Recovery

What to Expect

“The better your surgeon performs and the better you follow instructions, the more rapidly you will recover. Over 90 percent of our patients are able to be out to dinner the evening of their augmentation, and 96 percent return to full, normal activities within 24 hours.1”

Your recovery experience is the best indicator of the amount of tissue trauma and bleeding that occurred during your surgery.

Recovering from an augmentation is different from preparing for it. During preparation, there were many things that you could actively do to change the course of events. During recovery, your body does most of the work automatically, provided you don’t expect everything to happen quickly and provided you don’t tamper with the autopilot! If you understand what’s normal, what to expect, and some of the reasons behind the dos and don’ts, the recovery process will be smoother.

Recovery is a team effort and depends on two key factors: what the surgeon does during the operation and how well you follow the surgeon’s instructions postoperatively.

  1. The better your surgeon performs, the less the trauma to your tissues, and the less bleeding during surgery, and
  2. The better you follow instructions following your augmentation, the more rapidly you should recover.

Recovery Is Variable

Is recovery similar from patient to patient? The answer varies from patient to patient and from surgeon to surgeon. If you understand some of the reasons for variations in recovery, the whole process should be easier.

Patient Variations

Your body and your breast tissues are different from other women’s. The tighter your breast skin envelope and the more surgical manipulation required, the more tightness and tenderness you can expect following surgery. Everyone has some tightness and tenderness, but the amount varies according to what’s required of your tissues. Generally, if you’ve had children prior to your augmentation, your tissues have been previously stretched, and you’ll feel less tightness for a shorter time. If your skin is very tight and has never been stretched by pregnancy, you’ll feel tighter longer.

Some patients are more tolerant of discomfort than others. Some patients are better able to get moving after surgery despite discomfort. Some patients follow instructions better than others.

Your individual pain tolerance, motivation, and ability to follow instructions will affect your recovery.

Adopt a positive attitude, follow instructions, get moving early and get well sooner!

Surgeon Variations

A surgeon can’t change what you bring the surgeon to work with. But how the surgeon works with what you bring can significantly affect your recovery. The less surgical trauma the surgeon causes to your tissues, the easier and shorter your recovery.1 The less bleeding the surgeon causes while creating the pocket for your implant, the easier and shorter your recovery. Hopefully, you learned from chapter 8 how to ask the right questions about recovery before surgery to help select a surgeon who minimizes surgical trauma.

In the previous edition of our book, we told you that if your tissues are thin and submuscular placement of the implant was necessary for adequate tissue coverage of your implant, you’ll have more tenderness compared to patients whose implants are placed over the muscle. With new, dual plane2 and 24-hour recovery1 techniques that we have published, you can experience the same 24-hour recovery whether your implant is over or under muscle.

With optimal techniques and instruments, today there is no difference in pain or recovery if your implants are placed submuscular or submammary.2

Even if you choose a surgeon whose techniques still cause more post-operative discomfort if your implant is under muscle, this is a short-term inconvenience for long-term protection against seeing edges of your implant and possibly a greater risk of capsular contracture. If your surgeon used blunt dissection techniques, you can expect more tenderness and the possible inconvenience of drain tubes for a few days.

The easier your surgeon expects your recovery to be, the shorter the list of postoperative instructions.

The more the surgeon can do in the operating room, the less you’ll be burdened with after surgery.

Surgeons’ postoperative instructions vary a lot. The most important thing to remember is to follow your surgeon’s instructions! A surgeon knows what is done in the operating room and because of that, what needs to be done or not done after surgery.

Don’t try to outthink your surgeon! Follow your surgeon’s instructions.

And don’t follow your friend’s postoperative instructions if she had a different surgeon.

If you personally know other patients who have had breast augmentations, especially subpectoral breast augmentations, one of your greatest difficulties will be in believing that 24-hour return to normal activities is even remotely possible. We assure you that this rapid return to normal activities is possible whether your implants are over or under the pectoralis muscle.

