Speaker 1: Welcome to Plastic Surgery talk with Dr. Steven Mulholland, brought to you by Spa Medica.
Dr. Steven M.: Hello and welcome. Dr. Steven Mulholland here in Toronto, Canada with Plastic Surgery Talk and welcome to our podcast series. Today we’re going to talk about some of the post-breast augmentation lifestyle questions that I get commonly asked over the past 25 years. This will hopefully help you understand what you’re in for once you get the nice improvement of your figure, shape and form. If you really enjoy these podcasts, please a sign up, subscribe, comment on them, share them on your social media channels with friends and family, and we look forward to you joining us every week. So you’ve undergone a breast augmentation. Most commonly in 2018 is going to be a gummy bear, cohesive gel silicone implant is going to respond to gel. This is the kind of gel that’s not liquid but a softer than earlier generations of gel 10 years ago.
Dr. Steven M.: And when you stand up, it’ll slide a bit and look teardrop. When you lie down, it’ll look round. They feel natural. They don’t tend to feel ripley, they don’t feel artificial. They actually feel quite natural. Most common is going to be an under the breast incision, is going to be inserted under the muscle most commonly, so that’s the most common kind of breast augmentation now, cohesive gel, gummy bear, inframammary incision, submuscular pocket. And you’re going to use some type of Vectra 3D or computer imaging that’s going to help you decide before you do the breast surgery, what kind of size and shape looks best for you. Now you’ve done the surgery, you’ve gone through for the first two or three days. We have quite a bit of pain like running through the house. You your thigh in a coffee table and you’ve got a charlie horse, but now you’ve got one here and one there and when you breathe in as sore and it feels like you’ve got a horse standing on your chest and it’s uncomfortable and so you’ve gone through that two days.
Dr. Steven M.: You now coming out of that kind of discomfort, it’s now more of a stiff bruise. You’re able to move more. You’re able to do a little breast massage. Now, what can you expect? You’ve gone through the hard part, it’s done in your healing. Over the next two or three weeks, the implants will drop into their pockets more. They tend to write a little high in the submuscular plane. They will drop and soften as the skin and the soft tissue envelope stretches out. You’ll generally find they look quite good in an open blouse or a lower neckline by about three weeks. By about three weeks, you can start general physical activity. For that first week or two, you’re not going to be exercising other than doing your stretching, touching the top of your head, moving your pec major, your deltoid, your shoulder, so your shoulder doesn’t get stiff.
Dr. Steven M.: You’re really not going to be massaging the breast or breast implants, you need the incisions alone and at about the two or three week mark, we generally see patients back. We show there’s some general softening lymphatic massage exercises to soften the engagement and the breast to get the implants to drop a little more, and at two or three weeks you can start going back to the gym and you could do an elliptical stair climber, some leg exercises like the thigh master your calves. You’re not going to be at working your pec major, your chest muscles. You’re not going to yet do jogging. That high impact aerobic activity will not feel good, but elliptical stair climber, stationary bike by three weeks for sure, by six weeks, by six weeks, things have dropped. They look really good and you can start to go back to the gym and start working on your pec major again.
Dr. Steven M.: Do some pec flies, do some bench presses for some pull-downs. Start working on your bicep, start toning through yoga or palates, and then at six weeks you can start to jog. Now you’re going to have to wear a supportive sports bra, maybe even double down on two sports bra, and you can start to wear an underwire if your incision’s well healed, so by two to three weeks, modest exercise and activity by six weeks, a full return to starting to strengthen and tone your entire physique, including the chest area. Okay. It’s one thing to return to the gym and your physical exercise routines. If you don’t work out, you can return to that immediately. If you have to go to a job that is sedentary, desk driven, computer and phones, you could literally go back to work on day three. I don’t recommend it. I think that’s being unkind to yourself and certainly maybe unfair to the work environment where you might not be as productive because you’re still in pain.
