2. POST-OPERATIVE INSTRUCTIONS : DRAIN CARE

A drain has been placed to evacuate fluids that will accumulate after surgery.

Expect the drainage to be bloody at first, and then to lighten over several days.

When the drainage clears, it will often have an appearance similar to apple juice. This fluid is full of the protein fibrin. Fibrin is the protein that forms scabs when dry. When the fibrin congeals in the tube it forms clots of white to yellow appearance. Blood clots may also form. These clots should be stripped (milked) from the drain when identified. They often cannot be completely removed.

Keep a daily record of the drain output with the provided sheet. Record any significant change in the character of the drainage.

It is normal for the skin to be irritated, inflamed and tender around the skin exit site. This is the bodies’ normal reaction to a foreign object. Any redness that extends for more than an inch from the drain should be brought to our attention.

It is normal for the skin exit site to be tender and painful.

Please notify the office during regular business ours if any of the following occurs.

1. Temperature greater than 100.4 degrees
2. Foul odor of the drain fluid (it should smell salty, like the ocean, not like beer, cheese, or rot).
3. A change in the drain fluid from clear to cloudy
4. Redness which extends more than an inch from the surgical wound or drain exit site
5. Marked swelling at the surgical site
6. Thick bloody drainage which clots in the drain bulb and fills it (some clots, especially with clear fluid, are normal).
7. Failure of the drain to maintain suction

When the drainage is less than 20cc per day for two consecutive days, call the office to arrange for drain removal.

3. BREAST POST-OPERATIVE INSTRUCTIONS

PAIN MEDICATIONS

Take ibuprofen (Advil) or naprosyn (Aleve) for your pain FIRST.

Both of these medications block the production of the chemicals that cause pain and inflammation. They are the first step in the management of post-operative pain.

Choose one of these medications and take it around the clock, (according to package instructions), for the first 48 hours after surgery. This will help reduce the pain and inflammation after surgery.

After 48 hours use these medications for the management of your pain on an as needed basis. That is, take it as directed by package instructions, when you need it for pain.

Use the provided narcotics (Percocet, Tylox, and Lortab. Lorcet, Ultram, etc.), for breakthrough pain after surgery; that is pain which is not alleviated by Advil or Aleve.

Local anesthetic has been injected into and around the surgical site. The local anesthetic will usually block any significant discomfort for 6 to 12 hours from the time it was injected. When you begin to experience post-operative pain (usually a sharp stinging or burning around the surgical site), take the narcotic medication prescribed for your pain.

It is best if you do not take any of your pain medications on an empty stomach.

Do not take additional acetaminophen (Tylenol), beyond what was prescribed. Most narcotics used for post-operative pain management contain acetaminophen. Taking extra acetaminophen can easily lead to overdose and liver damage or life threatening liver failure.

ACTIVITY

From the first day after surgery (post-operative day #1) to 14 days after surgery, any activity which does not cause significant discomfort is acceptable. Vigorous exercise and repetitive activities (folding clothes, washing dishes, painting fences, table tennis) are prohibited during this time. Activities of daily living (personal hygiene, etc.) are acceptable and encouraged.

EXERCISE

Routine exercise and return to normal physical activities are encouraged after post-operative day 14. The scars at this time will be very thick, tight and inflamed. Expect the scar tissue to begin to significantly thin and become more flexible over the next 4 weeks (post-operative day 14-48). An exercise regimen to maintain shoulder and arm mobility can be discussed at the first post-operative visit

WOUND CARE

Your wound is closed with multiple layers of fine, but strong absorbable sutures; no sutures are visible above the skin. The wound is also covered with short (½ inch wide and approximately 1 inch long SteriStrips (butterfly closures) which are applied over benzoin skin adhesive. On top of the SteriStrips is a light gauze dressing.

HYGIENE

It is acceptable and encouraged for you to remove the top gauze dressing in 24 to 48 hours after surgery (post-operative day 1 or 2) and shower or sponge bathe. Do not use any special soap, nor apply any creams, ointments, or other medications to the surgical site. Do not soak the wounds underwater. Pat the wounds and the SteriStrips dry. Do not vigorously rub the area. If any adhesive residue remains around the wound, it can be removed with mineral oil, cold cream or a special formulation we carry in the office. We will be happy to provide the adhesive remover to you at your first post-operative visit. When the SteriStrips edges begin to peel up, the SteriStrips can be safely removed.