If you talk to several women who’ve had breast augmentation, you’ll find a tremendous amount of variation in their recovery experiences. If your surgeon is giving you instructions that sound a lot simpler than what you’ve heard, be grateful! Your surgeon is probably doing a lot of things in the operating room that allow you to have an easier and shorter recovery. If you hear from another patient that you shouldn’t lift your arms, lift your child, or drive your car, and your surgeon is telling you it’s okay to do all these things immediately, go for it! Your surgeon just made your life easier. On the other hand, if your surgeon tells you not to do these things, the surgeon probably has reasons. Always follow instructions.

Your Surgeon’s Staff

Your surgeon’s staff is an extension of your surgeon. The goal is to help you get better sooner, so it’s important to follow the staff’s advice and instructions. When a person calls to check on you, listen carefully to that person’s questions and instructions. The information you convey will help the staff make the best recommendations to speed your recovery. The more knowledgeable the surgeon’s staff, the better they can help answer your questions and give you optimal advice. If you’re in doubt about anything after speaking with staff, ask to speak directly with your surgeon or ask for an appointment to see your surgeon.

The Most Important Do’S

The following is a checklist of the most important do’s that apply to almost all postoperative augmentation patients:

  • Follow your surgeon’s instructions to the letter. Don’t try to outthink your surgeon
  • Stay hydrated. Drink plenty of fluids for the first few days after surgery.
  • Eat. And eat well. You need nutrition to heal.
  • Never take any pain medication on an empty stomach.
  • Resume normal activity as soon as possible, following your surgeon’s instructions.
  • Read your postoperative instruction sheets. They’ll help you expect what’s normal.
  • Expect to be frustrated that your tissues don’t change rapidly according to your schedule.
  • Expect to be too big, too high, and too tight for a few weeks.
  • Expect differences and constant changes in size and shape of your breasts for three to six weeks. Expect to feel bloated and heavier for a few days. You were given fluids during surgery that will increase your weight (sometimes by several pounds), make you feel tight and bloated in some instances, and may make you feel full in the lower ribs and upper abdomen areas. Don’t worry. Within 24-72 hours, most of it all comes off as urine.
  • Get out of the house and do something. Staring at your breasts does not reduce swelling and tightness.
  • Don’t expect shape changes to occur quickly. We don’t make any judgments about shape for at least three months.
  • Remember that two breasts never match and that no surgeon can make them match.
  • If anything seems wrong, check your written instructions and information, then call your surgeon!

The Most Important Don’Ts

Your surgeon may give you a longer list of things to avoid, but the following is a basic checklist of don’ts that we use following augmentation:

  • Avoid any type of aerobic or other activities or anything that causes a significant increase in your pulse for two weeks. Walking is okay; running is not. Sex is okay, but Olympic sex is not!
  • Don’t lift heavy objects (over 30–40 lbs) or strain hard for two weeks.
  • Don’t take too many pain pills. Pain pills can nauseate and constipate you.
  • Avoid whatever else your surgeon tells you to avoid.

Pain Medications—Relief Versus Recovery

Pain medications are a two-edged sword. the less you need, the better.

They’re necessary for relief, but they can interfere with recovery.

Pain medications may relieve discomfort, but all narcotic-strength pain medications have side effects that can interfere with recovery. The stronger the pain medication, the more side effects, such as drowsiness, nausea, and constipation. One of the most important things you can do to get better is to get moving. The trick is to use enough pain medications to dull the discomfort at first. As soon as you get moving, things get better, and you’ll need less pain medication.

The three worst routine side effects of pain medications are drowsiness, nausea, and constipation.

If you’re sleepy, nauseated, and constipated, nothing’s going to get moving!

If you don’t get moving in the first 6-8 hours after surgery, your recovery will definitely be longer and more difficult.

“Get moving” doesn’t mean trying to be an Olympic woman. Just resume normal activities.

Any pain medication can cause nausea if you take it on an empty stomach. Nausea after taking pain medications is not an allergic reaction. It’s a side effect. The stronger the pain medication, the more likely it will cause nausea, especially if taken on an empty stomach.

Always put something in your stomach before taking pain medications: Crackers, toast, bagel—just something.