Dr. Steven M.: Do people do it? Absolutely. They don’t have any sick leave. They have no work pay. You might have to get back to do your job because time is money and if it’s sedentary without much lifting or activity, a desk job, day three. If you have a more active job that is still office space where you still have to lift things, move around and be active, I generally recommend a week. In fact, if you can all afford to with your holiday pay or you’re sickly, you want to take a week off just to be kind to yourself. Once you get back at a week, it can be answering the phone and moving. It can be lifting office supplies on loans. That’s not a heavy duty job. Let’s say a Ford Motor plant on an assembly line. If you’ve got a heavy duty job with heavy lifting, you’re a server carrying trays of beer glasses, plates and food, 15, 20, 25 pounds.
Dr. Steven M.: You really need to wait often two to three weeks to get back to that kind of heavy activity job. What if you have little children and kids, which is why you had the breast deflation in the first place? When can you hug them? When can you hold them? When can you pick them up? Because if you have a little toddler, they’re not gonna understand why mom can’t pick them up and can’t hug them. And so in general, if you have really, really young kids and a lot of them, they’re 18 months, 24 months and they’re very active, you might consider hanging out at a good friend’s place for five, six, seven days. Because when you go back, you’re back into the fray of being a mom with young kids, you want to be able to pick your 20, 25 pounds toddler up and hold them, hug them without having too much discomfort.
Dr. Steven M.: So I recommend staying with a friend for three, four, five, six days if you have a young family, if you have a little older family, where they’re four, five, six, seven years old. Don’t have to be picked up or being driven to their activities. You can just say, “Mum’s got a booboo and really can’t hug you.” But you can start being huggy and affectionate, you can lean in and not do that sort of fraternity hug with your kids. Mom’s got a booboo and the full on chest hug is usually around two or three weeks when you’re back in the gym if you’re a workout or doing the elliptical. And so when you have kids, you’ve got to plan around it because they don’t appreciate that mum’s recovering from surgery and you’ve got to be kind to yourself so you don’t have a lot of pain and discomfort from just too many kitty hugs. Be careful.
Dr. Steven M.: What do you wear after your breast augment surgery? In general, and most plastic surgeons are pretty consistent, a nice soft sports bra that’s supportive but not too constricting and tight. Certainly no underwire. Now, if you get a non-sports bra with an underwire on the day of surgery, your surgeon staff or team will cut and take out the underwire. You don’t want that kind of pressure on your under the breast inframammary incision. So a soft non underwire wonder bra or a simple Nike, Lululemon Under Armour type of sports bra that gives you support. In general, we encourage women to wear that supportive non-underwire sports bra for about six weeks, morning and night? So you’re gonna lie in bed at night. You’re in pain, you’re not gonna be able to lie on your tummy. It’s going to hurt too much in the first week to two weeks, increasing you can start to lie on your side.
Dr. Steven M.: You still want support from that sports bra and if you’re lying on your back, even better because there’s no pressure on the breast and you’re not putting pressure on your face, creating all those lines and wrinkles, so back sleeping is preferred, side sleeping will be acceptable. Front sleeping won’t be comfortable to be able to do that for about six weeks and during that first six weeks, a sports bra, 22 hours a day, when you’re not wearing it, shower, wash your hair cleanse, dry, put on the sports bra, close and right to work. Does the modern cohesive gummy bear gel implant shift after surgery? And the answer’s almost always no. Now shift versus move. These are two different things. You want a natural implant that integrates with the breast over top of it and the two move together as a breast would, it bounces, it moves, you lie back, you go to your side, you stand up, you want the breast to ship within the pocket and you want it to move in conjunction with your normal breast gland over top.
