Breast Surgery Recovery: What To Expect

Speaker 1 (00:03):
Welcome to Kind of Beautiful with board certified plastic surgeon Dr. Tracy Pfeifer, the podcast for women seeking the very best of modern beauty. 

Dr. Pfeifer (00:17):
Right after surgery, the patient is brought into the recovery room and we will have explained all of this to everybody ahead of time so that they're aware of it. So the patient wakes up in the recovery room, the breathing machine is removed, the patient's breathing on their own. But because there's a lot of um, medication used during the surgery, the patient's will usually have amnesia about this part of it and they won't remember waking up in the recovery room, in the operating room rather. So they will remember waking up in the recovery room and they'll see one of our nurse assistants in the recovery room with them. They'll have a blood pressure cuff on, they'll have a little clip on their finger to measure their oxygen level. They'll hear the monitors kind of dinging a little bit. That's all normal. And uh, you'll open your eyes and you'll see the face of our nurse there with you and you'll see the walls of the recovery room and the clock and everything. 

(01:11)
Usually the first thing the patient asks is, you know, what time is it, 'cause you've been sleeping and you have no idea what time it is. So for the patient, you'll go to sleep. It'll seem like it was two seconds. And let's say you go to sleep around 12 o'clock and it's, you know, you wake up at two o'clock, you'll say, we'll say, what time is it? Oh, it's two o'clock. I'll say, oh, it's two o'clock. I can't believe it feels like, you know, I just went to sleep. So it goes very quickly for the patient. They wake up very comfortable. That's one of the things we wanna make sure that they have really no discomfort. A lot of times we'll put ice compresses on the breast so that you'll wake up with a little cold feeling. It just helps you feel more comfortable. After the surgery and after you're a little bit awake, let's say 10, 15 minutes in the recovery room, we'll have your family member come in and take a peek and say hi. 

(01:58)
And everybody's happy that they see each other. And then about an hour after arriving in the recovery room, we'll get you up. You'll have a little something to eat, little something to drink, help you go into the bathroom, which is right next to the recovery room. So you can go to the bathroom and then we start helping you get dressed and make sure you feel okay, you don't have any nausea. And then we get you into the car. So usually between after surgery, about an hour and a half after surgery, you'll be in the car heading home with your, whoever's picking you up, whoever's your patient escort. After surgery, typically we'll see the patient about five to seven days later. So I'll see you in the office. Occasionally our physician assistant will see you post-op if I'm not available. And then I see you the week after that. 

(02:43)
But you'll see somebody usually within, um, five days after surgery. Patients love to look at their results. Sometimes I have patients look at their results in the recovery room. That's pretty typical actually after breast augmentation. But some people might, might not wanna look right away. So usually at their first office visit post operatively, we'll take the bra off just to check everything, make sure everything's healing okay. And they'll take a little peek and, and look down. And you know, it's always a fun experience to be with the patients. The first time they look and they love it. Post operatively, the body is gonna have its own flow. So for the first three days, it's initiating the healing process, which involves inflammation. So that results in swelling. So for the first three days, you're going to have increasing swelling. So day one, it's gonna be a little swollen. 

(03:33)
Day two, it's gonna be a little more swollen. Day three, a little bit more swollen, and it plateaus and it slowly dissipates over a three month period of time. So you'll see the swelling decreasing at 10 days, three weeks, six weeks, three months. So it's a rapid increase in the swelling and then a slower resolution of the swelling. During those first three days, you're also gonna be tired because healing takes a lot of energy and the body is healing like crazy those first three days. So there's not a lot of energy left over for other stuff. So you should be comfortable. On a scale of one to 10, you should be a two or three on the discomfort scale. Some of the medication that you're gonna take to keep you feeling comfortable, which includes muscle relaxers, Tylenol, sometimes a little narcotic. Medications are gonna make you feel a little tired also. 