Pain medications can be extremely habit forming quickly. If you insist on stronger narcotic pain medications, you’re often creating a problem instead of solving one. Using 24-hour surgical techniques,1 narcotic strength pain medications are totally and completely unnecessary. Even without 24-hour techniques, you should not need any pain medications that are stronger than codeine or a codeine-equivalent drug. Over 96 percent of our augmentation patients1 receive nothing but 800 mg ibuprofen for pain, and the majority of them take it only for two or three days following surgery. At least 50 percent don’t take any pain medication after 48 hours. More than 3000 patients now prove that being out to dinner the evening of surgery and returning to full, normal activities is routinely predictable without any narcotic-strength pain medications. Patients who take narcotic-strength pain medications rarely, if ever, experience this rapid recovery because they are drowsy, do not mobilize in the first eight hours after surgery, become stiff and more uncomfortable, and have much more difficult recoveries. We know because before we developed 24-hour recovery techniques, our patients required stronger pain medications and experienced three-to ten-day return to normal activities. There are countless examples of 14 patients who have become addicted to stronger pain medications such as Demerol, Tylox, Percodan, or Valium after taking them for as little as seven days. Don’t be one of them.

What to Expect That’s Normal

If you know what to expect that’s normal, you’ll be less frightened or concerned.

If you’re more knowledgeable and less concerned, recovery is much easier.

When you get concerned about something, first consult the following checklist. Everything on this list is normal following augmentation, so expect it. And continue to expect it for at least six weeks after surgery. If it’s gone before then, you’ll be pleasantly surprised.

  • They don’t match! My breasts are a different size and shape!
    And they’re different every day!
  • They’re too high!
  • They’re too big!
  • They’re too tight and shiny.
  • They’re too swollen!
  • They’re too firm!
  • I hear sloshing inside my breasts.
  • They don’t move!
  • They’re numb or they’re too sensitive or I have weird sensations.
  • I can’t lie on them because they feel like basketballs! (96 percent of 627 of our patients were lying on their breasts the evening of surgery!1)
  • My waist has disappeared.
  • The magic time when they’ll feel like they belong to me is three months after surgery.

Remember, breasts never match. Your Creator didn’t make them match, and neither can your surgeon. Early after your surgery, one will always swell more than the other, adding to the difference. All of that is normal! Your breasts are supposed to feel too big, too tight, too firm, too swollen, and weird. Remember, yesterday you didn’t have this much inside your breast. Your skin envelope requires time to adapt and stretch, and until it does, you’ll feel strange and variable sensations. After surgery, with or without drain tubes, you’ll produce a little fluid inside the pocket around your implants. This fluid, combined with a small amount of air that stays in the pocket from surgery, can produce a sloshing sound that you may or may not hear for a week or two after surgery. Don’t worry. Your body will absorb all of this in a few days. As long as your skin is tight from being filled, your breasts won’t move normally. When the skin stretches, they will move.

The larger your implants or the tighter your skin envelope, the more stretch the implant will put on sensory nerves. When nerves are stretched, they usually do one of three things: go numb, get more sensitive, send weird sensations to your brain, or all three. Sensory changes are very variable and very unpredictable regardless of the surgical technique. Sensory changes can take a long time to resolve, as much as two years in rare cases. Most patients’ sensory changes are resolved by one year, but some take even longer. Other patients experience virtually no problems with sensation. It’s just very unpredictable. There is something magic about three months. At about three months, most of our patients feel their implants are a normal part of their body. They stop referring to “them” and start talking about “my breasts.” The reason that this time period is magic is because your tissues will require about three months to return to a more normal state that you don’t constantly notice as “different.”

There is something magic about three months. At about three months, most of our patients feel their implants are a normal part of their body. They stop referring to “them” and start talking about “my breasts.” The reason that this time period is magic is because your tissues will require about three months to return to a more normal state that you don’t constantly notice as “different.”

Remember the two things that you and your surgeon can’t control are capsular contracture and tissue stretch. Capsular formation and tightening of the capsule around the implant never occur the same in both breasts and neither does tissue stretch. Capsular tightening tends to tighten the lining around the implant, reducing the forces of the implant pushing downward that produce tissue stretch. A capsule forms around every breast implant, and the manner in which the capsule forms is always different from one breast to the other. Even if a capsule does not tighten excessively and cause a capsular contracture deformity, it will tighten slighty differently in one breast compared to the other, another reason why breasts never match on the two sides following augmentation. All of these factors happening differently in your two breasts over time assure that not only will your breasts never match, but how they don’t match will constantly change over time, especially in the first three months following your augmentation.

