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DR BRUCK IS GOING TO ANSWER SOME OF YOUR QUESTIONS!!!

“HOW LONG SHOULD I SLEEP ON MY BACK AFTER A BREAST AUGMENTATION?”

I advise my patients to sleep on their back for 6 to 8 weeks. During this period the capsule forms around your implants. If you continuously sleep on your side, in particular the same side it may alter how the capsule forms, implant position and the shape and appearance of your breasts. During this period I recommend that patients wear a surgical bra that is comfortable with good support. They can switch to a sports bra after the first month and then at the third month can return to wearing a non-surgical, non-sports bra.

“HOW DO I MASSAGE MY BREASTS AFTER BREAST AUGMENTATION?”

Ask five plastic surgeons and you’ll probably get several different answers. Personally I do not have patients massage their breasts after surgery.  I may have patients exert a gentle downward pressure at the upper border of the implant, hold for a 5 – 10 seconds and repeat several times on each breast two to three times a day.  In some instances I have patients where a breast band that continuously exerts downward compression on the implants for the first two weeks. This will vary from patient to patient and is based on assessment during postoperative visits.

“BREAST AUGMENTATION RECOVERY: WHAT TO EXPECT?”

Recovery varies from patient to patient but in general most patients who do not have to do any type of lifting or strenuous activity, and in particular if you have a “desk job”, can return to work within one week. During the first few days patients are given medication to relieve pain/discomfort. After that time many patients will discontinue taking prescription level pain medication and can switch to non-narcotic products such as extra strength Tylenol. Celecoxib, (brand name Celebrex), a prescription medication similar to ibuprofen but one that does not increase the likelihood of bleeding can be prescribed and taken in conjunction with Tylenol. After the first two weeks, patients can gradually resume more strenuous activities. It is ALWAYS best to check with your surgeon, as guidelines may vary. As recovery varies from patient to patient, so does the appearance/fading of scars. Patients who are genetically predisposed to favorable healing, light skin, blond hair blue eyes will have scars that will fade more rapidly and be minimally perceptible within several months. At the other end of the spectrum, scars of those patients with very dark skin, hair and eye color will take much longer to fade and may remain visible even after a year. There are topical agents such as silicone gel sheeting that help to optimize the appearance of scars early on after surgery. Scars that tend to have prolonged redness can be treated with a laser than can significantly reduce redness. This may require several treatments, but the treatments are brief, painless and have no downtime. Please keep in mind that the answers to you your question will vary from surgeon to surgeon. In the end, recovery is relatively short and well-tolerated by most patients.

“HOW CAN I MAKE MY BOOBS BIGGER? CAN PILLS OR CREAMS MAKE MY BREASTS BIGGER?”

Yikes!! It’s always disheartening to see that there’s someone selling hope in a bottle. Pills and creams will not make your boobs bigger. While there are instances that one of the side effects of birth control pills may be increase breast fullness, that is not an indication for birth control pills. There are two ways to increase breast size, breast augmentation and fat transfer to the breast. Fat transfer to the breast involves performing liposuction from one area of your body, processing the fat and then transferring it to your breast. However, this sounds easier than it is. For one, not all of the transferred fat survives, and there is a limitation on how much fat can be transferred in one session. More than one session may be necessary. This technique works best in patients who desire a modest increase in breast size.

“HOW LONG IS THE RECOVERY PERIOD FOR A FULL TUMMY TUCK?”

Let me answer the question with a question, recovery to do what? For many patients their main concern is return to work and usual activates of daily living (driving, household responsibilities, kids, etc.), for others its when can I go back to the gym, when will I see my final result and start building a new wardrobe. Recovery from a tummy tuck is a gradual process and everyone recovers at a different rate.

