Leading Up To Surgery
There are things that YOU can do BEFORE surgery that can have a big impact on how quickly and easily you recover after surgery!
At Davis and Pyle Plastic Surgery we have implemented an “Enhanced Recovery After Surgery”, or ERAS protocol to ease your recovery and get you back to feeling normal quickly after surgery.
The goals of ERAS are to:
1) Prepare your body to deal with the “stress” of surgery.
2) Treat pain before it happens
Starting 4 weeks before surgery:
Improve your fitness. A well rounded exercise regimen, combing both cardiovascular exercises (walking, running, swimming, cycling, etc…), strength training (free weights, weight machines, calisthenics, etc…), and flexibility exercises (stretching, yoga, pilates) is important. If you do not frequently exercise, now is a great time to start!
If you already exercise, try to supplement your workouts with the other forms of exercise to make them well rounded.
Medication & Supplements to stop
Stop taking Aspirin, products that contain Aspirin, and all other supplements two weeks before surgery. This includes:
BC or Goodies powders
Weight loss medication
Meal replacements or protein shakes
Please make sure to get your prescriptions filled prior to your surgery date. You will be expected to bring your prescriptions with you the day of surgery.
The pain medication that is prescribed can cause constipation. You can start prevention as early as two days before your surgery by taking Colace, or Activia yogurt. After your surgery, you can have things like MiraLAX or Milk of Magnesia, but these should not be taken before.
If you become ill or have to postpone your surgery for any reason, please notify us as soon as possible.
Day Before Surgery
You will receive a call and email the day before your surgery with instructions regarding where and when to arrive.
This will include instructions regarding medications.
Day Of Surgery Instructions
Food and Drink
Do not eat after midnight the night before your surgery.
You can brush your teeth, but do not swallow any toothpaste or liquid.
Do not consume candy or gum.
You may drink water or Gatorade (any flavor except red) up to two hours before your surgery.
Do not drink coffee or tea day of surgery.
2 hours before surgery
Take three medications which are all non-narcotic medications that work in different ways to prevent and decrease pain:
1) Three regular strength Tylenol (975mg total)
2) One Celebrex tablet (prescribed to you)
3) One Gabapentin tablet (prescribed to you)
With these, drink a 12 ounce gatorade, or half of a 20 ounce gatorade (any flavor except red)-This will give your body a “last minute” carbohydrate energy boost which will make you feel stronger before and after surgery.
1 hour before surgery
Take 4 tablets of the anti-nausea medication Zofran (Ondansetron).
Do not wear jewelry or make-up to your surgery appointment. Wear loose, comfortable, and warm clothing. A top that zips or buttons up is preferred. Please wear glasses instead of contacts if applicable.
Sweat or Pajama pants are preferred. No yoga pants/leggings.
Fingernails must be short. If polished, it must be clear.
A responsible adult must take you home. You will need someone to stay with you for the first night after surgery.
Note: If you are a minor, a parent or legal guardian must accompany you.
No Taxi Cabs, Lyfts, or Ubers as your transportation home.
If you need transportation/help after surgery, the team at Metro’s Other Woman, https://www.metrosotherwoman.com/raleigh-nc, have helped our patients with care, housekeeping, dog walking, taking children to soccer practice, and everything in between.
What to expect
Once you arrive in our surgery suite, the clinical staff will discuss the details of your procedure and ask you to sign an informed consent. If applicable, you will take a pregnancy test prior to surgery.
You will speak with your anesthesia provider prior to your surgery. They will go over your history with you one last time before we get started and tell you what to expect when you are in the operating room.
You will only need to undress from the waist up.
From there, your surgeon will come in, discuss the procedure, and create his markings before we get started.
After Your Surgery
What to Expect Physically
You can expect a little pain and discomfort, as well as some swelling and bruising on your breasts and surrounding tissues. You may feel temporary heaviness in your chest and areas of numbness (especially at your incision line). You may also feel or hear crackles in your breasts. These are air bubbles, which will gradually go away.
What to Expect Visually
Your breasts may appear very round and the skin tight and shiny. It may take a few months for your breasts to assume a more relaxed and normal shape. You may see a small amount of bloody drainage at your incision site. You will have steri-strips applied over your incision site. Please leave these in place.
Sit in an upright position for the first two to three days to help with swelling.
We will provide a bra for you to wear after surgery. If it feels better without it, you can leave it off.
Do not wear an underwire or push-up bra for six weeks after your surgery. If you are given an upper band, wear it at all times, except when showering. You can wear this with or without the bra or over a t-shirt.