Dr. Steven M.: What we don’t want to have happen is have the entire pocket expand from the way to the implant and then it’s too floppy, too hyper mobile and that’s called pocket expansion, which is opposite to one of the more common complications in about one and a half to 2% of cases where you get hardening of one or both breasts. That’s a capsular contracture and there’s no movement and that usually needs a surgical correction. Fortunately it’s only about one and a half to risk at about one and one and a half percent, the implant will stretch out the pocket over time and the implant will move around too much. It won’t go where it doesn’t belong, but it may fall into your armpit or be too low and you lose some of that support, so pocket expansion and hyper mobility can also be easily corrected by tightening up the pocket, proceeded that being form under local anesthesia, and it only happens about one to 2% of the time.
Dr. Steven M.: Are there any other medium short or long-term lifestyle adjustments after breast augmentation? Well, the first question I often get from young, middle age and even older women is, “When can I be intimate again after breast augmentation, when can I have sex?” And my answer is always just like exercise, there’s low impact intimacy and high impact intimacy. High impact intimacy, where your significant other is lying on top of you. It’s just not going to feel good having 180 pound guy or partner lying on top of your freshly augmented breasts. And so just like lying in your tummy, that’s a no, no for about six weeks. It doesn’t mean you can’t by week two or three have low impact intimacy and sexual activity just like in a gym, elliptical stair climbers. Okay? So use your imagination about low impact activities, low impact intercourse, low impact contact.
Dr. Steven M.: Perfectly acceptable. As long as you’re not traumatizing or entering the breast tissue. What other short and long-term lifestyle adjustments need you make? Well, think about it. You now have a figure shape and form that doesn’t require breast pads anymore. So you’re going to have to buy new clothes and new wardrobe. You may have to get a new cocktail, dress or evening gallery, you can now wear tank tops without a bra or more blouses with plunging neckline, your actual bus size, you haven’t been padding up, we’ll increase. You may have to get new tops. You may have always pad it up and you can throw away all your padded bra or browse and buy non-padded bras. The lifestyle is going to be, you’re going to show and probably more reveal more of your breast and cleavage. At social events and you have to get used to that and by the appropriate clothing to do so.
Dr. Steven M.: You’re also gonna find that when you exercise, you’re going to be a little more self-conscious that you’re a little more busty. And so some women love that and they show off their new enhanced a breast assets in the gym, while the others are quite self-conscious. They don’t want that attention and they’ll often have to double down on a sports bra, two sports bra to keep the breast implants contained while they’re working out because you’re always doing place slight and small chest and an athletic looking. Now you’re a little more busting. That may not be a good thing because you don’t want that. You have that unwanted attention in a gym and that will extend to your social life. You may find you had a lot more glances where guys just look right at your chest and not your eyes when talking to you.
Dr. Steven M.: You may like that and want that. Many women don’t. And so you might find that in the workplace you’ve been padding up and wearing a blouse that does up, you may continue to do that because you don’t want the unwanted attention. You’re certainly going to find your athleticism maybe compromised somewhat. If you’re a cross trainer, if you do half marathons, if you do five and 10k races, you’re not used to running that race with three or four more pounds of cohesive gel and you’ll find you might not be quite as fast and quite as limber as you were before, but you’re only working out for a small percentage of your life and the other advantages of having a balanced figuring for them more than outweigh those of those moments, and so there are many ways that breast implants will work their way into your lifestyle.
Dr. Steven M.: You’ll be more considerate of their impact on how you appear to others or how you allow them to appear to others, and this will affect your athleticism, your exercise, your social life, your dating life, and the workplace. So you got to think about these things in advance or anticipate them and not be stressed out when they occur. Again, a lot of questions from breast augment patient. “Am I going to loose my sensation to my nipple and areolar area. Am I going to be numb? A I going to be hypersensitive. Can I still breastfeed after? How long will the swelling last one, when will it feel natural?” These are very common questions and so first when you do a breast augment with the under the breast incision, you leave all the nerves and tat to the nipple. However, you’re taking your breast and you’re increasing in about an hour.