(04:27)
So for the first three days, patients are typically hanging out at home, chatting with their friends. You could text, you could be on the phone, you can read a little bit, watch some movies, and then you're gonna be drowsy. You're gonna take a little nap. Starting around the fifth day, people will go out, they'll drive their car. You're not gonna do any exercising or any cardio type stuff, but you can go out and about and you're gonna notice that around four o'clock you're tired because the body is still healing and it's taking that energy and you're gonna hit a little wall where you're like, oh, you know, I felt fine, but now I'm exhausted. And that's just normal. You just have to go home and rest. You know, don't push it. So most people after breast augmentation will take off a week from work. If you're working from home, you can often on post-op day, I would say between four and five, do a couple hours work from home, understanding that around four o'clock you're gonna be a little tired, you're gonna need to stop the second week. 

(05:30)
Most people will return to work full-time, whether they're working at home or in the office. For example, a city patient, she comes into work. Let's say she takes a subway. When she comes to work the second week, I'm gonna ask her to take an Uber because she's not gonna wanna be on the subway with people bustling and maybe jostling her and bumping into her. At the end of the day, they're gonna go home, have a dinner, you know, early dinner, go to bed early, get up the next day, the third week you'll start to feel a lot better. If you wanted to meet your friends for a cocktail or something like that after work, you'd be up to do it. There are some plastic surgeons who talk about, you know, a rapid recovery and the patients are going out that night. And I understand the philosophy of it, which is that we wanna do very gentle surgery, which we do do so that there's very little tissue trauma, very little inflammation or as little inflammation as possible post operatively. 

(06:29)
But to me, the idea that you can go out to dinner with your friends the night of surgery just doesn't make sense because your body needs to initiate that healing process and it, it takes energy. So pushing yourself like that I don't think really helps in the long run. What helps in the long run is, you know, careful dissection, gentle handling of the tissues, you know, very precise pocket development so that everything looks as beautiful as possible. And I, that's how we approach it and it works really well. You can't do any heavy exercising for a couple weeks. And again, this goes back to how the body heals. So I'm sure that some people have heard about the lymphatic system. The lymphatic system is part of our circulation that basically sucks up fluid that's in the tissue and circulates it around and puts it back into the bloodstream. 

(07:17)
So when you've had surgery, your lymphatics have basically been traumatized so they're not working properly. So you have swelling as part of healing. And the lymphatics haven't really recovered enough to start getting rid of that fluid that's in the tissues for a couple days after surgery. So if you're doing exercise that's vigorous and your heart rate is getting up, you're gonna have more swelling because more fluid's gonna accumulate in the tissue from the exercise. So if you start exercising too soon after surgery, the swelling's gonna be greater, the lymphatics can't absorb it and it's gonna take longer for the swelling to go down. And we're trying to get the swelling down. So you don't wanna exercise because A, you're gonna be too tired to do it. B, it's gonna deplete your energy and divert it away from healing, which is what we wanna happen first and foremost. 

(08:15)
And the third reason is because you're gonna increase the swelling and prolong how much swelling you have for a longer period of time. So you don't wanna do any cardio until we see that the swelling is really starting to decrease, which is the sign that lymphatics have recovered and they're starting to work. So most people after breast augmentation, I will tell them, no vigorous exercise for four weeks. If you feel like you wanna try something in the third week or the fourth week, just go for a walk. But don't push yourself. I tell people all the time, pretend you're the queen of England and you're strolling around, you're not racing around and pushing it. And if you do, the next day you'll see that you're swollen and you know you did too much. So usually around six weeks we can start doing some leg work or some core. 

(09:04)
We wanna avoid doing any arm exercises that involve the pectoralis muscle, whether it's under or over the muscle for at least six weeks. We really, really wanna wait. And if there's any question about it, we wait three months on arm exercises. And that's kind of typical. If it's underneath the muscle, we wait for three months to start doing arm exercises. And the whole time you're also wearing a support bra just to give you a feeling of security and safety so that you don't feel vulnerable with your, you know, your breast implants and your breasts are a little sensitive. So sports bra 24/7 after surgery for six weeks. After surgery, if people wanna resume, you know, sexual relations with their partner, I usually tell 'em, wait about three weeks. It might be a little soon at three weeks, but three weeks seems to be okay for most people after surgery. 

(09:57)
Some patients get creative even though we give them instructions about what to do and not to do. We had a patient who had sex, I would say 24 hours after surgery, which I do not recommend. And uh, we had to do some morning after pill type things for her. We've had patients exercise too soon and they are totally exhausted for about two or three days. Most people will not go in the water because they understand that that's not a good idea until that incision has really healed. But I would say the most common thing people do despite our advice, is to think that they're sort of superwoman and they can exercise and they can go back to work right away and, and then they come in and say, oh, you know, you told me not to do it. And I did it and I was so tired and I got really swollen so I stopped. 

