Pre & Post-Operative Instructions

Pre-Operative Preparation

What not to do before surgery

• Do not eat or drink after midnight on the night before your procedure, unless instructed otherwise.
• Do not smoke for at least six weeks before and six weeks after surgery. Smoking significantly increases the risk of complications, particularly with implants — ideally, do not resume after surgery.
• Do not consume alcohol for two weeks before and one week after surgery.
• Stop all vitamins and supplements at least two weeks before and one week after surgery.
• Do not take anti-inflammatory medication for at least one week before and after surgery. This includes ibuprofen, Nurofen, Voltarol, Naproxen, Piroxicam, Indocid, Surgam, Froben and Lederfen.
• Do not take anticoagulants or blood-thinning medications containing aspirin/salicylates, or cold and flu remedies such as Lemsip, for at least one week before and after surgery.
• Avoid garlic and garlic-containing foods for one week before and after surgery, as this increases bleeding risk.
• Remove all piercings, nail varnish and artificial nails before coming to hospital on the day of surgery.
• Do not wear contact lenses, eye make-up or face make-up on the day of surgery.
• No sun holidays should be planned until 4–6 weeks post-operatively.

What to do before surgery

• Take any regular medication previously approved by Mr Sarakbi, up to and including the day of surgery — check with us if unsure.
• Shower or bathe on the morning of surgery or the evening before, cleansing your entire body.
• Remove contact lenses, nail polish, jewellery and all make-up at home on the day of surgery.
• Wear comfortable, loose, front-opening clothing to hospital.
• Bring your post-surgery bra to hospital.
• Arrange for a responsible adult to stay with you during the first 48 hours following surgery, as you may find it difficult to move around.
• If you will be at home alone (not recommended), shop for prepared meals, fruit and other easy foods in advance.
• You will be given antibiotics and pain medication before discharge — take them exactly as prescribed and complete the full antibiotic course.

Post-Operative Recovery

Common symptoms following breast surgery

The following are normal and expected as your body heals:

• Tightness, heaviness, stiffness, tingling, burning or intermittent shooting pain — these are normal as skin, muscles, tissues and sensory nerves heal, and as the muscles stretch to accommodate implants (if applicable). Pain medication will help manage discomfort. Consistent sharp pain should be reported to us immediately.
• Shiny skin or itching — swelling can cause the breast to appear shiny. Mild to severe itching of the incision area is common during healing. An antihistamine such as Claritin can help with severe constant itchiness. If skin becomes red and hot to touch, contact us immediately.
• Bruising and swelling — typically resolves within 2–4 weeks, though residual swelling may persist longer.
• Asymmetry — breasts looking different or healing differently — completely normal. No two breasts are perfectly symmetrical; they may look or feel quite different from each other in the days and weeks following surgery.

From discharge until your first post-operative appointment

You will only be discharged into the care of a responsible adult. All of these instructions must be clear to the adult who will monitor and support you in your first days at home.

• Rest, but not bed rest — rest is important early on, but equally important is that you are ambulatory. Spend approximately 15 minutes every two hours in light walking indoors.
• Recline with head and chest slightly elevated — use two pillows under your head. This is more comfortable and helps reduce swelling.
• Monitor your symptoms and be alert to the warning signs listed above.
• Stay hydrated — drink non-carbonated, non-alcoholic, caffeine-free beverages such as water, fruit juices, milk and yoghurt drinks.
• Eat well — follow a soft, bland, nutritious diet for the first 24 hours. Constipation and bloating are common after surgery — increase fluids, reduce salt, eat bananas and high-fibre foods. A stool softener such as Miralax may help. Take prescription pain medication with a small amount of food to reduce nausea.
• Take all medication exactly as prescribed — complete all antibiotics unless told otherwise by Mr Sarakbi.
• Keep incisions and dressings clean and dry — leave dressings in place until your first follow-up appointment, or until instructed to remove them. You may sponge bathe with assistance, or use baby wipes.
• Do not smoke — smoking impairs healing, increases infection risk and results in more noticeable scarring. Your caregiver must not smoke anywhere near you.
• Limit arm use to daily activities such as brushing teeth, eating and brushing hair for the first few days. Avoid pushing, pulling or lifting.
• Wear your surgical garment/support bra at all times as directed. (For patients with implants under the muscle, a breast band must be worn for 1–2 weeks, day and night.) You may remove garments for one hour per day — or 20 minutes in the morning, 20 minutes at midday and 20 minutes in the evening.
• Apply cool (not cold) compresses to alleviate discomfort, swelling or bruising. Wrap ice packs in a towel. Never apply ice directly to skin. Apply for no longer than 20-minute intervals. Do not apply heat — it will worsen swelling.
• Do not lift your hands above your head. Do not lift anything heavier than approximately 3 kg.
• Do not drive until after your first post-operative appointment — driving can usually be resumed 7–14 days after surgery.
• Your first post-op appointment will be approximately 7 days after surgery. Your dressing will be changed and initial healing assessed.

From your first appointment until your 6–8 week appointment

You will feel better day by day. It is important to ease into your daily activities gradually.

• Gradually ease back into your daily routines — but still no heavy lifting, exercise or strenuous activity.
• Continue wearing your post-surgery bra — day and night, until your 4–6 week appointment.
• Shower, but do not bathe — warm (not hot) showers are fine, limited to 10 minutes. No baths yet.
• Continue to cleanse wounds as directed.
• Moisturise the skin on your chest — it will feel dry, flaky and itchy. Use Bio Oil or any cream containing vitamin E.
• Walk daily — walking every day is essential to prevent blood clot formation.
• Maintain a healthy diet.
• Do not smoke — while incisions may have sealed, smoking deprives your body of oxygen needed for proper healing and results in wide, raised scars.
• You may sleep on your side 2–3 weeks after surgery — a soft pillow under your mid-back and shoulders offers more support than a single head pillow. Do not sleep on your stomach at this stage.
• At your 6–8 week appointment, Mr Sarakbi will show you how to massage your breasts and care for your scar.
• No sun holidays during this period.

After your 6–8 week appointment

• Ease into your regular fitness routine — be aware that your upper body may take time to return to prior strength. Always wear a high-impact sports bra during exercise. If you feel pain when exercising, pause, then gently resume. Pain following a workout may be relieved with ibuprofen.
• Most bruising, swelling and discomfort should have resolved, though for some patients it may take longer.
• Massage your breasts with Bio Oil — as instructed by Mr Sarakbi, 10 minutes per breast per day for 3–4 months. The longer you continue, the better — this increases blood circulation, aiding healing and helping the breasts feel softer and settle faster. Never massage straight after a shower or bath as the risk of implant rotation is high.
• Continue scar care as directed — apply a circular, light-pressure massage over your scar with Bio Oil to aid healing and improve appearance. Scars will be firm, pink and bumpy to start — they improve significantly with massage and typically take 6 months to a year to fade into fine lines and flatten.
• Practice good sun protection — do not expose your breasts and scars to direct sunlight for up to one year following surgery. Apply at least SPF 50 to your chest, breasts and scars, and cover them in the sun. Sun exposure during healing can cause inflammation and unnecessary complications.
• Do not wear an underwired bra for six months after surgery. Wearing one occasionally for a few hours is fine, but should not be routine.
• You do not need to wear a bra at night, but support at other times is important — gravity and implant weight can cause premature sagging.

Ongoing care

• Continue the monthly self-examination of your breasts.
• When having a mammogram, always inform the radiologist of your surgery, regardless of the type of breast surgery you have had.

We are always here to help — please feel free to contact us if you are in any doubt, or have any questions at any stage of your recovery.