Breast Augmentation Pre-Op & Post-Op Information

Day of Surgery

You will be given a list of instructions to follow on the day of surgery at your pre op. Those instructions will include what to do, what to wear, what time to be here, etc. Dr. McMenamin will be marking out the “pocket” for the implants on your chest and taking final photographs. You will be taken to the operating room where you will meet the anesthesiologist. He will ask you some general health questions. An intravenous line (IV) will be inserted and monitors for blood pressure, pulse, oxygen saturation, and carbon dioxide levels will be hooked up to you the same as for major surgery in a hospital.

The anesthesiologist will administer IV medication for deep sedation. (This is not general anesthesia requiring assisted breathing or intubation.) You will pleasantly drift off to sleep and stay asleep until the procedure is over. Most patients have very little discomfort on waking, but do often describe a tight, heavy feeling on the chest much like the feeling women have after childbirth when their milk "comes in.” Steri-strips will be applied to the incision sites and a comfortable bra that we supply will be put on you. An absorptive dressing will be applied over the incision sites and a roll of gauze may be placed under the bra over the sternum (breast bone).

Written post op instructions and medications will be given to you along with Dr. McMenamin’s home phone number. He or an office staff member will be calling you daily in the early post op period to check on your status and answer your questions. You are urged to call him in the event of an emergency.

Recovery from Breast Augmentation

You are required to have a driver to take you home from surgery and to drive you to and from your post op visit the next day. You must also have a caregiver to help you in the first 24 hours and longer if you have small children. Most patients are able to drive themselves one week after surgery if they have a car with power steering. All post op patients are required to have a comfortable place to sit and sleep elevated for at least the first week. A recliner chair is highly recommended even if you have to rent or borrow one.

Be careful not to use your arms to pull yourself out of the chair. This type of upper body exertion can lead to bleeding. Along with staying elevated, you must apply ice packs at least 20 minutes out of every hour for 24 hours a day the first three days then for at least 20 minutes out of every hour for 12 hours a day for an additional three days (usually during daylight hours so you can get some needed sleep). This means you will be icing for six days total.

Lastly, you must severely limit your activity for the first week. Remember, you have had major surgery requiring diligent post op care. Those patients who have a sedentary type job (i.e., a desk job) can usually return to work after five to seven days. At the other extreme, those patients with strenuous jobs requiring heavy lifting, pushing, pulling, etc., should plan on taking two to three weeks off work.

Post op patients are also asked to abstain from "working out" and from submerging the breasts in water for one month. You will be counseled from one appointment to the next on what you can and can't do. If you have any question about that, don't do it until you have talked with the doctor. To repeat, you will have Dr. McMenamin’s home phone number in case of an emergency, and you will usually be called or seen by him or the P.A. on a daily basis in the initial recovery period.

You will be asked not to shower or wash your hair after surgery until 24 hours after your stitches have been removed. This includes not taking a bath. Warm water can cause blood vessels to vasodilate (open up). That is what causes your legs to turn pink in the bathtub. Vasodilatation of blood vessels increases your risk for bleeding. Therefore, you are asked to sponge bathe only for the first week or so. After that, you may shower, but still not submerge your breasts.

Very rarely do any of our patients require narcotic pain medication (i.e., Darvocet) after surgery although it will be supplied to you. Local anesthetic on the chest wall and intravenous pain medication given to you at the time of surgery will keep you pretty comfortable for the first 8 - 12 hours or so. Staying elevated, icing, and keeping very quiet will help minimize swelling, bruising, and especially, pain. We do recommend that you take one to two Extra-Strength Tylenol (acetaminophen) every four to six hours even if you think you do not need them. This will help prevent the pain cascade from starting. Narcotic pain medications can cause nausea particularly if taken within the first 24 hours after surgery. They can also cause other unpleasant side effects. After 24 hours, if you are not acceptably comfortable, you may take Darvocet (Propoxyphene) for pain as long as it is taken with a meal. Do not continue to take them if you suffer from nausea, constipation, or other side effects. Do not take Tylenol and Darvocet together as Darvocet already has Tylenol in it.

You will be given antibiotics to take for 7 - 10 days after surgery. Post operative infections when a foreign body or prosthetic device (implant) is involved can be particularly serious. For that reason, antibiotics are given as a precaution. Please take them as directed and report any problems with taking them to the doctor such as nausea, change in bowel habits, muscle/tendon pain, or vaginal yeast infection. These side effects happen infrequently, but can cause considerable discomfort and should be addressed.

Follow-up and Long Term Care After Breast Augmentation

At your two-week post op visit, you will be shown how to do pocket expansion exercises on your new breasts. These exercises are very simple and take less than a minute out of your day. The purpose of these exercises is to physically put pressure on the pockets surrounding your implants to help keep them open and therefore help to prevent capsular (scar) contracture. Just as importantly, by doing the exercises you will be alerted to a contracture early on. We request that you do the pocket expansion exercises every day for as long as you have implants. This will be covered with you in more depth at your post op appointments.

The additional weight from breast implants causes more stress on your natural breast tissue and the overlying skin. To help preserve the look of your breasts after surgery, we request that on a day-to-day basis you wear a very good support bra. We recommend all women with implants wear a soft “sleep” bra on a regular basis. That is not to say you cannot wear fancy, skimpy lingerie for a special occasion. We recommend that you not buy any bras until after your two-week appointment. We will go over our bra recommendations with you at that time.

We ask our breast augmentation patients to abstain from any dental work, including cleaning, for 90 days after surgery except in a dental emergency. After that and for the first year after surgery, we ask that you take antibiotics before and after dental work, including cleaning. There have been studies that show a link between bacteria in the blood and capsular contracture (scar tissue formation) of the breast implant pocket, particularly during the healing phase. It takes approximately one year for the pocket to heal completely. Therefore, again as a precaution, we ask that you take a very short course of antibiotics. This will be explained in more detail to you and a handout will be provided regarding support bras, pocket exercises, and antibiotic use.

If you are doing fine at your two week post operative visit, we will not see you back for four to six months unless you have a question or problem. After that, we like to see you on a yearly basis for routine follow-up. You are urged to call if you suspect any problems and may make an appointment for evaluation. Your routine post operative care is included in your surgical fee. Our post operative patients will also not be charged for consultations regarding other cosmetic procedures.