Dr. Steven M.: The projections, you’re stretching all those sensory nerves and when you stretch them, a lot of them will go through temporary numb peers, so you will have patchy areas of the breast that may be numb, especially above the scar on the sides of the breast, and sometimes even the nipple areolar complex right in the middle can be numb and you’re worried it’s going to be permanent. Rarely is it permanent, a stretch nerve usually returns over three, six months. You get your sensation back. Occasionally you can get permanent numbness. What about production of breast milk? Let’s say you had an augment when you’re younger. You get married in your late 30’s and you had decided to have children. Can you breastfeed after breast augment? The answer’s almost certainly, yes. About 85 to 90% depending on the study you read of all breast, augment women who then get pregnant at some period after their augment can successfully breastfeed.
Dr. Steven M.: And so you have a huge probability that you’d be able to breastfeed if you can’t, you’ll never know because you had small breasts that were meant to breastfeed because up to five or 10% of women can. Or was it the implant that pressed on the ducks and that compression compromised your ability to make milk, but 85 to 90% chance, no problem. Many patients also ask then, “Will I ever have to get new implants? Do I have to swap these out?” And in the earlier days in the 70’s and 80’s and 90’s when saline implants were more common, salt water fill rather than cohesive gel, almost invariably you’d have about one in two chance that by 10 years, 50% chance one or both implants have deflated and you have to swap them out. So that’s where that 10 year came from.
Dr. Steven M.: If your cohesive, gel implants are doing well and you love them and they’re soft and you’re liking them. You leave them for the rest of your life, In fact, the cohesive gel implant, the modern ones made by elegant or mentor are warrantied for life. There are hardy little device that never meant to be changed, and so there’s no 10 year shelf life, they’re there, bumper to bumper warranty for the rest of your natural born days. Are there any other complications other than wound healing? A good scar, minimizing the risk of sensory nerve loss, capsular contracture, which is an immune reaction to the implant. These are the more common things. One, two, 3%.
Dr. Steven M.: And generally they’re fixable. There are some unusual and rare complication you need to watch out for occasionally, especially textured implants which are not as common, no smooth implants, but in the textured implant world when you get a capsular contracture, you can sometimes get fluid buildup around the implant called the Seroma and even get a delayed many years later large cell lymphoma or lymphomarous type infiltration around the implant that doesn’t tend to happen with smooth implants and the modern approach to implant surgery, but it’s a rare complication that you need to watch out for.
Dr. Steven M.: You can’t get late fractures and compromising of the implant many years later, skiing or during a sporting activity, they can fracture. You need to watch for change in the shape they don’t leak because there’re semi-solid cohesive gel implants. But you can get delayed contracture, you can get soft, beautiful breasts. You’ll love them. 15 years later you get of an illness like inflammatory bowel disease or pneumonia and the immune system gets activated and you start to get hardening or one of your breasts and into late fashion. So you need to watch for long-term complications. One thing we do know, breast implants do not cause cancer. They can get in the way sometimes of detection of breast cancer or typical and traditional mammogram.
Dr. Steven M.: A lot of countries in the world, a lot of centers have moved towards MRIs, for following, for breast cancer. And so in general, you want to do acceptable screening, a mammogram, high resolution ultrasound, and you want to do an MRI to screen for breast cancer. You want to use your fingers to feel for lumps on a daily basis and you have the lump that doesn’t go away after two menstrual cycles or staying the same or getting larger. See your family physician, schedule for imaging, MRI, preferred mammogram, high resolution ultrasound, fine needle biopsy, lumpectomy, maybe radiation, maybe chemotherapy.
Dr. Steven M.: But your implant will live usually happily ever after under the muscle. So thank you again for joining me. Dr. Steven Mulholland in Toronto, Canada on our plastic surgery talk network with our podcast series. Today’s podcast was on Lifestyle and Recovery after Breast Augment Surgery. The things you need to think about, things that may impact upon your experience over that first six weeks, six months or a year. So I hope it was informative. I hope it helped. And if it has, please subscribe to our podcast series. Leave a comment and share the podcast on all your social media channels I look forward to seeing you next time.