What Do Other Breast Augmentation Surgeons Think of the Concept of a "24 Hour Recovery"?

Dr. Tebbets in TX has published on a 24-hour recovery (assuming moderate size implant) with no narcotic pain meds, raising arms above head immediately after surgery, ability to travel and return to work almost immediately... and most importantly a 1.5% rate of capsular contracture. I am confused! I just consulted with another of the top breast surgeons in the US who prepared me for the old standard post-op protocol: no lifting arms, off work 7-10 days, no air travel 2 wks, no exercise 6 wks...

Doctor Answers (21)

24 hour recovery breast augmentation surgery

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Many surgeons are promoting 'rapid recovery' breast augmentation, which is something I have always attempted to provide to patients.  Over the years I have incorporated surgical techniques and instrumentation that are extremely helpful in this regard, the ultimate goal being that of creating the least possible tissue trauma that is necessary to get the implants into an aesthetically ideal position.  We also incorporate the use of anti-inflammatory medication and early motion of the arm and shoulder to get patients back to their routine activities of daily living as quickly as possible.  Most patients have little to no pain the night of surgery, and a bit more soreness the next day - but they can still lift and carry normal-size & -weight objects, brush their teeth, brush their hair, etc.  We give patients a prescription for a narcotic pain medication 'just in case' but most never take any of it.  So most of our breast augmentation patients do truly have a '24-hour' recovery, although there is inevitably some soreness for several days.  Exercise is limited to walking only for two weeks and then patients can gradually resume their usual fitness routine over the next 4-6 weeks.


Some claim that there is no need for postoperative 'pain pumps' - the layman's term for the local anesthetic infusion devices that can be placed during surgery and deliver local anesthetic into the implant pockets for 2-3 days.  I still use them, as they add no cost for the patient (we cover the cost) and add no significant risk of complications, and because there are some patients that - no matter what you do to prevent it - will have some significant pain postop without the local anesthetic infusion.  We take the tiny catheters out usually on postop day 2, and because of this device we have many patients who describe having an essentially pain-free breast augmentation experience.  You can't absolutely guarantee that outcome, but we certainly try to provide it for every patient.


Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 41 reviews

24-hour breast augmentation recovery--Here is the truth.

+2

Ava, the fact that you're asking the question means that you are thinking appropriately about the fact that careful surgery and treating the tissues delicately is one thing, and healing and recovery quite another!

I do firmly believe that the basic idea of careful creation of the implant pocket, avoiding blunt dissection (ripping the tissues apart with the surgeon's gloved finger or "hockey stick-like" instruments), careful control of bleeding vessels, staying away from the sensitive and tender periosteum of the ribs, and appropriate use of long-acting local anesthetics, muscle relaxants, and anti-inflammatory medications all contribute to a better operation, less post-op discomfort, lower capsular contracture rates, and a smoother recovery. All true. The problem is that extending this concept to use of the phrase "24-hour recovery" is where reality distortion comes into play!

Healing, as all surgeons know, and most patients intuitively understand, still takes time. Lots of swelling, bruising and discomfort are certainly different from minimal swelling, hardly any bruising, and lower pain levels. But healing is a complex set of chemical and physiologic steps that all take time.

Assuming that each patient has good nutrition, normal vitamin levels, no aspirin or other blood thinner use, and all of the factors needed for collagen synthesis, scar formation, blood vessel repair and clearing of products of metabolism (HEALING), there is no way to really speed this up by a "special" technique or by going to a "special" surgeon.

I absolutely believe that technical finesse, careful tissue handling, and skillful administration of anesthesia and other medications all contribute to the best surgery a surgeon can provide.

But "24-hour recovery" is a phrase that has more applicability in marketing than in reality, as you properly surmised. There is no substitute for careful limitation of activities to reduce the rate of post-operative bleeding requiring re-operation (the rate in our practice, and we do over 300 breast augmentations per year, is about 1%). Follow your instincts and take it easy. You can go to the dance club in a couple of weeks. While healing, consider reduced activities an investment into your "healing bank." Your investment will pay off!

Best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 126 reviews

What Do Other Breast Augmentation Surgeons Think of the Concept of a "24 Hour Recovery"?

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Thank you for your question! The "rapid recovery" breast augmentation is a newer philosophy with many surgeons to expedite activity and expedite recovery following the breast augmentation procedure. In my practice, utilizing the fast track technique after breast augmentations, women are readily able and doing most things virtually immediately after this procedure. It is the similar techniques as described and is really gaining popularity. Meticulous breast pocket dissection and minimal bleeding have been shown to limit swelling and postoperative pain following the procedure. She is even recommended to go out for dinner that evening. Pain is often minimal and you will likely be on a scheduled antiinflammatory regimen/pain control along with early exercises/range of motion techniques immediately. Pain does vary among patients, however. Certainly, follow your surgeon's instructions for postoperative care and restrictions, but it is common for most women to resume many of the preoperative activities and duties within a week. I typically restrict heavy lifting and vigorous exercise for approximately 4-6 weeks Swelling and settling of the implant typically occurs over a 6-12 week period along with placement in a compression-type bra for the same time period, while your incisions commonly resolve to its final appearance in up to a year.

Consulting with a board-certified plastic surgeon well-versed in breast procedures and one you are interested in are useful in order to discuss his/her technique as well as the risks and benefits of the procedure. Hope that this helps! Best wishes for a great result!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

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+1

It really depends on a few factors. Adequate pain control is likely the most important. Individual pain tolerance differs greatly. I find that women who have had children generally have less post-op pain, as they have a much higher pain tolerance. From a surgical point of view, there are several things the surgeon/anaesthesiologist can do to decrease your post-op pain.

