Discharge instructions after Abdominoplasty

**please also read preoperative preparations**

When will I be discharged?

• Most patients will be ready for home after 1-3 nights stay in hospital. This will be dependent on how well you are mobilizing, your pain control and whether all the surgical drains have been removed.
• Dr Teh generally will keep you in hospital until all drains are out but in some cases, you can be discharged home with a drain. In some of the larger hospitals (ie SJOG), a nurse from the hospital will check on the drain daily when you are home. They will have given parameters are to when the drains are to be removed. In other hospitals, care instructions will be given to you about the drains and you will be instructed to return to Dr Tehs rooms to have the drains removed.
• You may have a urinary catheter when you wake up and this is removed once you are moving around well enough to get to the toilet.

What are my discharge instructions?

• Have someone drive you home after surgery and help you at home for a minimum of 2-3 days. If you normally reside more than 2 hours drive outside of Perth metropolitan area, you will generally be advised to stay in Perth for the first week after discharge.
• The abdominal supportive garment that you would have bought into hospital should be fitted before you go home. If its uncomfortable to wear it in bed, it can be loosened whilst in bed but the garment must be worn when you are mobilising. Make sure your garment is fitting well and that the garment doesn’t ride high such that it pushes up against the breast especially if you have also had breast surgery,
• You will need to wear the garment whilst up and about for 6 weeks after the surgery.
• Avoid sleeping on your side or tummy during this period. Prop you head up on a few pillows so you don’t lie flat. Some will find it easier to sleep on recliner couches, which is also easier to get out of than from a bed.
• If you need to cough, use a pillow to hug and support your tummy as you cough.
• 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.
• You may need to take laxatives to help soften the stools as you should avoid having to strain for the first 6 weeks.
• 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 abdomen 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 lower abdomen is universal after surgery. Recovery takes several weeks but will not be complete in most cases (ie there will be some long term residual numbness),

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).
• Immediately after surgery, you might need to walk a bit hunched in order to not pull on the abdominal closure but we would encourage you to begin straightening up over the course of the ensuing week. 
• You may perform light activities of daily living for the first three weeks, but do not do any lifting until 3 weeks post-op. 
• You can begin gentle lifting (up to 5 kg) from week 3-6 and from week 6-12, gradually increase the weights so that you are lifting normally by week 12.
• NO  heavy lifting, core body work or exercises like Pilates and Yoga for 12 weeks.  During this time, you will be limited only to light walking/cycling. 

• Do not drive for 3-4 weeks. When your abdomen 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 3-4 weeks unless they are performing purely home-based office duties
• You should avoid sexual activity for 6 weeks. 
• After the 6 week mark, you can stop using the abdominal garment but some patients will wear it for longer if they find that it helps to reduce the swelling. Should any clothing rub or irritate the scar, then it is best to avoid wearing that particular item 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. Sometimes a vacuum sealed dressing (Prevena) is used. 
  4. You will be able to have a shower the same night after surgery, if not the next day. Avoid soaking the dressing like in a bath, spa or pool.
  5. The dressing will come off at week 2 when the sutures will be trimmed.
  6. Ensure that the abdominal binder is fitting well and not irritating the scar or pushing up on the breasts.
• 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 can I expect?

• Maximum discomfort will occur the first few days following surgery. Most patients complain of a generalised tightness in the abdomen. Some will experience a more sharp and stabbing pain. This may indicate nerve related pain (neuralgia) and can be treated if troublesome with medications (ie Lyrica).
• Some oozing from the wounds can be expected during this period. Over time, some dissolvable sutures may extrude through the wound edge. These usually have a pimple like appearance which then bursts to extrude suture material.

What will it look like?

• Expect a degree of bruising which will tend to be worse in the more dependant areas of the abdomen(ie pubis and lateral flanks)
• 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 somewhere between 4-6 weeks from the initial surgery date.

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 is difficult to control with light pressure