So right after surgery, patients will awaken in the operating room. They usually don’t remember that part because they’re quite sleepy. We make sure that they’re stable and then we transfer them to the recovery room for observation. So we watch patients for an hour or two prior to discharge home with a responsible adult. And a few of the things we’re looking at are to make sure that the blood pressure and heart rate are stable, that the patients are not experiencing any kind of severe pain. Mild pain is normal after surgery. but severe pain is unusual. Patients should be able to tolerate some food and water. And before they go, we place a surgical bra for support.

When you arrive home after breast reduction surgery, I recommend that you get into bed and take a nap for two to three hours. Your breasts will already be swollen. Don’t panic. This is really normal. What I find is that the minute I put in the last suture, the breasts start to swell after reduction surgery. So I tell patients, when you wake up and look at your breasts, that’s not the final result. After you wake up from your nap, eat something solid, take pain medication if you need to, and then get into a nice warm shower. Now, a lot of my patients will have drains for one night after surgery. This is very surgeon dependent. So I tell my patients that if you have drains and you want to hold on your shower, that’s totally fine. A lot of patients get nervous about taking a shower with drains in. So if you want to just avoid the shower, just relax that evening. And then typically I’ll see patients a day afterwards. At that time, we take out their drains and we also perform lymphatic drainage. Lymphatic drainage is completely optional. Not every surgeon does this. I’ve found it’s really, really helpful for breast reduction patients right after or right before we take out the drains because it does help to get some of the extra fluid out and decrease the swelling. The breasts will definitely feel quite swollen at this stage, so I recommend that patients continue to wear their surgical bra for support. I ask them to avoid heavy lifting, exercise, and sexual activity for two weeks after surgery.

Two days after surgery, the breasts are obviously still swollen. We recommend wearing your surgical bra for support. The pathology results are usually available within a few days after surgery, and we call the patients to review those. Per New York state law, anything we take out from the breast has to be sent off to the laboratory for evaluation. I can tell you that having done thousands of breast reductions, I’ve only had two or three patients who’ve had anything unusual on their breast pathology, and fortunately, in all cases, it just needed to be observed. Most patients are able to return to work a few days after surgery, usually three or four days, but I still recommend avoiding heavy lifting, exercise, and sexual activity.

10 to 14 days after surgery, I see my patients back in the office, and at that point, I take off their Steri-Strips, which are little sticky dressings on top of the incisions. Most of the sutures that we put in are dissolvable. Anything that isn’t dissolvable is trimmed or removed, and the incisions are checked to make sure that they’re healing well. At this point, I allow my patients to get back to exercise as tolerated, and I recommend gentle, controlled motion. Patients can do heavy lifting at this stage as tolerated. What I recommend to everyone, whether they get back to activity within two weeks, three weeks, four weeks, take things slow. Go back to your normal level of activity slowly. If anything hurts, just stop and wait for a day or two. This is a good point at which you want to listen to your body. You can resume taking all medications, including anti-inflammatory medications such as Advil or Aleve. But again, keep it conservative. Don’t take anything if you don’t need to. If you take anti-inflammatory medications such as turmeric, take the normal dose. Don’t take several times your normal dose. Just keep everything at the normal level. I give my patients a scar balm to start using on all of their incisions, so I tell them to start using it at this point, and then continue using the surgical support bra for about six weeks after surgery. Now, this is going to be very surgeon-dependent. I recommend six weeks because about 80% of your incision healing is done at that point. So I find that if you have good support for that period of time, your scars are less likely to become wide or thick.

Six weeks after surgery, you’re still going to be swollen. There are no limitations on your activity at this point, and you can wear any garments that you want.

Three months after surgery, I bring patients back for another evaluation. The swelling is just beginning to come down at this point. It’s not completely down. And some patients who have very fatty breasts, as happens after breastfeeding or menopause, a lot of that swelling will be starting to come down at this point, but for the majority of patients who have very dense breast tissue, there’s just a minimal reduction in swelling. Mild asymmetry is really normal at this stage. We always joke that the breasts are sisters and not twins. One breast swelling will definitely, definitely come down before the other breast swelling. So keep in mind also the breasts that had more tissue removed usually remain swollen for a bit longer. Patients with denser breast tissue, as I just mentioned, may remain swollen a lot longer than those with primarily fatty breasts.

Six months after surgery, I bring the patients back to the office for a final visit. We took photographs and usually at this point their breast swelling has started to come down quite a bit. However, in most cases there’s still some present, especially on the lateral or the sides of the breasts. Mammograms are totally okay at this stage, but make sure you tell your mammographer that you’ve had a breast reduction.

About a year after surgery, most if not all of your swelling should have resolved. Again, my younger patients around 18 or 19 years old with very, very dense breast tissue may notice some lateral swelling that persists. That will go down. The scars will continue to fade, although some patients may note persistent scars with time. So that’s really our post-operative regimen.