Frequently Asked Post-Operative Questions

Bathing / Water Exposure

When can I shower?

If you do not have drains, you will generally be able to shower 48 hours after cosmetic plastic surgery in the Phoenix area. Keep the showers brief. The water temperature should be warm, but not too hot, and the spray of the shower should be aimed away from your surgery site for most of the shower. It's fine if the steri-strips get wet; just gently pat them dry when you get out of the shower. For the first shower, make sure you have someone supervising nearby, in case you become light-headed. If you have a drain, sponge bathe only until these are removed.

When can I bathe, swim or use a hot tub?

You should not bathe, swim or use a hot tub until your incisions are completely healed. Swimming in a pool can be resumed after approximately 4 weeks. Hot tubs, and swimming in lakes/ oceans/ rivers should be avoided for at least 6 weeks after surgery.

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Tape / Drains

If I have drains, when will my drains come out?

Drains stay in for variable amounts of time depending on the type of surgery and the amount of drain output. For breast reductions, drains will usually be removed within a few days after surgery. For abdominoplasty (tummy tuck), drains will usually stay in for 5 to 7 days after your cosmetic surgery. Unless Dr. Cohen removes your drains the day after surgery, it is important for you to keep track of the daily fluid output for each drain. When a particular drain produces less than 30cc for 2 consecutive days, that drain is ready to come out. Call us at the office when your drains are producing close to 30cc a day, and we will arrange for Dr. Cohen to remove your drains. If you are a patient who has Strattice™, Dr. Cohen would like the output to be less than 20ccs for two days in a row.

How long will my steri-strips stay on?

Your steri-strips will usually be removed by Dr. Cohen after seven to ten days. If you have been cleared by Dr. Cohen for showers and you still have your steri-strips on, simply shower over them and pat dry after the shower.

Bras / Compression Garments

How long do I have to wear the surgical bra?

After breast surgery, patients are generally able to switch to a soft, non-underwire bra within about a week. There are many non-underwire bras available. Many of our patients seem to prefer the Ahh Bra or Genie Bra (which is available at Target, Walgreens, and other department stores).

When can I use an underwire bra? Why the wait?

You may resume use of an underwire bra after 3-4 months. The reason underwire bras are restricted is to prevent sores or skin breakdown if the underwire rubs on the underside of the breast before the blood supply and nerves have completely re-established themselves. If you are going to a special occasion and need to wear an underwire bra for a few hours, this is acceptable after 2-3 months.

Do I need to sleep in a bra?

It is advisable to sleep in a bra for the first few weeks after surgery. After that, if it is more comfortable for you, you may sleep braless.

What is the compression strap for and how long do I need to use it?

For breast augmentation patients: The compression strap is used to help settle the breast implants into a natural position. The compression strap should be high in the front so that it sits on the upper slope of the breasts. Make sure it is not bunched up in the armpit areas (you may need to readjust it periodically). The compression strap does not need to be very tight- even gentle pressure over time is helpful, and if it is too tight, it will cause indentations in your skin. For Strattice™ patients, some sort of downward compression is advised for 6 weeks after surgery.

For male breast reduction patients: The ACE wrap is used to compress the surgical area for the first day or two. After this you should switch into a compression tank. These can be ordered at www.underworks.com and should be tried on prior to surgery to ensure a snug/comfortable fit. The compression tank should be brought with you to your first follow-up appointment.

How long do I need to wear my surgical compression garment?

Tummy tuck and liposuction patients need compression of their surgical sites for 4-6 weeks. Spanx compression undergarments or an equivalent store bought compression garment (such as Donna Karan) can usually be substituted for the original Velcro surgical garment within two weeks once the drains are out. Any new compression garments (like Spanx) must start below the lowest point of surgery (i.e. at the knees if you had thigh liposuction) and go above the highest point of abdominal surgery (i.e. up to just under the breasts if you had a tummy tuck). Make sure any new garment is snug and supportive, but not excessively tight. If it hurts to pull the garment on, keep using the Velcro garment from surgery until you have healed more.

Activity / Exercise / Driving

How soon should I get out of bed?

