Elevation of the chest/breast area above heart level is what surgeons are trying to achieve by these type of recommendations, so that gravity can help remove tissue swelling and aid in faster and more comfortable healing.45 degrees is arbitrary, and may be hard to continue for any length of time. I personally tell my patients that head higher than heart is sufficient, and that can be nicely achieved by simply placing a sofa cushion or two side by side under the head-end of the mattress. (Trying to sleep on 2 or 3 pillows doesn't work very well when you roll over or shift in your sleep!) The length of time is also arbitrary, since patients swell, bleed, bruise, and hurt after surgery differently. If every patient had the same exact response to surgery, it would be easier to "set" a precise timetable for these recommendations. Some surgeons might prefer "easy" over "best," and others will recommend what they feel is best for their patients, even though they understand that difficult-to-follow recommendations will NOT usually be followed exactly! So the best recommendations are the ones that both make sense and are relatively easy to follow.That's why I recommend that my BA patients sleep elevated (not 45 degrees, but head higher than heart, as a cushion under the mattress allows) for 2-3 weeks. Longer if there is more swelling and discomfort, shorter if there is less or a more stoic patient.But since every surgeon has their own formula for success, this is one question you should ask your own surgeon. I hope my personal recommendations, and why I make them, sound sensible and can act as a basis for your discussion with your own surgeon. Best wishes! Dr. Tholen