Let’s talk about the first one to two weeks. When you leave the facility where you had your tummy tuck (usually an outpatient facility) you will be standing in somewhat of a bent over position because closure of the incision with the underlying tissues is performed with the operating table flexed, much like a beach chair. Once you get home, you’ll also recover in that position either in a recliner, adjustable mattress or with pillows under your thighs and behind your back. Over the next one to two weeks you will find that little by little your body will return to its normal upright position. This is not something that you consciously do. During the initial one to two weeks your activities will primarily be limited to walking around at home and minor tasks of daily living. It’s a time for others to take over your responsibilities. You cannot lift anything more than several pounds so that excludes lifting babies, small dogs, doing the laundry.

If you have drains, they may be ready to be removed after a week. However in some instances more time is required. While there are some patients who may be able to return to work after two weeks, many patients require an additional week or two. If a job requires moderate to heavy lifting, performing strenuous activities, then 6 – 8 weeks may be necessary. It’s important during the initial two weeks that you do not engage in any activity that can increase your blood pressure, as this can cause bleeding. This includes even passive sex. By three weeks, many patients can return to work as long as there is no heavy lifting, light upper body weights, walking on a treadmill, light activities such as driving (by this time you should not be taking narcotic medications or muscle relaxers), light housework and cooking are permitted. You should review with your plastic surgeon a list of activities that you normally do and when each activity can be resumed. This which may vary from activity to activity. Listen to your body. By four to six weeks, light exercise can be resumed but no heavy lifting, squatting, crunches etc. Again, before resuming exercise and more strenuous activity review these with your plastic surgeon. By eight to twelve weeks you can resume most activities including strenuous exercise with the approval or your plastic surgeon.

As time progresses the appearance of your abdomen will continue to improve. By three months you will, in all likelihood, have seen major changes in the overall appearance of your abdomen. However improvement may continue through six months and beyond. The scar itself will also continue to improve and may take beyond a year to reach its final appearance. Scar treatment as well as treatment to reduce swelling initially (such as lymphatic drainage) can speed up the process. By six months, most patients have resumed their usual activities, for some, this period may be longer.

Before and After Photo Gallery

HOW LONG SHOULD YOU WEAR YOUR BINDER/GARMENT AFTER A TUMMY TUCK?  

Let’s start with the binder. A binder can cause more harm than good. More often than not patients think that making the binder tight will speed things along; NOT SO. On the contrary, binders can put unnecessary pressure on the tissues and diminish blood supply and actually lead to tissue necrosis (tissue death) especially in the area above the mons pubis where blood supply is already diminished by the procedure. Binders can also interfere with patients taking deep breaths which can lead to build up of secretions in the lungs. Binders tend to “ride-up” and a binder may double over on itself leading to increased pressure on the tissues further compromising blood supply; SO NO BINDERS. Once drains have been removed, or if no drains, a compressive garment usually from just below the ribcage to the mid-thigh area and may help reduce swelling, especially when used in conjunction with lymphatic drainage performed by a licensed massage therapist, trained in lymphatic drainage techniques. These garments, properly fit, often make patients feel more secure and can be worn for the first 4-6 weeks. Many patients, especially in the cold weather, will continue wearing the garment for a longer periods of time, three to six months.

CAN I WEAR A BIKINI ONE (1) YEAR AFTER A TUMMY TUCK?  

It depends! On the placement and design of the incision by your plastic surgeon. It’s important to discuss your goals with your plastic surgeon well before the day of surgery, which, among other things, includes bathing suit styles (bikinis) and underwear. While there are no guarantees, a properly planned incision should allow you to wear a bikini. Depending on the width of the bikini strap/band and how you heal, you may be able to wear a bikini well before a year. Just remember to protect your scar from the sun. And what about the belly button scar? The belly button is the crowning jewel of a tummy tuck. It should be inset giving a natural three-dimensional appearance. While belly button “creation” occurs at the latter part of the surgery, meticulous attention to detail is paramount. Sutures should be placed such that there will be no external visible suture marks. So while you may be able to protect the scar along the bikini line (covered by the swimsuit fabric and sun block) you just might have to wait close to the year-mark to expose your belly button (to the sun). Always and forever wearing sun block, of course.