What’s Not Normal . . . Contact Your Surgeon

If you develop any of the following, you should contact your surgeon:

  • Fever higher than 102 degrees or fever with chills
  • One breast that is much, much larger than the other
  • One breast that appears much more bruised than the other
  • Noticeable redness and tenderness in any area of the breast
  • Any drainage from your incision area after three days
  • Any unusual discomfort
  • Any breathing problems
  • Any other symptoms that your surgeon advises you to call about

A Typical Recovery With Our Patients

The typical recovery of our augmentation patients has changed dramatically since we developed and published our methods that allow 24-hour return to normal activities1 and allow most patients to be out to dinner the evening of surgery. If someone had told us seven years ago that this type of recovery is possible, we categorically wouldn’t have believed them and probably would have questioned what substance might be producing their delusions. But the dramatic changes are real, are predictable, and are consistent. Dramatic improvement in our methods, techniques, and devices can truly impact the patient experience.

The following is a description of a routine recovery in our augmentation patients.

The Night of Surgery

You leave the surgery facility a bit drowsy but comfortable. You will already have raised your arms fully extended over your head several times before you leave the surgical facility. When you arrive home, make yourself comfortable on the couch or in bed but no more than a two hour nap! Get up, drink some liquids, and eat some crackers, a bagel, or something light. Take an ibuprofen pill, wait about twenty minutes, and get in a hot shower. Wash your breasts, and raise your arms and wash your hair. When you come out of the shower, you’ll feel much less stiff. Lift your arms, fully extended, above your head and touch the backs of your hands together, like performing a “jumping jack.” With your arms over your head, your upper arm biceps muscles should be touching your ears. Lower your arms and repeat four times for a set of five. Repeat this entire sequence, performing a set of five every hour before bedtime, and you’ll be amazed at how much easier the rest of your recovery will be! If you are out to dinner, do your arm a two hour nap! Get up, drink some liquids, and eat some crackers, a bagel, or something light. Take an ibuprofen pill, wait about twenty minutes, and get in a hot shower. Wash your breasts, and raise your arms and wash your hair. When you come out of the shower, you’ll feel much less stiff. Lift your arms, fully extended, above your head and touch the backs of your hands together, like performing a “jumping jack.” With your arms over your head, your upper arm biceps muscles should be touching your ears. Lower your arms and repeat four times for a set of five. Repeat this entire sequence, performing a set of five every hour before bedtime, and you’ll be amazed at how much easier the rest of your recovery will be! If you are out to dinner, do your arm raises as soon as you return home.

After you return home, don’t stay in bed or recumbent for more than two hours. Get up and perform normal activities or do minor housework. Go out for a brief walk, shopping, or out to dinner the night of surgery. (More than 90 percent of our patients are now out of the house doing these activities the evening of surgery.)

When you feel really hungry, provided you didn’t have nausea with lighter foods and drinks, eat whatever you’d like. Don’t pig out, but feel free to eat anything that sounds good.

Before you go to bed for the night, we want you to lie totally flat on your breasts. Yes, we know you don’t believe us, and yes, we know the thought frightens you, but yes, we want you to do it! Most patients report that when they first begin to put weight on the breasts, they are apprehensive, but as they apply more pressure to the breasts, apprehension and discomfort usually decrease significantly. Getting up is harder than getting down. Don’t attempt a push up; that stresses your pectoralis muscles. Instead, just roll to the side and sit up. If you find it difficult the first time, you can have someone help by placing their hands under your shoulders, but most patients can sit up without assistance the first or second attempt.

When you’re ready to go to sleep for the night, provided you’ve put food in your stomach, take one of your 800 mg ibuprofen tablets and enjoy your rest. If you awake during the night and have trouble going back to sleep, take one of your 50 mg Benedryl capsules, rearrange yourself to get comfortable, and try to go back to sleep without additional pain pills. Sometimes, hugging a pillow to your chest can make you feel more comfortable. If you want to slip into a soft bra or jog bra, feel free to try it. You can’t harm anything! Most of our patients are more comfortable without a bra, but you can treat your breasts as normal breasts. Wear or do not wear a bra according to your comfort.