You should be up and out of bed (going to the bathroom counts) at least three times on the day of your plastic surgery in Phoenix, and at least five times a day after that. This low level of activity will reduce your risk for blood clots in your legs. Make sure to move your feet up and down in bed to stretch and flex your calf muscles every once in a while as well.

When can I begin lifting?

Lifting restrictions depend on the surgery. For any surgery which involves lifting or tightening muscles (i.e. breast implants and full tummy tuck surgery) you need to be very careful to avoid tearing a muscle and causing bleeding. Do not lift anything heavier than a pound for the first two weeks. Between two and four weeks, try not to lift more than five to ten pounds. After that, as each week goes by, you can slowly increase lifting. At six weeks, there are no specific restrictions- just use common sense. For surgery that does not involve muscle tightening, the same guidelines are helpful, but you do not have to be as strictly careful. Once again, just use common sense.

When can I exercise?

As you start to feel better (within the first 5-10 days), you may increase your level of activity, such as walking around the mall or going to the office to do desk work. At four weeks, you can begin light, non-impact cardio exercise, such a recumbent (sitting back) bicycle. At six weeks after surgery you will be released to ease back into full exercise activity. The internal healing process takes longer than you think, so it is important that you return to your regular exercise routine slowly and carefully. When you resume an exercise you have not done in a while, try it in a small dose and see how you feel the next day. If you are sore, you probably pushed yourself too hard. Let your body be your guide to what is the right amount of exercise. Running and high impact exercises are the hardest on your body and you may need to put these off for a number of months (i.e. an elliptical machine is better than jogging on a treadmill). For breast augmentation patients, it is also better to avoid or minimize pushups and bench press exercises because these can affect the appearance of your implants.

Why do I have to wait so long to exercise?

During the first few weeks after surgery, straining yourself puts you at higher risk for bleeding or disrupting stitches and needing to go back to the operating room. Even after this early period, your body is working hard to heal all of the surgery areas, so you do not want to divert the energy of healing to unnecessary exercise. Your body will recover faster and get more benefit from exercise if you are patient and wait the appropriate amount of time.

When can I drive?

You can drive when you are completely off all pain medications and are healed up enough that you can react quickly in an emergency situation without causing pain or damage to your surgery site. Remember, it is a DUI if you are caught driving within 8 hours of taking prescription pain medications.

Medications Refills / Non-Prescription Meds / Ointments

What should I do if I am running low on pain medications?

If you are low on pain medications and feel like you still need them to function well, please call our office early, rather than waiting until after-hours or the weekend. Some medications, such as percocet, can only be refilled with a written prescription and cannot be called in over the phone. There are alternative medications that can be called in, but it is always better to call us during office hours so that we will have the most options available to help you.

Do I have to take the colace (stool softener) after surgery?

Absolutely, yes! Your pre-op instructions and shopping list include the use of an over-the-counter stool softener (Colace 100mg, twice a day) after surgery. This is not a laxative. The pain medications during and after surgery dry out your stool and put you at high risk for constipation unless you use the colace to counteract this problem. You need to continue taking colace twice a day until you are off all pain medications and having normal bowel movements. If you still have not had a bowel movement after a few days with the colace, we recommend an over-the-counter laxative suppository called Dulcolax, which can be used twice a day (in addition to the colace) until you have had a bowel movement. If even this doesn't work after a day or two, please contact the office for further recommendations.

What is the Aquaphor ointment for? When do I use it?

The Aquaphor is a medical grade petroleum jelly. It helps to keep fresh incisions moist so they heal faster. You will use it on your incisions after your steri-strips are removed. The Aquaphor only needs to be used for a few days to a week on incisions, but it can also be used if you have any small areas that are slow to heal. The Aquaphor should be applied in a thin layer (like lip gloss) twice a day. You may need to cover these areas with gauze to prevent staining of your clothes.

Should I use Mederma, Vitamin E, or a similar product on my scars?