HOW SOON AFTER SURGERY CAN I START USING SILICONE SCAR SHEETS (TUMMY TUCK, BUT APPLIES TO ALL INCISIONS)? 

The entire length of the scar does not always heal at the same rate. Once it appears that the scar is uniformly healing, no scabs, crusting or “open spots”, you can begin applying silicone scar sheets. Make sure to remove them before showering and ensure that the skin is dry before reapplying them after showering. If water accumulates under the silicone sheets it can cause maceration of the skin making it appear wrinkly, wet and soggy, similar to the appearance of your skin when you’ve been soaking in a tub for a prolonged period of time. When that occurs around an incision/wound it can interfere with healing. If you live in a warm climate and find yourself sweating, sweat can pool under the gel sheets causing maceration of the skin, which in some instances can lead to infection. In that case, a roll-on gel can be used with similar benefits. You can purchase a gel that also provides sun protection. Ask your plastic surgeon whether additional sun block is recommended.

DOES SUCKING AND PRESSING THE BREAST INCREASE THE SIZE?

Definitely not. While there have been devices designed for that purpose they have not been shown to increase breast size. There are two ways to increase breast size breast augmentation and fat transfer to the breast. Fat transfer to the breast involves performing liposuction from one area of your body, processing the fat and then transferring it to your breast. However this sounds easier that it is. For one, not all of the transferred fat survives and there is a limitation of how much fat can be transferred in one session. This technique works best in patients who desire a modest increase in breast size.

BREAST REPLACEMENT WITH SURGICAL MESH. 

A surgical mesh may be incorporated with breast implant surgery for a variety of reasons. The mesh most commonly used is poly 4-hydroxybutyrate. This is a synthetic material that is generally placed in the lower pole of the breast to provide additional support to the implant. In addition, over time, there is ingrowth of a patient’s tissues into the mesh and as the mesh slowly dissolves over a period of 18 to 24 months, the patient’s tissues are left significantly stronger. The mesh comes in several shapes including one that is shaped like a demi-cup bra.

WHEN DOES SWELLING AFTER BREAST AUGMENTATION BEGIN TO SUBSIDE?

It is premature to assess breast size within the first few weeks after surgery. Swelling dissipates slowly over time. Not only will breast size change as swelling resolves but so will breast shape and implant position; patience is a must. Generally by two months most of the swelling will have dissipated but depending on the size of implants it may take somewhat longer until you can appreciate the appearance of your breasts. It’s also important to keep in mind when bra shopping after a breast augmentation, one bra that is a D cup may look and feel comfortable, yet another manufacture’s C cup (for example) will provide the same look and feel.

WHAT ARE THE SIGNS OF CAPSULAR CONTRACTURE AFTER BREAST AUGMENTATION?

Signs of capsular contracture can occur early after breast augmentation or not until many years after surgery. Forming a capsule, an envelope of scar tissue, around a breast implant is a normal process. However, when the capsule contracts, the implant is now in a space that has become smaller and depending on the degree of shrinkage or contracture, a patient’s breast may feel more firm, the shape may change as well, as the implant has often been displaced upwards toward the collar bone. Your surgeon can best answer this question based on information that you provide regarding changes you have noticed: firmness, shape, implant position, and by physical examination which includes looking at your breasts, comparing one breast to the other, and assessing the firmness by feel. While there are instances where capsular contracture can be improved by taking a medication, Singular, this generally does not resolve the problem and the capsule will need to be surgically removed, modified or a new space created for the implant.

HOW LONG DOES TUMMY TUCK SURGERY SWELLING LAST? 

There is also greater detail in the question (above) “HOW LONG IS THE RECOVERY PERIOD FOR A FULL TUMMY TUCK?”

Most of the swelling resolves over the first three months. There may be continued resolution of swelling up to six months after a tummy tuck. Lymphatic drainage beginning at about one week after a tummy tuck can speed up the process. This should be performed by a licensed massage therapist trained in the technique of lymphatic drainage.