The Morning after Surgery

When you awaken in the morning, you’ll feel stiff. That’s normal. Roll to your side and sit up to get out of bed. Relax in a comfortable chair or on the couch, and have a light breakfast of whatever you like. As soon as you get something in your stomach, take one pain pill, and enjoy the rest of your breakfast. When you feel the pain pill taking effect (you’ll feel less stiff with less discomfort), get into a very warm shower and let the water run over your shoulders, chest, and breasts for five to ten minutes. Then, gradually lift your arms above your head and you’ll loosen up just as you did the night before. When you leave the shower, repeat your arm raising exercises. You won’t believe how much better you’ll feel after getting your arms moving. Expect to feel some tightness at first. That’s normal.

If you’re feeling good, it’s fine to go out to shop, to a movie, or anything else you’d like to do. Don’t plan a whole day of anything. You’ll get tired easily for the first two or three days, so plan to do something, but then midafternoon, come home and relax. There’s no reason you can’t drive as soon as you feel like it. Most of our patients drive within the first 24 hours, the morning after their surgery. Never drive if you’re taking any narcotic-type pain pills.

While we’re on the subject of pain pills, you should be awarebut then midafternoon, come home and relax. There’s no reason you can’t drive as soon as you feel like it. Most of our patients drive within the first 24 hours, the morning after their surgery. Never drive if you’re taking any narcotic-type pain pills.

While we’re on the subject of pain pills, you should be aware that some surgeons do not recommend Advil or other forms of ibuprofen because they feel that these medications can interfere with normal blood-clotting mechanisms. Over the past ten years, we have used Advil and other forms of ibuprofen in over 2,500 patients, have had no increased rates of bleeding, and find these medications invaluable in shortening recovery and avoiding the side effects and addiction potential of stronger medications. Although we have tried other types of medications that are chemically similar to ibuprofen with supposedly less risk of causing bleeding, none of these medications so far have been as effective as ibuprofen, and our studies confirm that the doses that we are using have not caused any excessive bleeding.2,3,4

As soon as you feel like picking up normal weight objects or your small children, do it! Most of our patients with small children are able to pick them up by the day following surgery. Again, you won’t hurt anything by picking up normal weight objects. Just avoid heavy objects and straining.

Be sure to drink plenty of liquids to avoid constipation. Remember, we want everything moving.

The First Two Days Following Surgery

Don’t be surprised if you feel bloated. You received fluids during surgery, and you’ll accumulate some swelling around your breasts and chest. As this swelling gravitates downward, you’ll begin to feel that your waist is getting bigger. Don’t panic! All this will resolve, and you’ll go to the bathroom more often over the next two to four days.

The first two days following surgery are filled with the most nuisances and discomfort.

Immediately try to get back into most of your normal activities. The sooner, the better! Just plan your days to allow for some rest if you get tired in the afternoons.

The First Three Weeks bq. Listen to your body when it comes to all activity. If something is too stressful, stop and try it again tomorrow.

Your body will tell you what you need to know if you’ll just listen. That doesn’t mean to stop everything at the least sign of discomfort. Go ahead and move. But if something hurts, back off! Try again tomorrow or the next day. Whenever you’re comfortable, sex is fine. You probably won’t be overly amorous if someone puts too much pressure on your breasts the first few days, but there are ways around too much pressure. Your significant other may require a bit of coaching and understanding at first. Be creative when you feel like it, but save Olympic-level sex for a week or two after surgery.

During the first three weeks, your breasts will feel very tight. For most patients, the worst tightness is in the first three days, but this begins to decrease a lot after the first week. If your skin was very tight before surgery, expect the tightness to take longer to resolve. You’ll get used to it more after three or four days, and it won’t constantly occupy your mind after the first week. By three weeks, you’ll notice some tightness, but you won’t think about it much.

If you heard some sloshing in your breasts, that will usually be gone in three weeks or less. Numbness, excessive sensitivity, and strange feelings (like pin pricks or electric shocks) are all normal. Most of these sensory changes won’t disappear in the first three weeks. They take much longer to return to normal. Don’t make any judgements about sensation for at least six months to one year because sensation will continue to change and improve. mind after the first week. By three weeks, you’ll notice some tightness, but you won’t think about it much. If you heard some sloshing in your breasts, that will usually be gone in three weeks or less. Numbness, excessive sensitivity, and strange feelings (like pin pricks or electric shocks) are all normal. Most of these sensory changes won’t disappear in the first three weeks. They take much longer to return to normal. Don’t make any judgements about sensation for at least six months to one year because sensation will continue to change and improve.

