What to expect when you are explanting

Week 1 

• Your drains will usually be ready to come out 5-7 days after surgery. A few patients need them in longer. Your surgeon/nurse will determine when they are ready to be removed based on the output and clinical exam. Generally they should put out 20cc or less (each side) over 24 hours to be ready to be removed. 

• Please sleep in an elevated position for the first 2 weeks after surgery. A recliner is ideal. Side sleeping is allowed at 3 weeks, stomach sleeping at 6 months. You may shower in 48 hours. Remove your bra and ACE wrap at this time, then place back on once out of the shower and dry. No submerging your incisions in water for at least 3 weeks. 

• The external dressings and tapes will be removed when the drains come out. You may then put paper tape on the incisions and change out every 3 days for 3 weeks as instructed by our staff. It is sometimes good to wet the tapes in the shower prior to removal. After 3 weeks, you may begin a scar cream of your choice. Mederma (purchased at CVS or Walgreens) in the morning and Coco Butter at night is a good choice for 3 months or longer.  

• There will be clear sutures (look like fishing line) that will be trimmed by our staff when the drains come out. Do not pull on these sutures. All sutures will dissolve and incision lines may feel a bit bumpy until fully dissolved. 

• There WILL BE some dripping of fluid around the drain site down your side. Use gauze as necessary if this does happen.  

• There will be one suture on each side that holds the drain in place which will be removed during drain removal. You can place Neosporin and a band aid to this area daily after showering. The drain site will close after 3-5 days.  

• You will be given a surgical bra and/or an ACE wrap after the surgery. Continue to wear the bra after surgery and the ACE wrap can be discontinued one week after the drains are removed.  

• If you feel numbness or tingling in your arms then keep them elevated with pillows when sitting or sleeping to help reduce swelling. You may also loosen the ace wrap. This usually will subside within 48 hours.

• You can do restricted upper arm movements (T-rex). Please keep your elbows at your sides for the first 2 weeks after surgery. Do NOT lift anything > 5 lbs. from the ground or from cupboards. Single plates and cups are ok. After 2 weeks you may gradually begin using your arms normally but please do this slowly over time. 

• You can drive 1 week after surgery as long as you are not taking any form of narcotics or muscle relaxers.  Start with 15-20 minutes and work yourself into longer periods of time. 

• If you are travelling for surgery please find assistance for carrying your luggage. If needed a note can be provided for airport assistance. Please ask your coordinator or the front desk to provide this.  

• You can return to work after 1 week with light duty. 

WEEKS 2-4  

• Continue to observe activity and weight restrictions- nothing heavier than 10 lbs.  

• You can start laying flat at 2 weeks. If you lay on your side use a soft pillow for support/cushion at 3 weeks. 

• You can switch over to a comfortable sports bra at 2 weeks. Please make sure the bra is not digging or pushing into your incision or breast tissue. This is one of the leading causes of indentation and/or incision breakdown. Please do NOT wear padding, molding or underwire for 12 weeks after the day of surgery.  

• If you feel like there is irritation or redness you can pad the incision with a maxi pad.  

• The compression should be medium or feel like the breasts are being supported. It does not have to be a tight compression.  

• If you are a candidate for cupping (to be determined by surgeon) then you can begin cupping the areas your surgeon/nurse show you to at week 2. This can be performed at home or by a trained therapist.  Cupping is done for indents or puckering. If you do not have this then you do NOT need to cup.

• Helpful cupping video-  https://www.youtube.com/watch?v=_j6FyU-ayyQ  

• Where to buy cupping kits- Amazon has a good range of kits at a reasonable price. You only need 4-6 different cup sizes and can opt between glass or silicone based suction kits. I prefer the glass kits. 

• At week 3, gently start improving your upper arm range of motion by slowly raising your arms above your shoulders until you feel tightness or pain. You can do this 10 times twice a day.  

• Lymphatic massaging can be started at week 2. You can see a physical therapist as well to assist with lymphatic massaging, myofascial release and scar therapy.  This is not required but can help with a quicker recovery in some patients. 

• It is not uncommon to feel sore or swollen on the sides of the chest/breast area. This can last for months and even up to a year. You can apply heat or ice as needed for relief, 20 minutes on and 40 minutes off. Notify your surgeon/nurse if there is no improvement.  

WEEKS 4-6 

• You can start lower body exercises at week 4. Do not engage your arms, shoulders or chest muscles for these.  

• Stairmaster, Stationary Bike and Treadmill are all ok as long as you do not use your arms. Please keep your heart rate and blood pressure increases to a minimum. 

• You will continue to notice swelling as you increase your activities- this is normal. When this happens always use the following motto- compression, ice, rest and elevation. 

• Many patients do have some spitting suture during recovery. If the area becomes very irritated please let your coordinator know. Otherwise, wash and dry as normal in the shower and they will flake off over time.  

• You can submerge in water after 4 weeks as long as all the incisions have healed over. Swimming, Ocean and bathing is fine at the 4 week mark. Hot tub and sauna should be 6 weeks. 

AFTER WEEK 6 

• Activity as tolerated- everyone progresses at a different pace- listen to your body and do not over exert yourself. The only restriction is chest muscle exercises like bench press or pushups. These can be resumed 3 months post surgery. 

• Please continue to wear a bra, even at bed, for the first 3 months post surgery. 

• Detoxing through a trained/professional functional medicine doctor is ok after 6 weeks in select cases. 

• It is ok to get mammograms one year after surgery.  

• You can sleep on your stomach at the 6 month mark. 

MISC: 

*Please limit your intake of pain meds. Try to start with 2 extra strength Tylenol every 4-6 hours as needed for pain and if that does not work then try the prescribed pain medication. Most patients do not need them at all. They can cause constipation. If this does happen, please discontinue the meds and begin Colace 100mg twice a day (May purchase at CVS or Walgreens). You may also add a teaspoon of mineral oil and repeat as necessary.  

*You do NOT need to strip your drains. 

*You WILL have occasional sharp shooting pains for months after surgery as the nerves regenerate. These WILL go away.  It generally takes 6-12 months to obtain your final breast shape/softness so please be patient.  

“JP” Drain

 You have been discharged with a Jackson-Pratt Closed Suction System, better known as a JP drain. The perforated end of the tube is placed inside your body so that it can collect the body fluid that is produced as an effect from surgery.

Serous fluid and blood mixed together are called serosanguinous fluid. The drain is designed to collect the serosanguinous fluid by way of suction. The drain helps to reduce the risk of a seroma which is a build up of fluid in the soft tissues. The fluid color may look like a dilute blood or more yellow in color. There may be small clots that form in the tube and bulb. There is OFTEN some drainage outside the tube that may drip down the body and gauze may help in this situation. Please note that very little drainage in the tube is a good finding and may lead to the drains coming out sooner. 

How to care for your drain at home

 The drain reservoir should be checked for function every 4 hours. On days one and two the drains should be emptied and measured every 4 hours. On days three and four the drains should be emptied and measured every 6 hours. Finally, on days five through eight, the drains should be measured and emptied every 12 hours. If the drain is not full and is still compressed, it is functioning properly and does not need to be emptied at this time. Remove the stopper and read the volume after emptying into the graduated cup provided. Re-activate the drain by squeezing the air out of the reservoir and replacing the stopper. Record the volumes sequentially; we will ask for this information to evaluate when it is OK to remove the drain. When a drain contains less than 20mL in 24 hours, it can be removed.