Breast Augmentation

by

Providing for Quicker Recovery in Breast Augmentation
Joe Gryskiewicz, MD, FACS
What surgeon would let a breast augmentation (BA) patient return to normal activity the first day after surgery?This study reviews the author’s patient population with respect to postoperative recovery following breast augmentation.The goal of the protocol was to measure if certain adopted practices would predictably return breast augmentation patients to full normal activities within 24 hours of surgery.In turn many patients could be spared from a slow, painful recovery.
METHODS
In 2002, we initiated methods to promote a quicker postop recovery.These quicker recovery principles have been used to care for 2,430 + 2012 + 2013 patients to date.
Surgical Technique
Multiple steps from prior publications and additional practices by the author were followed to provide quicker patient recovery. Care was taken to maintain gentle traction on the breast throughout the procedure.Furthermore, only the operator’s fingers or the implants were allowed to touch the ribs, because metal instruments contacting the ribs may cause multiple periosteal or perichondrial hematomas or bruising, which are painful.Prospective hemostasis was maintained during the dissection when possible. Thorough hemostasis was achieved. Finally the instillation of Sensorcaine 0.25% with epinephrine 1:200,000 (APP Pharmaceutical, Schaumburg, IL) was done before closure.
Postoperative Care
Beginning six-to-eight hours after surgery, patients were instructed to raise their arms overhead.Three sets of arm raises were done slowly every hour before going to bed the first postop night. These hourly exercises were continued for the next three weeks while awake.Depending on how secure the closure was felt to be, the patient was instructed to lie on her breasts for 15 minutes every day starting the evening of the surgery.Patients were instructed to lie face down, with their breasts on a hard surface (like a carpeted floor or a cutting board in bed) for 15 minutes daily.If this was not possible, kneeling at the bedside and gently leaning into the mattress will suffice, or at least gentle manual massage must be done advancing the implants in all directions except against the incision. All patients were assessed by a recovery room RN via telephone on the first postop day to ascertain their recovery. Patients were allowed to lift up to 30 pounds until three weeks postop when they were released to pursue vigorous exercise.
RESULTS
It was our clinical impression that BA patients recovered more quickly and with less pain once we instituted these principles, compared to the prior 18 years, when many BA patients seemed to have a most hateful recovery. These newly adopted practices seemed to return over 90% of all patients to full normal daily activities within 24 hours of surgery. This observation was shared by the recovery room nurses, anesthesiologists and anesthetists. The recovery room staff reported lower narcotic dosages compared to breast augmentations done by other surgeons at the surgery center.On postop day one many patients were able to leave home for meals, entertainment or to shop. Many returned to their desk job on the first day postop. The quicker recovery program seemed to provide patients a more comfortable postop experience with less down time.
DISCUSSION
The author uses the analogy of a marathoner for the postoperative exercies.The worst thing a marathoner can do after a race is to lie in bed and rest. Stretching and walking help the leg muscles to recover more rapidly.The same principle holds true for the pectoralis major muscles. Prospective hemostatis is important because blood in the pocket acts as an irritant, which also contributes to postoperative pain.The major limitation of this study is lack of a tool to quantify pain, although this has been done for these methods in the past. This study is anecdotal. With these steps, 96% of patients have been reported elsewhere to predictably experience a 24-hour return to normal activities. The second limitation is there is no control group.An IRB approved study will be forthcoming where a prospective, randomized study will be done to evaluate the effects of marcaine instilled into only one pocket (independent variable) versus a control.
CONCLUSIONS
A quick recovery program provided breast augmentation patients a more comfortable postop experience with less down time. These methods are reproducible. I look forward to continuing to offer my patients an improved BA experience.
References
1.Tebbetts JB. Achieving a predictable 24-hour return to normal activities after breast augmentation: part I. Refining practices by using motion and time study principles. Plast Reconstr Surg. Jan 2002;109(1):273-290; discussion 291-272.
2.Tebbetts JB. Achieving a predictable 24-hour return to normal activities after breast augmentation: Part II. Patient preparation, refined surgical techniques, and instrumentation. Plast Reconstr Surg. Jan 2002;109(1):293-305; discussion 306-297.
3.Gryskiewicz JM. Avoiding pain and suffering after breast augmentation. Plast Reconstr Surg. Dec 2002;110(7):1812-1813.
4.Teitelbaum S. Commentary on: Pain control following breast augmentation: a
qualitative systematic review. Aesthet Surg J. 2012 Nov;32(8):973.

Article by
Minneapolis Plastic Surgeon