Wearing a bra is totally up to you. If you’re more comfortable in a bra (any type), wear it. If you want to create a certain look, wear it. If you’re more comfortable out of a bra, don’t wear one. Despite anything you might hear, a bra should not affect the results of your surgery using techniques we have published.2 We’ve used this regimen in over 2,500 patients and have found that you know better about what makes you comfortable than anyone else.

By the end of three weeks, most of the worst nuisances are over, but your breasts still won’t feel like they really belong to you.

After three weeks, start thinking three months.

The First Three Months

Most of the time during the first three months you’ll refer to your breasts as “them.” They simply won’t feel like they belong to you. There are things inside your breasts. After the first three weeks, the skin begins to relax faster, but you don’t notice day by day. As the skin relaxes, the excessive upper fullness begins to decrease, provided you haven’t selected an excessively large implant for your tissue characteristics. The implants aren’t really “dropping,” but they appear to be. What’s really happening? As the lower skin stretches, it’s not pushing back against the implant as hard between the nipple and the fold under your breast. As pressure on the lower implant decreases, the filler inside the implant is not pushed upwards as much by pressure of the tight lower skin, and the filler redistributes into the lower part of the implant and the breast. As upper fullness decreases some, you may feel that your breasts are getting smaller. They’re not, but you may think so because most of the time you’re looking down at them. Check out a side view in the mirror. You’ll see that you’re gradually getting more fullness in the lower breast. This progression happens in every augmentation patient and more in some than others. Expect it, and don’t worry that your breasts are getting smaller.

Suddenly shopping is a lot more fun! Although your breasts will continue to change during the first three months, it’s a totally new experience to go shopping, wear anything you want, and look fabulous. Different patients feel comfortable shopping at different times, but when you feel like it, do it.

A patient gave us a great description of how augmented breasts feel during the first three months. She said that “they are like trying to dial a phone with false fingernails. They just feel weird until you get used to them.” That’s what over 90 percent of patients tell us. They’re not painful. You just notice them. Toward the end of the three-month period, you’ll begin to notice them less, and one day, all of a sudden, you don’t notice them at all. They’re just part of you.

The Years That Follow

Once you no longer notice your breast implants, you’ll almost totally forget them... provided you don’t develop capsular contracture and provided you have made wise choices about implant size.

Once your tissues heal and adapt to your implants, your breasts will no longer seem foreign to you. You incorporate the new you into your body image automatically. Your breasts are just your breasts. The implants are no longer an issue, and they usually don’t even cross your mind.

If you escape the low risk of capsular contracture, and you’ll usually know by the first six months to one year, your breasts won’t change much, and they will seem totally normal. If you made good choices about implant size, your breasts will mature at about the same rate as a normal breast the same size. You may develop slightly more sagging over time, just as any normal, larger breast does with aging, but your breast looks a lot better while it is aging. The larger the implant you selected and the thinner your tissues, the more sagging and thinning of your tissues you can expect with time.

And the Last Step

After recovery, you’ll enjoy living with your new breasts. In the next chapter, we’ll discuss living with your breast implants and the care and maintenance of the best breast.

Chapter 15 »

References

1 Tebbetts, J. B. Achieving a predictable 24-hour return to normal activities after breast augmentation. Part II: Patient preparation, refined surgical techniques and instrumentation. Plast. Reconstr. Surg. 109: 293-305, 2002.

2 Tebbetts, J. B. Dual plane (DP) breast augmentation: Optimizing implant-soft tissue relationships in a wide range of breast types. Plast. Reconstr. Surg. 107: 1255, 2001.

3 Tebbetts, J. B., and Adams, W. P. Five critical decisions in breast augmentation using 5 measurements in 5 minutes: The high five system. Plast. Reconstr. Surg. 116(7), 2005.

4 Tebbetts, J. B. Achieving a zero percent reoperation rate at 3 years in a 50 consecutive case augmentation mammaplasty PMA study. Plast. Reconstr. Surg. 108(6): 1452-1457, 2006.

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