DR. EPSTEIN’S COMPREHENSIVE Breast Augmentation Guide

Anesthesia – General, Sedation or Local?

What To Expect As I Heal?


It is important that you not engage in strenuous activities during the first three weeks after surgery. You may lift up to 25 pounds. Aerobic exercise will raise your blood pressure, which could cause late bleeding and harm your result. If your job keeps you sedentary, you may return to work when you feel comfortable. Once you begin exercising again, start gently and let your body tell you what it can tolerate. Don’t rush!!

It is recommended to avoid stagnant water for three weeks to prevent infection. Showering on the same day after surgery is fine, but submerging your breasts in a bathtub, hot tub, swimming pool or natural body of water (ocean, lake, etc) is not recommended to avoid the development of infection.

Sexual intercourse is permitted the evening of your surgery. Use common sense to avoid trauma to the breasts.

Healing of Sensory Nerves/Nipple Hypersensitivity:

Regeneration of the sensory nerves is accompanied by tingling, burning, or shooting pains, which will disappear with time and are nothing to be alarmed about. As the nerves regenerate, the nipples may become hypersensitive. If you nipples lost sensation after surgery, you may notice the lost sensation begin to recover. Your nipples may become so sensitive that wearing certain articles of clothing, or anything at all touching them may be uncomfortable. Fortunately, this will subside very shortly with time. You may find that gentle massaging helps. Some patients say that short bursts of discomfort in the breasts/nipples reminds them of Braxton/Hicks (false labor) uterine contractions.

Numbness in Breasts

You may experience numbness on the sides or bottom of the breasts. This is entirely normal. Most of the time the sensation returns, but in some cases there may be some permanent loss of sensation on the breasts, most commonly on the lower portion of the breasts. Loss of nipple sensation after surgery is very common, but permanent loss is rare.


It is quite common for the two breasts to heal differently. One may swell more, one may feel more uncomfortable, or the shapes may differ initially. After complete healing, they should look remarkably similar and natural. Breasts are almost always asymmetric to begin with, so the degree of symmetry you ultimately attain is related in some part to this. Patience is required, but if you are concerned, ask Dr. Epstein or the nursing staff.

“Sloshing” Sensation:

You may hear and feel “sloshing” in your breast after surgery. This is not the implant! It is the air and fluid that is trapped in the space around the implant following surgery. Following surgery, there is often a small natural fluid that accumulates. It will all be absorbed by the body within a few weeks.

Fluid Retention/Water Weight Gain:

The mere performance of surgery causes systemic physiological changes. Surgery is a form of stress, and stress causes release of certain hormones such as cortisol and aldosterone. These hormones alter the bodies natural fluid balance so that water is retained. This water retention results in swelling, not only in the surgical site (the breasts), but also on the rest of the body.

During the first week or so following breast augmentation, patients often note a sense of bloating in the abdomen, even extending into the pelvis and genitalia. Less commonly, there can be water retention in the lower extremities as well. Actual weight gain can be as much as ten pounds, although often it is less. Rest assured, this is a temporary phenomenon, and the water balance of the body will recalibrate back to baseline and the excess water will pass in the urine over the next several days.


The skin of your breasts and nipples may become shiny. This is a result of the swelling that occurs after surgery. Within a few weeks, the edema and swelling will subside and the skin will look more normal.

It is not uncommon to experience some swelling of your abdomen which may work its way down to your pelvis, even to the labia. In some rare cases there can even be some bruising associated with this. This is all normal and will resolve shortly. Do not be concerned with this.

Feeling of Heat/Warmth within the Breasts:

The first several days after surgery, you may experience a sense of warmth, or heat within or on the skin of the breasts. Some women describe this as feeling like there is a sunburn on the breasts. There is no associated redness or other signs of infection (infection, should it happen, almost always happens after the first week). This is entirely normal and not a cause for concern. Should you experience this and have a fever (temp > 101 F) and/or redness around the incision or on the breasts, or discharge of pus from the incision, you should call the office immediately.

Support Garments/Bra:

You are encouraged to wear a bra for support as soon as you feel comfortable to do so. If you have an incision under your breast, then avoid an under wire type bra for at least two months. After the first two weeks, routine use of a support garment during the day is strongly recommended.

Also, it is important to note that your breasts will change shape and continue to evolve for several months following surgery. For those who have more lax breasts from having borne children, it may take 3 – 6 months to reach final shape. For those who have not been pregnant, it make take one year or more as the breast tissue is much tighter and takes longer to relax. For this reason, don’t spend a lot of money on bras right after surgery. Buy just about what you need until your breasts settle in to their final shape. You may need a different fitting bra once your breasts settle as compared to what you wore shortly after augmentation.

