Recovering from Breast Reconstruction in Virginia, Washington D.C. and Maryland

NIGHT OF SURGERY

• Movement is Important. Make sure to get out of bed and be up and walking around immediately after your surgery. When lying down in bed or on the couch, make sure you are moving your legs and ankles. Take deep breaths frequently to keep your lungs clear.
• Sleep. Sleep on your back with your head elevated about 30-40 degrees (2-3 pillows). Do not sleep on your side. Keeping your body more upright will minimize swelling. Continue this for one week.

MEDICATIONS

• Pain. You will be prescribed a pain medication for post-operative pain control. If your discomfort after surgery is not strong you are welcomed to take Tylenol in place of the prescribed medication. Do not take the Tylenol with the pain medication, as most often the medication you are prescribed will have Tylenol in it. Do not exceed 4,000 mg of Tylenol in any 24-hour time period. Take medication with food to minimize the risk of nausea.
• Nausea. If you are experiencing nausea, which is common after general anesthesia as well as a known side effect of some stronger pain medications, we advise that you take your nausea medication. You may have been given a Scopolamine patch that is placed behind your ear. This will deliver anti-nausea medication for three days after its placement.
• Constipation. You will experience constipation if taking narcotic pain relievers. Miralax or other over the counter laxatives are recommended. Do not wait to take until you are constipated. Begin treatment with narcotic use.
• Medications to Avoid. Take only those medications approved or prescribed by your surgeon. Avoid medications containing aspirin or ibuprofen (Advil, Motrin, Ibuprofen, others) for two weeks before and after surgery. These medications may increase bleeding.
• Substances to Avoid. Avoid alcohol, nicotine, and caffeine, for these will dramatically slow the healing process.

NUTRITION

• Diet. A light low-fat diet is best after surgery. You may start a regular diet after your surgery as long as you are not feeling nauseated or vomiting.
• Hydration. Stay hydrated by drinking 8-10 glasses of water a day. Avoid alcohol for two weeks and while you are still having to take pain medication.

ACTIVITY

• Exercise. Light physical activity may be resumed 2-3 weeks after surgery. Remember to start easy and build back up to your previous exercise levels. At 6- 8 weeks or when further instructed by your surgeon, more intense exercise can be started. Just know that swelling may transiently be worse with exercise.
• Arm Movement. Limit your arm use to daily activities such as brushing your teeth, eating, and combing/shampooing your hair. Avoid strenuous activity and do not lift more than 10 lbs. for the first 2 weeks. Do not reach above your head for the first week. Perform gentle arm exercises daily starting one week after surgery.
• Compression Bra. You may be given a compression garment to wear the entire first week, and then as advised by your surgeon. The garment should fit snug but not too tight that you have trouble breathing or you develop wounds or blisters from the compression. Wear your garment at all times except for when you are showering or to wash it. This will help with minimizing swelling and help with recovery.
• Driving. No driving for 7 days after surgery. Do NOT operate a vehicle or make important decisions until you have been off pain medications for 24 hours. Use good judgment.
• Return to work. Most patients require approximately 5-7days off work depending on their job responsibilities. Returning to work with a light schedule initially or even part-time can be beneficial as well.
• Sexual Intercourse. Sexual activity can be resumed when you feel ready with no restrictions and incisions have adequately healed.

BATHING

• Showering. You may shower after removing the dressing, 48-72 hours after surgery. Using your hands, you can use soap and water to wash around your incisions. Pat the area dry with a towel. You do not need to re-cover the wound, unless you feel more comfortable with a light dressing for a few days to absorb minimal drainage that may occur.
• Hot Tubs/Baths/Swimming Pools. No tub baths, Jacuzzi, or hot tubs until your incisions have healed, and approved by your surgeon, around 4 weeks.

HOW TO TAKE CARE OF YOUR INCISIONS

• Dressings. Keep your dressings in place until follow-up appointment.
• Drains. Empty the bulbs attached to the drain every 12 hours and measure the fluid output separately from each drain. Keep a record of the output and bring this record with you each time you come to the office for post-operative care. Watch our drain management video at www.nadericenter.com.
• Sun Exposure. Avoid and minimize sun exposure. Use an SPF of 30 or greater when outdoors. Even a mild sunburn can worsen swelling and irritate an incision that is healing.
• Scar ointment. Scars may take up to a year to fully heal. After your incisions have completely healed and when your doctor has told you it is safe, you can begin to use silicon based ointment on your scars to improve healing.

WHAT TO EXPECT

• Bruising. You can expect to have bruising. Most bruises will heal after about 2-3 weeks. The bruise will go from a purplish color to a yellow/green shade as it starts to resolve.
• Swelling. Swelling is to be expected for weeks and sometimes months. The swelling can improve with intermittent rest and compression garments. Exercise and physical activity can transiently worsen swelling but is encouraged.
• Itching. Itching at the incision sites is normal for a few days. You may take Benadryl to help with this.
• Discolored Urine. If you had a sentinel lymph node biopsy with your mastectomy, your urine may have a greenish discoloration. This is normal and will resolve as the blue dye slowly leaves your body.
• Pain. It is normal to experience tightness, pressure, soreness, itchiness, and fatigue for several days to weeks following surgery as your skin and muscles heal. You may find that short naps will help with fatigue.
• Implant Position. If implants were used for your reconstruction, they may appear higher in position, firm, and uneven due to swelling during the healing process. After 3-6 months the implants should show a more final result with significantly reduced swelling.

DO NOT’S

• Do NOT apply hydrogen peroxide to incision sites. Keep postop dressings in place until follow-up.
• DO NOT soak in baths, Jacuzzis or hot tubs until all incisions have fully healed.
• DO NOT take Aspirin, Ibuprofen, Naproxen or other blood thinners until your surgeon advises you it is safe.
• Do NOT apply heating pads or ice packs to the treated areas unless otherwise instructed by your surgeon.

EMERGENCY SITUATIONS – WHEN TO CALL THE OFFICE (703) 481-0002 OR GO TO THE HOSPITAL

• Signs of Infection. Spreading redness, worsening swelling, increased drainage or drainage of pus, worsening pain and warmth at incision site. Temperature over 101 degrees Fahrenheit.
• Clogged Drains. If you notice significant leakage around the drains, this is not normal and the drains may be clogged. Your drains will need to be checked.
• Excessive Bleeding. If the dressings are saturated with bright red blood and you are having to make very frequent dressing changes.
• Other Emergency Situations. Shortness of breath or difficulty breathing, chest pain, lightheadedness that does not quickly resolve, severe vomiting, pain or asymmetric swelling in your legs.

SHOPPING LIST

1. Prescriptions. Fill prescriptions prior to your surgery date if given.
2. Tylenol (Acetaminophen). Alternative to narcotic pain medication if the pain is not severe. Do NOT take NSAIDS.
3. Laxative (Miralax, Colace, Milk and Magnesia). Helps with constipation that may be caused by anesthesia or narcotic pain medications.

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