(10:47)
And it's all better now, but nothing really exotic. Most patients are very careful about the incision and taking care of that and protecting it, which it heals 12 hours, it's closed. But they're aware that they don't wanna go into like a tub for an hour with that soaking underwater. You only wanna take showers. They know they shouldn't go in a pool, they, it's just intuitive. They know they shouldn't go in like a steam room or swimming in the ocean, but for some reason people think that they can uh, get away with exercising early after surgery and it never works. So don't do it. <laugh>, I love to talk to patients about the postoperative results and how long it's gonna take because it's different depending on the implant. So let's say you have a round smooth implant in place and people talk about the breast fluffing and they have different expressions for how it changes. 

(11:39)
But initially you'll have a lot of fullness in the top half of the breast and then due to the skin and the pocket opening up and relaxing a little bit in the lower half of the breast, the implant will drop down a little bit. That typically takes about three months. I don't advise any of my patients to do massage for any of their implants. Uh, some doctors do. The feeling is that if you are moving the implant around in the pocket and displacing it, that you're keeping the capsule a little bit larger than the implants. So theoretically you can't see capsular contracture. I don't advise that for my patients. Now if a patient has a textured surface device or they have a teardrop implant which has to be textured, those devices take longer to settle. So it's a much slower and I think controlled stretch of the skin, it's very gradual. 

(12:39)
So whereas a round smooth implant may look its best, or start to look its best, at three months. With a textured device, it'll also look better at three months. But particularly with a teardrop, it'll look even better at six months and nine months. A smooth implant will feel softer, quicker than a textured will. So that's always something to look out for too. And those are the main differences. So most people will be looking very good at three months. That's always improving. You know, you'll, like I said earlier, I think you'll see big differences at 10 days, six weeks, and then 12 weeks you'll see big improvements along that timeline. After surgery, we wanna make sure that the patient has really minimal to almost no discomfort. We don't like to use the word pain because we don't even wanna think that we're gonna have pain <laugh>. 

(13:40)
So we do a couple things after surgery. If the implant is underneath the muscle, the pectoralis major muscle because it's being manipulated, it's being lifted up a little bit, it's being stretched when the implant's underneath it, that muscle is gonna react by going into muscle spasm. So it's just the same thing as if you have a Charlie horse, you have a cramp in your leg, that cramp is gonna hurt. So we pretreat all of our patients with a muscle relaxer the morning of surgery. The patient takes two muscle relaxers. We use methocarbamol. Uh, one of the brand names is Robaxin and they take that the morning of surgery and then you take it on a schedule four times a day, breakfast, lunch, dinner, bedtime. So the preoperative dose is good because it's already in your bloodstream. So that muscle can't start having a spasm. 

(14:36)
And then you keep taking it so that the muscle stays relaxed. And we use this even if the implant is going to be on top of the muscle, because when we make the pocket on top of the muscle, we're right on top of it. And again, that stimulation from making pocket could cause the muscle to go into a spasm. And we wanna prevent that at the outset. So the patient is always gonna take their muscle relaxer, they're always gonna take Tylenol, which also relieves pain three times a day. And some patients will use Celebrex, which is an anti-inflammatory if they can tolerate an anti-inflammatory. And then patients are given a narcotic. We usually use Vicodin so that on the pain scale of one to 10, if you are taking your muscle relaxer and your Tylenol and you're a two or a three, that's good. If you start to become a three and a half, you wanna take a piece of your Vicodin. 

(15:35)
So maybe a third or a half because you can cut all these pills with a knife, just a little dose to get you back down to a two. And this works beautifully. Now some patients don't wanna take narcotics, which is fine. And in that case we use a non-narcotic pain regimen where we use Celebrex if they can tolerate Celebrex and gabapentin. So they would take those before surgery and then continue them on a schedule after surgery. And we have a nice little flow sheet that tells you exactly what to take and when to take it. And it's, it's very simple and straightforward. 

