What to expect after Breast Implant surgery

**the following applies patients undergoing cosmetic breast augmentation and breast reconstruction with implants**
**please also read preoperative preparations**

Discharge Instructions

• • For cosmetic augmentation patients, you will normally be discharged on the day of surgery. Most patients will not have a drain after surgery but if you do have a drain, most of them will be removed before you go home.
  • For breast reconstruction patients, you will normally be discharged home 2-4 days after surgery and most will have a drain in the operated breast. Most of the time, the drain will be removed prior to going home.
  • The surgical bra that you would have bought into hospital should be fitted before you go home. Avoid underwire garments as these will ‘dig’ into the scar. You will need to wear the garment fulltime for 6 weeks after the surgery including in bed and only have it off for showers.
  • Avoid sleeping on your side or tummy during this period. As a result, some will find it easier to sleep on recliner couches, which is also easier to get out of than from a bed.
  • Have someone take you home and an adult should be with you that night. You would normally be discharged with pain killers and antibiotics. Take the analgesics as instructed and avoid taking alcohol. Do complete your course of antibiotics unless you are unable to tolerate them.
  • Take the pain medications as instructed by the anaesthetist. If you run out of pain medications, please contact Dr Teh’s rooms for further instructions.
  • DO NOT SMOKE. Smoking delays healing and increases the risk of infection.
  • Eat a healthy balanced diet. Avoid caffeine (coffee and chocolates) as there is some evidence that this reduces wound healing, causes dehydration and increases blood pressure.
  • The wounds will be covered with a waterproof dressing which should stay on until you are seen again 2 weeks after surgery. Do not soak in a bath or swimming pool as these dressings will soak off. If the dressings come off early or become soiled, replace with another waterproof dressing.
  • Some patients will develop a rash, blistering and/or itchiness as a result from the dressing adhesive. You should contact Dr Tehs rooms if this is the case and you may need to replace the dressing with something less irritating to your skin.
  • It is normal to experience pain in the chest after surgery. This normally subsides over the course of a few days. You may also experience some intermittent sharp, burning or stabbing pains – this is usually caused by nerve irritation (neuralgia) and will take several weeks to resolve. If severe, contact Dr Tehs rooms and you may be prescribed medications to help with this.
  • Numbness around the breast and nipple is universal after surgery. Recovery takes several weeks but may not be complete in some cases.

What should my activity level be?

• • Avoid staying in bed for prolonged periods. This will help to reduce swelling and lowers the chance of blood clots (deep vein thromboses or pulmonary embolus).
  • You may use your arms for light activities of daily living for the first three weeks, but do not do any overhead activity until 3 weeks post-op.
  • Do not drive for 3-4 weeks. When your chest is sufficiently healed and symptom free to allow for sudden braking, you may resume driving. Also do not drive while taking narcotic pain medications which may be sedating.
  • Time off work will vary depending on your work requirements. Discuss time off work with Dr Teh but generally most patients will not return to work for 2-3 weeks unless they are performing purely home-based office duties
  • NO swimming, heavy lifting, upper body work or exercises like Pilates and Yoga for 8 weeks.  During this time, you will be limited only to light walking/cycling. 
  • Even heavier activities like horse riding (more than a canter), bungie jumping, mountain climbing or gymnastics should be avoided for 12 weeks.
  • You should avoid sexual activity for 3 weeks. Heavy handling of the breasts should be avoided for 8 weeks.
  • After the 6 week mark, you can wear your normal bras including those with underwire. Should the underwire or any bra rub or irritate the scar, then it is best to avoid wearing that particular bra until the scar becomes less sensitive. Continued irritation of any surgical scar may lead to the scar thickening.

How do I take care of my incisions?

• • After surgery (first 2 weeks):
    1. Keep your dressings intact.
    2. Reasons to change the dressing early is if you develop an irritation/allergy to the dressing, the dressing is peeling off or if the dressing has become soiled. In these cases, please remove the tape and contact the practice.
    3. Dr Teh will use a waterproofing glue and waterproof dressing to seal the wound after surgery. You will be able to have a shower the same night after surgery, if not the next day. Avoid soaking the wound like in a bath, spa or pool.
    4. The dressing will come off at week 2 when the sutures will be trimmed
  • After suture removal (weeks 2-8):
    1. Keep the scar taped for a further 2 weeks if you can tolerate the adhesives. We generally use a breathable tape at this stage (ie Fixomul/Hyperfix),
    2. After the taping period, we recommend the use of a scar therapy gel  like Stratoderm. Apply a thin layer of the gel to the scar with gentle massage twice a day for at least 6 weeks.
    3. Should the scar thicken despite scar therapy, please contact Dr Tehs rooms.
  • Long term scar management (>2 months):
    1. Avoid exposing scars to sun for at least one year and always use a strong sunblock if sun exposure is unavoidable.
    2. Scars can sometimes suddenly thicken months after surgery (ie keloid scars). Please contact Dr Tehs rooms if this occurs as early treatment can arrest further scar progression.
    3. Avoid wearing clothing that rubs, chafes or irritates the scar in any way to reduce the risk of an adverse scar.
    4. For more information on  general wound care, click here.

