasts.

These noises may result from fluid build-up or air bubbles within the implant pocket. They can also be heard when the implant has not settled. This will likely pass in a few weeks.

Risks

All procedures carry some risk. 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, but it is a doctor’s duty to inform patients of all their material risks. 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.

General Risks

• Smoking: Smoking increases the risks of all potential complications. This includes chest infections and poor wound healing. You should stop smoking 3 weeks before and 3 weeks after the surgery.

Risks of having a general anaesthetic

• 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)

Things that can go wrong in the operation

• Bleeding
• Damage to surrounding structures

Things that might happen in the first few weeks

• 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

Things that might happen long term

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

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.

After Surgery

First Days After Surgery

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 8 ounces 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. You must not smoke.

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. Do not smoke. While incisions may have sealed, smoking deprives your body of necessary oxygen that can result in poorly healed, wide, raised scars. 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.

Following Surgery

Healing will progress and your breasts will settle into a more final shape and position. You may ease into your regular fitness routine. However realise that your upper body may require some time to return to previous strength. Listen to your body and do not commence until you are ready

Continue your breast massage as instructed by your surgeon.

Continue to use scar treatments

Discomfort or tightness and tingling will resolve. Any lingering nipple sensitivity or lack of sensation should begin to greatly improve.

No need to resume smoking. You have now gone 4-8 weeks (4 weeks prior to surgery and 4 weeks following) without a cigarette. For your long-term health, there is no need to resume smoking.

Continue healthy nutrition, fitness and sun protection. Your scars will continue to refine. If they become raised, red or thickened, or appear to widen, contact your Doctor. Early intervention is important to achieving well-healed scars. Scars are generally refined to fine incision lines one year after surgery.

If your breasts develop an unusually hard feeling, or a highly rounded “squeezed” appearance, call us as soon as possible. You may be developing capsular contracture. Early treatment is the best solution.

Capsular Contracture

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

Detecting Capsular Contracture

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

Mammograms and Your Breast Implants

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.

Breast Feeding

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 breast-feed, regardless of whether you undergo breast augmentation. Women who have never had any kind of breast surgery may experience difficulty breast-feeding. If you do opt to have breast surgery, incision and 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

Frequently Asked Questions

What if I get sick and can’t keep my medicine down?

Taking your medication with food and water can help you keep it down during breast augmentation recovery.

If you simply cannot keep your medications down, tell your surgeon. You may need to have your prescription changed.

I am a very active person. How long should I wait after breast augmentation until I resume exercising?

Talk to your surgeon about when you can resume exercising after breast augmentation. Individual instructions may vary, but the usual advice is to wait at least two weeks. Although you may feel fine, you will not be completely healed at this stage. Doing too much too soon can set back your healing. You should not lift heavy objects, bend over, or take part in vigorous activities for at least three weeks after breast augmentation.

How long before my breast implants drop?

For most women, breast implants rest a bit high for a short period after surgery, and then they drop into a more normal position. This usually takes a few weeks. The time it takes your breast implants to drop depends upon several factors, including the implant size, what size you were before your breast augmentation surgery, the implant surface type, implant placement, your muscle tone and whether you massage your breasts. If your implants are placed underneath the chest muscle, they will drop slower than if they are placed over the muscle. If you had very small breasts before, and get moderate to large implants, they will take longer to drop because of the tightness of your skin. Sometimes, one side will drop before the other side.

Some surgeons advise patients to push their breast implants down or massage them soon after surgery to encourage them to drop. If you are having problems, your surgeon may have you wear a wide elastic band around the top of your chest to help push you implants down. If your implants still haven’t dropped within six to nine months, breast augmentation revision surgery may be necessary. Talk to your surgeon.

Why do my breasts appear red and feel sunburned?

Your skin has been stretched to accommodate the breast implants. The sunburned feeling and red color are caused by this stretching. This is a normal part of the healing process. Ask your surgeon what he or she recommends for your skin during your breast implant recovery.

Why are my breasts shiny?

The shininess is a result of your skin being stretched. As your skin begins to relax, the shininess will go away.

How long after breast augmentation will my breasts soften up?

This depends on your muscle tone and the implant placement. Your breasts will be firm for a while because of the post-surgery swelling. Textured implants may feel firmer than smooth ones.

