The Post-Operative Period

It is necessary that a responsible adult escort be available to transport the patient to and from the operation, and be available for the first 24 hours. During that time, the caretaker person will assist the patient in getting up to the bathroom, taking medications, and eating and drinking. It is best to stay in bed for the first 12 – 18 hours following surgery, and to limit intake to liquids.

You need to anticipate some discomfort until the blood level of the narcotic pain medication reaches a therapeutic threshold. This usually takes a double dose of the pain pills for the first 2 to 3 doses, after which a single dose is sufficient to maintain control of the pain. Antibiotics are continued for 7 days after the procedure to lower the risk of infection. Activity should be restricted to no lifting, pushing, pulling or driving for 48 hours. It is not advisable to drive a motor vehicle until one is completely off of narcotic pain medication and there is no restriction of upper extremity mobility, such as may be required in an avoidance maneuver with a car. A sports bra is left in place until the first post-op visit, and the breasts must be kept dry. You will go home with a small, portable pain pump that provides numbing medication into the chest area. A small amount of oozing at the incision sites and pain pump insertion site is to be expected. The breasts should not be manipulated in any way. One should be up and walking on the morning following surgery, and a light solid diet begun to the point of tolerance.

Certain events should be reported to the office immediately. A temperature over 99.5 degrees, chills or sweats, a markedly different degree of swelling between sides, and/or increasing rather than decreasing pain.

Patients are seen 3-4 days after the operation and their bandages and pain pump are removed and the healing assessed. After removal of the compressive bra, Dr. Parson will ask you to wear only a sports bra for a few weeks, or will provide you with a garment that maintains your implants in a desirable location. Bras with under-wires are not desirable as these may push the implants upward, creating an unnatural appearance. After this first follow-up visit Dr. Parson may ask you to gently massage your breasts several times a day. Patients are then allowed to bathe and to wash their hair. Showering is then permitted but the incisions should not be submerged, as in a tub or pool for 2 weeks following surgery. Most patients can resume a reasonably normal activity pattern and non-exertional type job situations within 7 days after surgery.

Risks of Breast Mastopexy and Augmentation

1. Bleeding (hematoma formation) – Unexpected, significant bleeding into the space around the implant can occur in this operation, although it is unusual. Large collections of blood around the implant require a return to the operating room for removal. Not doing so would produce an abnormal shape to the breast and a potential for hardening in the future.
2. Infection – Some of the tissues of the breast normally contain bacteria and are likely to come in contact with the implant during augmentation surgery. All of our patients are placed on antibiotics during surgery and for several days afterwards. The risk of infection is less than 1%.
3. Loss of nipple sensation – Most patients have some change in nipple sensation following augmentation surgery. The change may either be increased or decreased sensation and lasts several weeks. Nevertheless, the change is usually temporary. Permanent loss of sensation is unusual.
4. Malposition of implants – Every effort is made to make the breasts appear as symmetrical as possible. This requires fine adjustments in implant placement. On occasion, a second procedure is required to achieve satisfactory symmetry.

There is usually some difference in the size of breasts normally, and this is almost never perfectly correctable. There are fairly lengthy skin incisions that require a period of up to a year or two for completion of the scarring process for optimal appearance. In some ethnic skin types, scarring can be more prominent, and may require further treatment. It is important to realize, however, that the incision lines will be permanently visible. It normally takes approximately 6 to 8 weeks for all of the initial swelling to subside, and it takes 1 to 2 years for the scars to mature and fade. The doctor will discuss your particular scarring potential in more detail at the time of your consultation.

Long-Term Complications

1. Capsular contracture (hardening of the breasts by the presence of scar compressing the implant) – Every individual forms some scar around the implant. This is a normal response of the immune system to a foreign body. For not completely understood reasons, some individuals form thicker scars than others. A thick scar may distort the breast and even cause discomfort. The incidence of this problem is approximately 10%. When treatment is warranted, the scar is incised or removed and the implant is replaced.
2. Interference with mammography – Implants interfere with the ability to image the breast by mammography to a variable extent. Implants placed behind the pectoralis muscle allow the breast to be imaged more effectively by a method called the Eklund Technique. Using this technique, the presence of implants does not represent a statistically significant risk to patient of missing an early breast cancer.
3. Deflation/Rupture – The incidence of implant leakage is approximately 2% per year. Today’s implants are better than a decade ago, and so it is difficult to accurately predict what the true leakage rate is. It may actually be lower. In the event of implant deflation, saline (the solution of which 70% of our bodies are made up of) leaks into the surrounding tissues and is absorbed.With silicone implants, you may have what is called a “silent rupture.”Serial MRIs may be warranted every few years after surgery to help detect a rupture.A relatively brief, simple surgical procedure is required to remove the old implant and replace with another. With the warranty, implant manufacturers cover the cost of implant replacement for up to 10 years and assist with the cost of surgery as well.
4. Interference with breast-feeding. This complication is extremely rare. It is possible to divide the ducts that empty the breast gland and thus interfere with lactation. Additionally, the breasts may be too uncomfortable when engorged, and so lactation may be hindered in this way.
5. Visible rippling -Individuals with small breasts that have had a large augmentation can be at risk for visible rippling of the overlying skin. This problem is much more common with textured implants and those placed above the pectoralis muscle.Silicone implants have been found to decrease this complication as well.

At the conclusion of your procedure, you will be placed into a sports bra over tape and gauze dressings. The breasts become bruised, swollen, and tender for a week or so, but the pain should not be severe, and is usually well controlled with the pain medication that is prescribed. After 3 or 4 days, the dressings are removed and the incisions are checked to ensure that there are no problems or complications such as infection. You will then be able to shower. You will be asked to wear a bra for 3 to 4 weeks for support of the incisions during the early stages of wound healing. Though the skin of the breast may feel numb for a while, usually the feeling returns in 6 to 8 weeks.