Wait six hours after surgery before showering. The incision area can get wet, but do not wash it directly. After your shower, gently pat the incision site dry.
If your implants are placed under the muscle, do not engage in chest exercises for six weeks after your surgery.
Do not run or do any type of exercise that would cause your breast to excessively bounce for two weeks after your surgery.
Please ask your doctor or nurse directly to clarify the differences between under or over the muscle regarding your implant placement.
Rapid Recovery Instructions
You may have an additional first step to add after your surgery depending on the preference of your specific surgeon. If you have questions about this, please ask your doctor or nurse directly.
Specific instruction will be explained to your caregiver at discharge the day of your surgery.
Take the first six hours to relax, take medications as needed, and recuperate. After six hours, we will start your rapid recovery plan.
This applies to patients whose implants are placed under the muscle.
Step One: Lay flat on your stomach and on your new breasts for 15 minutes. If this is terribly uncomfortable, it may be easier to kneel and lean forward against the side of your bed for 15 minutes.
Step Two: Start your exercises. Do the first set in the shower with warm water running. Slowly lift your arms straight in front of you above your head. Hold your hands above your head with your arms straight for 10 seconds, then slowly bring your arms back down. Do this three times for each set. After your shower, pat your incision sites dry but leave the tape in place.
Step Three: Do a set of three arm raises every twenty minutes while you are awake for the first three days.
This is a way to keep your muscles limber and loose. Think of it like running a marathon. After a long run, it is important to keep your muscles loose and limber so they don't tighten and become painful. We are doing the same thing with your pectoral muscles with these two exercises.
You can place ice packs to the upper part of your breasts to help with swelling and pain. Use for 30 minutes on then 30 minutes off to prevent frostbite.
Do not use heating pads to help with pain. This could cause a burn.
Resume your normal activities as you feel comfortable. If it hurts, don't do it. If it doesn't, it is ok to do.
First 2 days after surgery: Take 3 regular strength Tylenol (975mg total) every 8 hours. Take Oxycodone as needed for breakthrough pain.
After 2 days: You can continue to take Tylenol as needed and can take 3 regular strength Advil or Motrin (600mg total) every 8 hours as needed as well.
Pain medication: Oxycodone
Take one to two tablets every six hours, as needed for pain
Do not use alcoholic beverages while taking pain medication.
Do not take more than 11 in one day.
Anti-nausea medication: Zofran or Ondansetron
After surgery, take one tablet every six hours, as needed for nausea.
Anti-nausea medication for extreme nausea: Phenergan or Promethazine
Take one tablet every four to six hours, as needed for extreme nausea.
Note: This may cause drowsiness
When To Call The Office
Call the office if you have a fever over 101 degrees, experience any sudden increase in swelling (especially on one side), or notice redness around your incision sites (especially if it’s warm to the touch).
Frequently Asked Questions
How long do I have to take off work?
Three to five days
How long does the procedure last?
About 45 minutes
How long will I have to be in recovery?
At least 45 minutes
When can I drive again?
You can drive when you are no longer taking pain medication and feel comfortable driving again. Always consider that you would need to be able to react in case of an emergency.
Can I sleep on my stomach after surgery?
You can sleep on your stomach as long as it doesn't cause you discomfort. Generally this will happen five to seven days after surgery.
When can I get in a pool/beach/lake?
You can get in a pool/beach/lake after 3 weeks from your surgery date.
When can I wear a normal bra again or go shopping for a new bra?
Wait until six weeks after surgery. We would not recommend doing this earlier due to restrictions and healing.
What size bra will I wear after surgery?
Unfortunately, there is no black and white answer for this. Generally speaking, implant sizes that range in the mid to high 300s will increase your bra size by two.
Do I need to buy a bra for after surgery?
After surgery, you will be given a loose-fitting bra, called a Coobie bra. If you would like multiple options, you can buy more bras like this. Do not wear bras with underwire or push-ups until six weeks after surgery.
Can I go to a tanning bed or get spray tanned after surgery?
You can get a spray tan two weeks after surgery, but make sure your incision line is protected or covered. We do not advise patients to go to the tanning bed until six weeks after surgery.
What can I do for scar care after surgery?
You will be given a scar gel from, Skin Medica, at your 6-week post-operative appointment.
What happens if I get a capsular contracture?
We do everything we can to prevent this from happening. In the case that it does, we will do surgery to correct it.
Will I need to replace my implants after I have children?
Most women's bodies change during pregnancy and breastfeeding. There is a possibility you would need a revision after this, but it is not guaranteed and is up to the individual.