What will it look like?

• • The newly augmented breast will be swollen after surgery and will look larger than its final size. Swelling will subside over the course of 6 weeks and during this time the implant will appear as if it has dropped.
  • Expect a degree of bruising which will tend to be worse in the more dependant areas of the breast (ie lower and outer parts of the breast).
  • The majority of swelling will subside in 3-4 weeks, but some swelling may persist for up to 3 months.

What follow-up care will I receive?

• • Your 1st post-operative visit will be scheduled approximately 14 days after surgery, sutures will be removed during this visit. Please phone Dr Teh’s Secretary to schedule a post-op appointment when you are discharged from hospital if you do not already have one scheduled.
  • Your 2nd post-operative visit will be scheduled 6 weeks after surgery. A scar check is perfomed and post operative photos are taken at this visit.
  • a final visit 6 months after surgery. 

When should I call Dr Teh?

• • If swelling and redness persists after a few days.
  • If you develop increased redness along the incisions.
  • If you have severe or increased pain not relieved by medication.
  • If you have any side effects to medications, such as, rash, nausea, headache, vomiting.
  • If you have an oral temperature over 38 degrees.
  • If you have any yellowish or greenish drainage from the incisions or notice a foul odour.
  • If you have bleeding from the incisions that does not stop with light pressure.

What should I look for in the long term?

Breast implants may last a very long time in some patients, but they are not designed to last a lifetime. The longer you have implants, the more likely they will develop a problem requiring them to be removed. In general, expect them to require an exchange every 10 or so years. Reasons for this include:

1. 1. Increasing pain and hardness in the breast may indicate capsular contracture. Contact the rooms for an appointment.
   2. Sudden increase in breast swelling is a concern. Causes include chronic seroma, secondary bleeding, infection and anaplastic large cell lymphoma. Contact the rooms for an urgent appointment.
   3. You should monitor your breasts regularly while you have implants. If you notice any abnormal changes in your breasts, you should contact the rooms as soon as possible. You will still need to have regular breast mammograms/US/MRI as per the national guidelines for breast cancer screening. You should inform the radiographer that you have breast augments prior to the scan.
   4. Rippling may be visible or/and palpable. The risk increases with size and age of the implant. Implant malrotation may occur with teardrop(anatomic) implants. While these issues are not a major risk to your health or the implant, do contact the rooms for an appointment should it become bothersome.
   5. Implant rupture may be subclinical but a large tear may alter the shape of the implant. If you suspect a tear, contact the rooms to have an ultrasound or MRI to confirm this. A ruptured implant should not be left inside the breast for too long a period as the silicone may migrate to the breast tissue or lymph nodes in the armpit/axilla.
   6. Since the 1960s, there has been a reported link between silicone and autoimmune disease. This syndrome is now termed Breast Implant Illness and symptoms include fatigue, chest pain, hair loss, headaches, chills, photosensitivity, chronic pain, joint aches, rash, body odour, anxiety, brain fog, sleep disturbance, depression, neurologic issues and hormonal issues. It remains a poorly defined entity with no definitive cause as the studies have been hampered by poor design, confounding factors or find no evidence.  Consequently, the debate continues as to whether or not the link is one of cause or effect. More recently, there is some evidence that Breast Implant Illness may be related to a subclinical infection of the breast implants. Contact the rooms for an appointment.
   7. Even if there are no issues with the implants, you should consider having an ultrasound to check on them every 4 years (beginning 2 years after surgery) for the first 10 years and then every 1-2 years after that.
   8. Over time, you may wish to replace the implant for a different size or to have them removed and not replaced. If not replaced, you may see changes to your breasts after the surgery such as increased skin laxity (which presents as ptosis/drooping or wrinkling), breast tissue loss (puckering, dimpling) or other undesirable cosmetic changes. Contact the rooms for an appointment to discuss this further.

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