/Body Feminization Surgery/Practical/Postoperative instructions/Breast augmentation by implants/

Breast augmentation by implants

If you are not staying in our Guesthouse: a responsible, capable adult should accompany you during 24 hours after the procedure. If you are staying in the guesthouse: a night nurse is present during the night, as are Petra (our nice resident) and your patient coordinator during daytime; they will take care of you.

General

Freakout — You need to understand as well that even though you may want this surgery more than anything else in the world, most transgender women that undergo breast augmentation freak out right after surgery. The freakout is due to three factors – first, suddenly having this huge mass on your chest which you’ve never had before, which can be psychologically shocking. Try to prepare yourself for this, and if you have a spouse or significant other, tell them to expect that you could freak out. Second, the effects of general anaesthesia can produce unusual psychological effects for days to even weeks after surgery. And third, you may very well be in some degree of pain, not only from the incisions itself, but from the discomfort of the skin stretching.
Pain — Your level of discomfort will depend on where your implants are placed. If your implants are placed on top of your chest muscles, your pain will subside quicker (in about a day) than when they are placed under the chest muscle (a few days). Feelings of sharp shooting pain, burning pain, or general discomfort are common as part of the healing process and will eventually go away. Usually serious discomfort passes 1–2 days after the surgery. We will provide you with pain medication to make sure that you are comfortable during recovery.
Swelling and bruising — After surgery, your breasts may appear discoloured and will feel very swollen. These are normal side effects of surgery that will gradually subside over the course of several weeks. A medium level of bruising and swelling is normal. Your breasts will probably feel sore and swollen for at least a month after surgery. If you have a large amount of swelling, see a doctor.
Resuming activities — After 2-3 days have passed, you should resume very light activities, such as walking around your neighbourhood. This will minimise swelling and reduce your risk of blood clots. Regular physical activity should be avoided for at least three weeks, and strenuous exercise (such as heavy lifting) should be avoided for at least 5-6 weeks. If your job requires a lot of physical exercise, you may require additional time off from work, or your normal work routine will have to be modified. You can go back to your usual routine when you feel well enough to do so (i.e., normal movements don’t cause pain). This is typically after 1–2 weeks but can take longer in some cases.

Before your operation

We will provide you with the following items:
- Painkillers: Paracetamol-codeine, Tramadol, Voltaren.
- 2 sports bras.

Day after surgery

Keep your Implant ID-card together with these guidelines in a safe place. There is a life long warranty on your implants.

Do not make any forceful movements of the chest muscle and do not raise the arms above your head.
It is normal to experience tension and pain in the chest or diminished strength and mobility of the arms.
No shower — Best is to leave the bandages on the breast alone: Wash at the sink.
Muscle stretching exercises — As soon as you are sufficiently awake: Gently pull back your shoulders five times per hour. Do not raise your arms above your head.
Painkillers — The first 2-3 days will be the worst. You will be provided with three lines of pain killers.
- 1st line — Paracetamol–Codeine tablets: 1 to 2 every 4 hours, maximum 6 tablets a day.
- 2nd line — If still in pain: Tramadol 50mg: every 4 hours one, maximum 6 tablets a day. Might give light nausea and dizziness.
- 3rd line — If still in pain: Voltaren 100mg (suppository): one in the morning, one in the afternoon and one in the evening. If not sufficient, please ask the nurse. We can provide more.
Sports bra — You should wear the sports bra continuously for 4 weeks!

Day 2

No shower — Best is to leave the bandages on the breast alone: Wash at the sink.
Micropore tapes — Keep the micropore tapes over the scars for 10 days.
Painkillers same as day 1.
Muscle stretching exercises — More muscle stretching exercises every hour, under a hot shower, if necessary.
Sports bra — A sports bra should be worn continuously for 4 weeks.
Large implants warning — If you have rather large implants, and little skin to start with, the breast might look a bit weird at this point. The skin from the lower pole will however stretch, and volume that is above the nipple will go more below the nipple. Do not freak-out or worry! It takes about three months for the skin and breasts to settle.

Day 3

Pain killers — Gradually diminish your painkillers (start with dropping the third line, then the second line etc).
Muscle stretching exercises — Stretching exercises of the pectoralis muscle.
Take off sports bra for the first time; remove compresses/gauzes over the scar (don’t worry, there is micropore tape underneath covering the scar!). The micropore tapes should be left in place till day 10.
Hot shower — You are now allowed to take hot showers (no baths!).
Sports bra — A sports bra should be worn continuously for 4 weeks.
Gradually resume all activities that are not painful. Avoid forceful movements of the pectoralis muscle, weight lifting or raising the arms above head level.

Day 4 and following

Gradually stop all painkillers.
Stop stretching exercises.
A daily hot shower to relax the muscle for as long as is necessary. Enjoy!
Sports bra — A sports bra should be worn continuously for two weeks.

Day 10 and following:

Remove band-aids around the scar.
Remove the continuous suture by gently pulling the end. If there are little loops, cut these first.
Gently massage the breast and body with moisturizing cream, not the scar itself.
Micropore tape — replace the micropore tape over the scars to block them from widening. Use the micropore tape for 3 months. We believe this is better than scar creams. After these 3 months, you can still use a scar cream. However (!) the scar should be closed to continue micropore at this point. If in doubt, send a clear picture to dr Doornaert, because micropore can trap fluids coming out of a non-closed wound.
Sports bra — A sports bra should be worn continuously for two weeks
Resumption of activities or sport — After 4 to 6 weeks.
Solarium — Allowed after six weeks, always use sunblock on the scar area.
See your surgeon for a checkup after six weeks, one year and every five years.