There is not a lot of evidence that Mederma has any special powers against scars. You are certainly welcome to use it after the incisions have healed. Vitamin E can actually be harmful to scars and should not be used either topically or orally (it is fine in a multivitamin). If there are any issues with raised scars, the best product is silicone sheeting, which can be ordered online, or bought at the pharmacy (Neosporin Scar Care). Silicone sheeting needs to be worn around the clock for a few months to have an effect. Alternatively, simply rubbing any firm areas of scar tissue will help to soften and remold the scars. Scars will generally fade from pink to white over a period of a few months to a few years depending on the person.

Sex / Alcohol / Tobacco / Tanning

When can I resume sexual activity?

Although many of my Phoenix reconstructive and cosmetic plastic surgery patients are embarrassed to ask this question, it is certainly an important issue. Resuming sexual activity depends on the type of procedure you have undergone. If you have had breast augmentation and/or a breast lift, or a breast reduction, you may resume careful sexual activity around the two week mark. You should be lying on your back, and your partner should be very gentle. You should not have the full weight of your partner on top of you. This timeline also applies to liposuction, mini-tummy tucks, and facial surgery. If you have had a full tummy tuck surgery, or labia reduction, you may resume sexual intercourse after six weeks. Use your body as a guide: if it hurts, don't do it!

When is it ok to consume alcohol?

Alcohol use should be discontinued 2 weeks prior to surgery. It is reasonable to consume alcohol modestly starting 2 weeks after surgery. Do not drink more than 1-2 drinks in a day until at least 6 weeks after surgery. Do not drink any alcohol when on pain medications or antibiotics.

When can I resume smoking cigarettes or using tobacco?

Smoking and tobacco use are about the worst things you can do with regards to wound healing and infection risk, so in reality you should never start again. It is absolutely critical that if you do restart, you wait at least 6 weeks after surgery to allow the incisions to progress with regards to healing. During this time you must strictly avoid second hand smoke exposure as well.

When can I tan?

Once again, the best answer to this question is to minimize tanning after surgery as it causes darkening of the scars and weakening of the skin elasticity. With proper use of sunscreen, it is acceptable to have prolonged sun exposure after four to six weeks. Even if your scars are covered by a bathing suit, you need to keep sunscreen on your incisions under your bathing suit. You should avoid any tanning of your scars for 1 year after surgery to minimize darkening of the scars (this does not mean you have to avoid the sun for a year- just remember to protect your scars with clothes and/or sunblock).

Breast Massage

When do I need to worry about breast massage?

Anyone who has smooth (as opposed to textured) breast implants placed needs to begin a daily regimen of breast massage starting 48 hours after surgery. Breast massage is generally done twice a day and should be continued as a lifelong habit to minimize the risk of capsular contracture (tightening scar tissue around the implant). For patients with textured Sientra implants, I generally do not recommend any massage. At most, I may have patients do some downward stretching in the early recovery period. This will be demonstrated to you at your follow-up appointment. I do not advise breast massage in patients who have Strattice™ in addition to their implants.

How do I perform a breast massage?

The breasts need to be massaged in three directions: 1) upward, 2) towards the cleavage, and 3) downward. I do not recommend outward massage as this can create excessive space between the breasts. If you are performing the massage yourself, start by placing one hand on top of the other (palms upward) then push upward and towards the body with your hands on the lower left breast. This forces the implant in an upward direction and stretches out the upper breast pocket. Repeat for the right breast. The massage for the cleavage works the same way except you are pushing on the outer breast towards the body which moves the implant towards the middle, thus stretching out the pocket. Repeat on both sides. Finally, for the downward stretch, place your overlapped hands on the upper breast just above the areola. Press your hands towards your body in a somewhat downward direction. This will force the implant down and will stretch out the lower breast.

How long do I massage in each direction?

Each direction should be done with 2 hands at the same time and should be held to a count of 30 seconds. Press in slowly until you feel a good stretch. This may be sore, but stop before you feel true pain. Make sure you press in and release slowly and gently to minimize discomfort.

Are there any exceptions to breast massage?

As noted above, patients with textured implants or Strattice™ are not adviced to do breast massage. If you have had a revision breast surgery with internal pocket tightening, the massage regimen may differ so please refer to the specific instructions of your Phoenix plastic surgeon at your postoperative visit.

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