|Need assistance (days)||2.8|
|Time Off Work (days)||6.3|
|"Back to Normal" (days)||34|
|Exercise again (days)||49|
|Sleep comfortably (days)||18|
|Do it again||100%|
|Breast Lift + Implants||Mean|
|Need assistance (days)||3.5|
|Time Off Work (days)||10.2|
|"Back to Normal" (days)||32|
|Exercise again (days)||48|
|Sleep comfortably (days)||25|
|Do it again||100%|
Patients are often pleasantly surprised that there is not as much discomfort as they expected after a breast lift. Usually, there is not a great deal of pain with this procedure. In fact, the average pain rating is a moderate 4.2/10, likely because there is no deep dissection into the breast tissue and the muscle is not lifted. Patients take painkillers for six days, on average, are back to work in six days, and report feeling "back to normal" in one month.
However, if a breast augmentation is performed simultaneously, there is more discomfort from stretching the muscle to place the implants. The average pain rating reported by a patient after a breast lift with implants is 5.3/10. A breast lift and augmentation is typically no more painful than a breast augmentation alone. The average pain level after a breast augmentation is 5.9/10. The recovery experience is virtually identical.
Usually, I do not use drains in performing breast surgery. The dressings come off when the patient returns to the office on the day after surgery. Patients may then start bathing right away. The incisions are covered by small semi-transparent adhesive strips ("Steri-StripsTM") which stay on even during bathing. A light gauze dressing is inserted in the bra for comfort and to collect small amounts of fluid which ooze from the wound. This tissue fluid usually stains the gauze yellow and is normal. The Steri-StripsTM come off at the second office visit, usually one week later. Sometimes they start to peel off sooner, and that is okay. They are an extra precaution and are not even used in patients who are allergic to them. The soft sports bra is worn day and night for a month, and then according to patient comfort, on during the day and off at night. Underwire bras are avoided for at least a month to avoid any undue pressure on the incisions while they are healing. A moisturizer may be used to treat dry skin. A topical antibiotic such as Neosporin® is used to treat any areas of crusting or delayed healing after the Steri-StripsTM come off.
The breasts swell right after surgery. They may feel tight and look unnatural - flat across the bottom rather than rounded, with excessive upper fullness and an indistinct cleavage. This is due to swelling and skin tightness. These findings are expected. Gradually the swelling dissipates and the tissue relaxes. Over the next few months, the breasts will settle and look more pendulous and natural. Bruising can take several weeks to clear.
Because the skin is cut during the procedure, small sensory nerve branches in the skin are divided. Gradually these tiny nerve endings regenerate and the feeling gradually returns. Nipple sensation usually remains intact, because the nerves that supply it from below are preserved. (In a breast lift, it is the surrounding skin which is removed while the nipple itself is left attached to the underlying breast tissue). However there may be loss of feeling in the nipples, usually temporary, particularly if breast implants have been used, because there has been more stretching of tissues and the deeper nerves are stretched, including the important 4th lateral intercostal nerves.
Although the usual time period off work is one week, many women resume working after three or four days, provided they have a sedentary job. Jobs requiring physical activity (waitress, factory worker, etc.) will have longer recovery times, up to three weeks. Women can walk right away, and walk a few miles, to maintain fitness about two weeks after surgery. Exercise involving upper body activities should be avoided for one month, when patients may resume full physical activity.
Like all scars, particularly on the body (as opposed to the face where scars generally heal well), breast scars may widen. There is certainly a genetic component to this, and clues may be obtained from other scars on the body, especially the abdomen. How did the appendectomy or Caesarean section scar turn out? If a patient has a nicely healed and inconspicuous abdominal scar, chances are their breast scars will do well too. However, if they heal with thick, raised hypertrophic scars or are prone to keloids, their breast scars are likely to be similarly affected. In this situation, it may be best not to have the surgery – the balance is too much on the cost side (significant scars) and not enough on the reward side (improved breast shape).
Surgery creates some tension on the scars. Tension tends to make them widen. Later, when the tension has reduced by relaxation of the tissues, the scars may be revised.
Scarring and the older "Inverted-T" Technique
The horizontal scars left by the older inverted-T technique can often be seen running close to the middle of the chest and on the sides where they may not always be concealed by the inframammary crease. Patients find these scars the most objectionable of the three scars (periareolar, vertical, and horizontal) that are part of the old inverted-T anchor incision. Fortunately, this scar is not part of the vertical technique, and this technique may be used to shorten existing horizontal scars in patients who have had the inverted-T technique previously.
Improved Scar using the Vertical Technique
The vertical scar often heals nicely, although it is not unusual to have small areas of delayed healing. If it needs to be revised, because of an excessively wide scar, this may often be done under local anesthetic. It is not unusual for me to come back and remove this scar along with some additional skin and breast tissue to create more tightening in patients who want the perkiest result possible.
Puckering or "Dog Ears"
There is a pucker ("dog ear") at the bottom of the vertical scar. This is created when an ellipse of tissue is removed above it. The only way to avoid such puckering is by making the incision longer. Of course, we don't want to make the incision any longer because we want to limit the length of the incision so as not to leave a scar continuing down on to the abdomen. However, it is sometimes necessary to come back and treat a persistent dog ear by cutting out a small area of puckering that does not completely flatten out.
Even with diligent surgery and follow-up care, scars may widen. But they will look better with time. They will soften and the redness will gradually fade. If necessary, they may be revised.