I generally perform breast blocks prior to making any incisions with a mix of short- and long-acting local anaesthetics. I have found this greatly reduces post-op pain. I also encourage patients to take the prescribed pain killers regularly every 4 hours especially for the first 24-48 hours. If you don't stay on top of the pain in the immediate post-operative period, it is extremely difficult to "catch-up". Most of my patients experience very little post-op pain after breast augmentation.

Of course, the type of augmentation you have will also determine your post-operative discomfort. Larger implants, and subpectoral implant placement will also increase post-op discomfort. This doesn't mean you shouldn't get large implants, or place them under the muscle - you simply need to know what to expect. Many women also experience difficulty with sleeping in the first few weeks after augmentation due to the weight of the implants on their chest. This is more significant in back-sleepers.

To answer your question about time off work, my experience has been that there is a huge range. I have patients that go back to work the next day (against my advice), and I have had patients take as much as 2 weeks off of work. It really depends on what you do for work, and how you feel. As for taking care of your kids, if your implant is placed under the muscle, it will be a few weeks before you feel comfortable enough to pick them up.

As for scars, I tell patients it will take a year to see the absolute final result. Practically, however, by 3-6 months the scar will be very close to the final result. I suggest 3M paper taping, and have a specific scar massage protocol I use to help speed scar resolution.

I hope this helps. Good luck!

Sincerely,

Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 28 reviews

Quick recovery from breast augmentation

+1

Getting back to daily activities including returning to a desk job in 3-5 days is not unreasonable. Yes, you can lift your hands above your head in the first 24 hours. Yes, you can travel after 24 hours.  I think the "24 hour recovery" is a marketing gimmick to get people to come see one plastic surgeon versus another. Most nearly all of my patients recovery in a timely fashion without a lot of unnecessary extra steps or interventions. Breast augmentation is a safe and straightforward surgery. A gentle technique, which includes gentle handling of your breast tissue and gentle placement of the implant, does a lot to minimize postoperative discomfort. Also, pain tolerance is different for different people.  I have some patient who after surgery are ready to run a marathon and other patients who won't move for two weeks. A pain pump can be a good idea and i use it frequently.

Remember it takes six weeks for a stable implant pocket to develop around the shell of your implants but that doesn' mean that you can't have light activity and do most things.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 37 reviews

Quick Recovery Breast Augmentation

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If you ask ten surgeons the same answer, you will most likely get ten answers.  We use the Tebbetts  rapid  recovery  breast  augmentation,  also  known  as  the “no-touch technique,” a surgical procedure that uses special instruments and techniques to minimize tissue damage and avoid touching the ribs (hence the term “no-touch”). It causes far less trauma to the surrounding tissue. (Dr. John Tebbetts’ book, The Best Breast, CosmetXpertise, 1999.)  Out patienst are encouraged to keep moving after the procedure and this has worked well for us.  Good luck and all the best, "Dr. Joe"
 

Joe Gryskiewicz, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 45 reviews

24 hour recovery

+1

Dr. Tebbets is a wonderful surgeon.  I perform alot of breast surgery and I am a bit more conservative.  Eventhough the surgery is raltievely bloodless and can be done in most cases fairly quickly, I am concerned not with the movement but the overall exertion that can  say "knock off " a clot on a cauterized blood vessel after surgery with an increased blood pressure or heart rate.  My patients often go back to work within a few days to a week, but I do suggest that they avoid sports and aerobics for a few weeks.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

24 hour breast implant recovery

+1

Recovery from breast augmentation is usually only a few days and it is true that you should expect less pain with a smaller implant, especially when placed under the muscle.  I prefer patients to take it easy for more than just 24 hours.  The main risk  with resuming normal activity sooner  is post-operative bleeding, known  as a hematoma.  Most hematomas occur within 24 hours of the operation, but they can occur later and are often associated with over activity, particularly sexual.    The resumption of activity has little to do with capsular contracture rate so I don't think that's a relevant factor.  Return to work  time depends on what type of work you do.  If you do desk work you should be able to return in 3 or 4 days, longer if you do more physical type work requiring heavy lifting.  I can't fault your surgeon for his recommendations.  You don't want to travel  a long distance, get a hematoma, and  then try to find  another surgeon to deal with it.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 11 reviews

Early motion and Breast Displacement Exercises speed Breast Augmentation Recovery and lessen Capsular Contracture

+1

Dr Tebbets is an excellent surgeon and world expert on Breast Augmenation-if he is your doctor follow his advice.

I start Breast Displacement exercises day 1 or 2 after Breast Augmentation and avoid compressive dressings of any type and discontinue the surgical bra day one or two.

I believe limiting Breast Implant motion by compressive dressings and inactivity delays recovery, makes post operative pain worse and raises the risk of capsular contracture.

However, very vigorous activity such as sports, push ups, heavy lifting etc will put stress on your suture lines and are to be avoided for two weeks. You do not want to rip your incisions!

Narcotic pain medications are individualized for the patient. Some need them and some do not. They certainly can improve comfort and make early mobilization easier and I give my patients the option for Narcotic Medication.

Pain tolerance is an individual matter and I do not impose my will on my patients.

 

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
5.0 out of 5 stars 34 reviews

24 Hour Recovery

+1

For an experienced breast surgeon I think your surgeon's protocol is quite conservative and it's difficult to advise you without knowing the details of your case.  However, if you're confident that your surgeon is experienced and understands your situation clearly, then I commend him/her for giving you a true opinion regarding your recovery rather than an answer designed to simply make surgery sound more enticing to you.

Scott E. Newman, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 25 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.