 Am I too firm?

Firmness is relative. Some individuals think they are too firm when they are only slightly firmer than before, while others crave firmness and fullness around the top side of their breasts. There is no one-size-fits-all answer.

How soon can I go back to work after Surgery?

This depends on your job, your incision type, your implant placement, and how fast you heal. If you have a sedentary job, you can generally go back sooner than if your job is physically demanding. If you have had a lift, your breast lift recovery will make your overall recuperation more involved.

When can I tan my new breasts?

Tanning is not good for any part of your body, including your new breasts. Tanned skin is damaged skin. If you want to tan anyway, you are going to have to wait at least until your skin is no longer red and shiny. Tanning too early after your breast augmentation surgery can increase your risk of hyper pigmentation, a condition in which patches of skin become darker than the surrounding skin. Keep your incisions out of direct sunlight for six months to a year after surgery. Scars take about one year to mature, so cover them! The skin on your breasts will also stretch out and heal before your scars, so if you start tanning, cover your scars with some kind of tape, not just sunblock.

My new breasts are squeaking and gurgling! Is this permanent? When will it stop?

Do not panic if you hear gurgling, squeaking or crackling noises coming from your new breasts. These noises can result from a fluid build-up or air bubbles within the implant pocket, or from the implant settling in. Give it a few weeks. Although the noises might be disturbing, this is normal after breast augmentation.

My breasts look like cones or torpedoes?

Your breasts may be odd looking because your skin has been stretched over them. Don’t worry, this is likely temporary. If your breasts look like torpedoes, your implants probably haven’t “dropped” yet. The lower half of each breast is probably still tight, forcing the breasts into a high, hard-cone shape. In the weeks immediately after your breast implant surgery, you may think your breasts are too big, too small, too round, not round enough, too square, too high, too low, too ugly, too this, and too that. This will pass in time. If your implants were placed under the chest muscles, it may take some time for the muscles to relax. If you are right-handed, your right breast may not drop as fast as your left one.

My breasts are too big! I hate them!

Take a deep breath. In the weeks after surgery, your breasts will be swollen and you will not be used to them yet. They may also be relatively high up on your chest. Wait until the swelling goes down before you decide that they are too big and/or that you want revision breast augmentation surgery. If you still think they are too big after a year.

When can I start jogging again?

You need to be fully healed before you can start jogging again. Activities like jogging, jumping rope, basketball and horseback riding subject your breasts to a lot of up-and-down movements. Jumping without good support for your breasts can stretch your skin, ligaments, and connective tissue, causing sagging. Talk to your surgeon before you take part in any strenuous activity. And when you do start up again, wear a good support bra or your compression bra.

When can I begin having sex again?

Sex is still exercise. You should not participate in any activities that can significantly raise your heart rate or cause excessive movement in your breasts for a week or two after your breast augmentation. The antibiotics that you are taking to prevent infection may interfere with your birth control pills, so use another form of protection while you are on antibiotics if you do not want to become pregnant.

How soon after surgery can I fly?

You will need to stay in Phuket near your surgeon for the first week of your breast implant recovery in case of complications. You will also need to be nearby for your follow-up appointments.

Will I have to sleep on my back or side forever?

No. Just like the swelling, pain and redness, this is only temporary. You should sleep on your back with your head elevated for the first five to 10 days after surgery to reduce your discomfort and swelling. You can sleep on your side or stomach after 10 days.

My breasts are numb. Will I ever have sensation again?

In almost all cases, the sensation in the skin does return after breast augmentation. The nerves in the skin have pressure on them from the swelling and from the skin being so tightly stretched over the implant. This pressure may temporarily numb the area. What’s more, nerves around your incisions may be cut, and this can take longer to heal. As the breast envelope relaxes and your swelling s/p/pubsides, you will notice sensation returning gradually. This may take up to a year.

When can I wear an underwired bra?

After the removal of the bandages you will be fitted with either a support bra or boob tube style garment (depending on the surgeons recommendations). Do not wear underwire, ‘push-up’ bras or tight clothing for at least 1 month after the surgery (this may vary as per your surgeons recommendations). The push up bras and tight clothing may cause the implants to be shifted into abnormal positions.

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

Original Article – Phuket International Aesthetic Center