Breast Reconstruction Post-Op Care Initial Recovery Expectations

Dr. Salzberg and the staff of the New York Group for Plastic Surgery are here to support you after breast reconstruction surgery with implants and Alloderm or Strattice. The following instructions and guidelines will help your recovery process after Direct-to-Implant, or “One-Step,” breast reconstruction:

DURING THE FIRST 1-2 WEEKS…

• You will leave the hospital within 1 to 2 days following your surgery. Call our office at 914-366-6139 (Tarrytown) OR 914-239-8700 (Hudson Valley) to schedule your post-op appointment when you are discharged from the hospital.

• During the first week, rest or sleep on your back slightly propped up so that you’re comfortable. Do not lie on your side or stomach. This will help your implants stay in the best position during your healing process.

• You should have a prescription for an antibiotic to prevent infection and a pain medication. Follow the instructions on the bottles.

• We encourage you to take it easy the first week after surgery, but moving your arms is OK. Reaching for something in the cabinet, brushing your hair etc. are all things you may do, and will actually help with your range of motion. You can become stiff if you are not moving your upper body at all. At your first post-op appointment, we will review specific range of motion exercises you may do.

• The surgical bra you wear leaving the hospital is designed to hold the dressing in place and has the ability to hold your JP drains. When your drains are removed, you will go into a more shaping and supportive bra for 6-12 weeks (see below). Remain in the surgical bra until evaluated at your first post-op appointment. No showering while drains are in place.

• DO NOT remove the white bandage strips (Steri-Strips) that lie on top of your incisions. They will fall off on their own in about 10-14 days. (You will be able to shower in these bandage strips, but you may not do so until the drains are removed). Once the Steri-Strips fall off, you may begin scar massage and/or silicone scar sheets (see below). You can gently remove your Steri-Strips if they have not fallen off by week 3 after surgery. You can do this while you are in the shower and they will gently peel off like a Band-Aid.

• Your drains will stay in for at least 7 days and be removed in the office by Dr. Salzberg or a physician assistant (PA). The sutures holding the drains in place are the only ones that need to be removed.

• Dr. Salzberg uses dissolvable sutures on the breast incision. There is no need to remove these sutures. Do not be alarmed if a suture pokes through the skin. This can be easily removed in the office.

• Do not panic if your nipple develops a scab, changes shape or becomes faint in color. This can occur because the tissue beneath the nipple has been removed during the mastectomy.

• Your breasts will be high and seem very tight after surgery. This is normal and expected. Do not worry about the implant position, as this will settle and soften over the next 12 weeks. You may have irregularities in your skin and/or bruising. This is also normal and part of the healing process.

AFTER DRAINS ARE REMOVED and over the next 6-12 weeks…

• Dr. Salzberg recommends any of the following bras to be worn after surgery once the drains are removed:
• The American Sports Bra: Dr Salzberg’s choice as it best shapes the breast postop and provide skin compression
– Wacoal Underwire Athletic Bra (Style#855170)
– Donna Karen Signature Active Sports Bra (Style #35137)
– Natori Sports Bra (Style #234439)
– Natori Performance Sports Bra (Style #731439)
(- Champion Double Dry Distance Underwire Sports Bra – this is a good bra to wear once you are exercising)

• The purpose of wearing the bra is to help shape and mold the breasts and keep the implants in the correct position. (Think “down and in.”)

• Over the course of 6-12 weeks after surgery, your implants will begin to settle. The fullness you see right after surgery in the upper part of the breast will diminish, and the volume of your breasts will be centrally located so that your nipple/areolar complex will lie in the correct position. This is a gradual process.

• You can return to driving when you are off prescription pain medication. Over-the-counter pain medications will not impair your ability to drive. Make sure you’re able to safely maneuver the car before driving.

• You may sleep on your side after 2 weeks or when it is comfortable for you.

• Avoid engaging your pectoralis muscles! This means no heavy lifting, pushing, or pulling anything over 5 lbs., NO chest exercises such as push ups, and avoiding vigorous upper body exercise until Dr. Salzberg gives you clearance—typically at 8-12 weeks after surgery. At 4 weeks from surgery, it is OK to lift 10 lbs. if necessary. You may begin an exercise routine at 2 weeks after surgery if desired. You may walk, run, lower body strength training etc. (again, avoid upper body strength maneuvers), but go slow as you work up to your normal routine because you are deconditioned from recent surgery. Listen to your body—if an activity is sore or painful, back off.

• It’s normal to feel the pectoralis muscle spasm or have shuddering pains in your breast. This indicates that the nerves to the muscle are repairing themselves.

• Begin gentle breast massage at 2 weeks after surgery. Small circles with gentle pressure (the weight of a nickel) over the entire breast using any type of lotion will help the swelling resolve. Massaging your actual incision will help soften the scar. You may also use silicone scar sheets (sold at Dr. Salzberg’s office) to help the scar soften and fade.

• It’s normal for your implant to move when you engage your pectoralis muscles (again, you may begin to do so at 12 weeks post-surgery). You may feel weakness in your upper body strength as you start upper body exercises at 12 weeks—this is normal and will improve with time.

• Return of touch sensation to the breast and nipple varies. It may take months to years, and may never fully return along your actual incisions or within the nipple itself. The breast itself usually regains sensation within 1 year.

• Your scars will fade with time. These scars typically take 1 year to fully form, flatten, and become lighter in color.

• If you are from out of town/state and cannot return for frequent post-op visits, this is perfectly fine. We can communicate via email and phone. We will give you our email addresses and suggest that you email us your progress, as well as breast photographs, at 2 weeks, 4 weeks, 6 weeks, 8 weeks, and 12 weeks.

• Please call our office at 914-366-6139 (Tarrytown) OR 914-239-8700 (Hudson Valley) if you have any signs of infection: Elevated temperature, redness of incision or drain site, or area is warm/hot to touch.