(16:10)
Yeah, recovery is usually a very comfortable process. I think the most important thing is for the patient to understand what it's gonna be like so that they realize what they're going through is normal. Of course, we call the patient every day, sometimes twice a day. The patient has my cell phone number, they have the cell phone number of my assistants so they can always reach us 24/7 if they're not sure what's going on. But I think the main thing is understanding what the process and flow is going to be like. The patients that have been worried about surgery in the past have been patients that have had surgery in another office and they were told pre-op, oh, you're gonna be fine. It's not a big deal, don't worry about it. And then, you know, they have what is normal, which is swelling. They have some discomfort and the patient automatically jumps to, you know, something's wrong, 'cause they told me like there wouldn't be any anything, you know, <laugh>. 

(17:06)
So if the patient knows what to expect and then it happens along that timeline, I mean, I can't tell you how many people tell us, oh, it was exactly what you told me was gonna happen. It was it, it all just flowed and it was exactly what you said it would be. Then they do. Well, if you kind of underplay what things are gonna be like, then patients naturally think that they're falling outside the norm and something's wrong. So I think preparing ahead of time, just understanding what the flow is gonna be is the best thing. And then close contact with them, especially during the first couple of days because they wanna make sure they're taking their medicine properly. Every patient wants to do everything that they can to not mess anything up, which we would never let anybody mess anything up because would, you know, control it so tightly that it would, it would be impossible for that to happen. 

(17:53)
But they just need a little checkup, make sure they're on their schedule, they can ask any questions and then everybody's happy. It works really beautifully. And we give them a packet that shows them after surgery that even on an, an emotional level, that they're gonna have ups and downs. So sometimes, you know, you're really looking forward to the procedure and you've been looking at post-op pictures. Remember the post-op pictures are usually taken six or, you know, 12 months later. So the way you look day 10 is not gonna be the way you look day 25 or you know, day 40. So there's a little bit of a roller coaster where you might almost have like a little bit of a postoperative letdown, you feel like a little depressed and that's normal and that'll go away very, very quickly. But we have a little flow chart at the back of the pre-op packet that shows them that, and we always point that out to them so that they also know that that's normal. 

(18:52)
Like a little post-surgery letdown is normal. And then you'll bounce right back and you'll be like, oh, this is great. I feel fine. Another thing we like to tell patients about their post operative treatment is, you know, Dr. Google is not really your doctor <laugh>, right? Your friends are not really your doctor. So you wanna be careful who you're talking to, like the night before surgery. Don't go on and google, you know, breast implant problems, <laugh>, the, we all know that people are more likely to report like negative than positive things. So you really should stay off the internet because while it is a great source of information, in some cases you wanna have had enough time to look at that information and discuss it with me before surgery. So you don't wanna look at it the night before surgery and then come in, it's like, oh, I, I read this last night and can this happen? 

(19:50)
Don't do that to yourself. Look, look at it way ahead of time so that we have plenty of time to discuss it and I can give you the context and you know, put it all into perspective for you. And the same thing goes postoperatively just because your friend was told by her doctor that she could, you know, go to the gym on day number 10. You know, <laugh>, I, I'm telling you not to go to the gym on day number 10. So you know, please listen to me, not Dr. Google, not to your friends 'cause I know what I did during the surgery. I know what we need to do to get the best result with the implants that you have based on the surgery that I did for you. And the best thing to do is to follow, you know, my instructions. If you have questions, definitely ask me, you know, how come my friend did massage and I didn't do massage? 

(20:33)
Fine, but don't just do it on your own and then come in and say, oops, you know, my friend told me it was okay. <laugh>. If you'd like to schedule a consultation with the office, you can reach out to us directly by telephone, uh, which is on the website, Dr Pfeifer.com. Or you can reach us through the contact, uh, page that's on the website and Arlene will get back to you within 24 hours of you reaching out to us. And we certainly look forward to hearing from people. If you have any questions or wanna find out more about your options. 

Speaker 1 (21:07):
To learn more, go to Kind of Beautiful podcast.com or follow Dr. Pfeifer on Instagram at Dr. Tracy Pfeifer, spelled P F E I F E R. Links to learn more about Dr. Pfeifer and anything else mentioned on today's show are available in the show notes. The Kind of Beautiful podcast is a production of The Axis, T H E A X I S.io.