Palpable Lumps in the Wound:

You may feel small lumps in the wound. This is usually the sutures under the wound. These sutures are dissolvable and will do so in three to six months. Sometimes, you may see or feel “cords” extending from below the wound. They may be one half inch to a few inches in length. These are called Mondor’s cords and probably represent some clotted blood in the tiny skin veins that were cauterized when the initial incision was made. This is a harmless condition and will resolve in a matter of days to weeks.

Signs of Infection:

Infection after surgery is rare. However, if you should develop increasing breast pain or tenderness, redness, especially near the incision, fever, drainage or swelling, please contact the Dr. Epstein immediately.

Remodeling of the Breasts:

Your breasts will remodel with time. Initially, your breasts will look very full on top, tight on the bottom and “boxy” on the sides. They may seem to be excessively projecting forward. As gravity and tissue relaxation occur, the lower breast envelope will stretch. This will cause a re-distribution of the breast volume, yielding a much more natural shape as there will be less upper breast fullness, and a more rounded, natural lower breast. This usually takes about 3 – 6 months in women who have had children, and 12 – 18 months in those who have not.

How close together will my breasts be (“cleavage”):

Initially after surgery, the breasts will feel tight and firm. This is because your breast tissue needs to stretch to accommodate the new implants. When the breasts are firm, they will appear further apart. As the breasts relax, the breasts will move more freely on your chest wall, and clothing, bras and bikini tops will help them to move closer together. How close they will be will depend upon your implant size, your the soft tissue characteristics of your breasts, and the natural distance between your breasts. You can view diagrams and learn more about this topic here.

Stretch Marks:

New stretch marks are very unusual after augmentation. In our experience, when patients see stretch marks shortly after surgery, they can usually be found on the pre-surgical photographs.

Skin Rashes:

Occasionally, a rash may develop around the incision, on the breasts or around the breasts. This is usually due to the Dermabond glue. This has the appearance of multiple tiny red, often raised dots on the skin, coupled with itching. This is easily treated with topical medicated creams. If you experience this, please call us and let us know. You may begin treatment with over-the-counter hydrocortisone cream 1%. If the itching is bothersome, benadryl 25 mg may give some relief. Benadryl may make you sleepy, so it is probably not a good idea to drive an automobile, operate machinery or heavy equipment for 24 hours while taking benadryl. If these remedies are not helping, please call the office to let us know so that other medication can be prescribed.

Occasionally, a rash may develop a couple of days to a few weeks after surgery in a location remote from the incision or on the breasts such as the trunk or extremities. The rash may get worse and spread to other parts of the body. This may be a drug allergy rash. Other than symptomatic care as described above, there is nothing to do. If this should happen to you, please contact Dr. Epstein to discuss if you need to be seen right away versus at your next scheduled appointment.

Concerns About Size:

Although a very positive experience overall, any significant change in body appearance can be emotionally stressful. You may experience emotional good days and even some days when you feel down. It is not uncommon after surgery to wish that you were a “little bigger” but usually these thoughts abate over the next several weeks to months as the breasts soften, assume a more natural shape and feel more a part of you. Dr. Epstein’s re-operation rate is well below the national average and requests for implant size changes after surgery are exceedingly rare.

After surgery, your implants will seem high. What is really happening is that the lower portion of the breast is not expanding as much as the upper portion. As time passes, and the lower breast tissue relaxes and stretches (an appropriate amount), the distribution of implant volume in the upper breast diminishes as the volume in the lower breast increases. This will result in a much more natural appearing breast*. Also, understand that breast cups often contain the lower portion of the breast. So as more volume redistributes to the lower breast with time, your cup size requirement may increase, or your bra may fit more snugly. In this regard it is advisable not to invest much money in bras right after surgery until your breasts stabilize in shape. For women who have not borne children, this may take a year or so, and for women who have children, it may take as little as three months or so. All this depends upon how compliant or “stretchy” your breast tissue was to begin with.

Although extremely unusual, if you still have concerns about size after your breasts have settled, please discuss them with Dr. Epstein, If you wish to have a second operation to change your implant size because you desire different size breasts, the financial responsibility will be yours entirely. The reason for this is that Dr. Epstein strives to find the ideal size implants for your breasts based upon your breast tissues so as to provide you with the best aesthetic result, the greatest longevity of that result, the easiest recovery and the least chance of needing a re-operation*. The size of your breasts after augmentation may not match your initial personal preference for size. Dr. Epstein will educate you about this pre-operatively.

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