DR. EPSTEIN’S COMPREHENSIVE Breast Augmentation Guide

Anesthesia – General, Sedation or Local?

After Surgery Instructions


During the first week, attempt to sleep on your back instead of on your side. We want your implants to stay in a perfect position during the initial healing process. This is not a “life and death” issue, however. If you cannot sleep on your back, sleep in another comfortable position.


It is important that you not engage in strenuous activities during the first three weeks after surgery. You may lift up to 25 pounds. Strenuous 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!! Generally, I tell my patients the following:

  • Sex (gentle-use common sense – no “olympic sex”) is OK the day of surgery
  • You may WALK on a treadmill (no incline) the day of surgery
  • You are encouraged to go out to dinner and shopping the day of surgery
  • Aerobic activity is OK at two weeks
  • Return to gym at three weeks (If you do very heavy lifting, wait until four weeks)

It is recommended to avoid stagnant water for three weeks to prevent infection. Showering on the same day following your 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.


Use of Ice/Cold Packs:

You may find the use of cold packs soothing to your breasts. Ice packs may be a bit too cold, but will not harm you. Commercial cold packs, or easier yet, bags of frozen peas, placed on the breasts for twenty minutes on and twenty minutes off, may be very soothing and pose no risk for you. they may also help with swelling. It is important to not leave cold packs on longer than twenty minutes, or you may suffer a mild burn to your breast skin.


When you awaken right after surgery there may be some discomfort in the breasts. This is entirely normal. You will be given medication in the recovery room for this. When you get home, you will be instructed to take ibuprofen (if we have not given it to you already in the recovery room) and you will take a 2 hour nap. After you awaken from the nap, you should feel dramatically better. Most women describe the discomfort as a sense of muscle soreness, or a feeling similar to “when your milk comes in”, rather than one of true pain. As this resolves, you may have a little soreness on the sides of your breast/chest. Again, this is all normal.


The wounds will be dressed with Dermabond, a surgical wound sealant. This will create a transparent film over the incision line. Do not pick it off. The sealant provides an antimicrobial barrier to prevent infection, as well as limits drainage through the wound. Gauze dressings are generally not necessary but can be applied locally to any areas that may be oozing. Oozing of small amounts of blood the first two to three weeks is not common due to the wound sealant, but if it should occur, it is of no concern.

Following breast augmentation, the breasts will be fairly tight, and there will not be much motion of the breasts. A bra is not absolutely essential right after surgery, but a soft, sports bra with a front closure device will be helpful as it provides some support. For larger breast augmentations, I believe that support with a bra the first day or two after surgery is very helpful to prevent sagging later on. If you prefer, you are perfectly fine with no garment for the first week until the swelling subsides, however, if you want support, there are several satisfactory choices.

  • Sports bra with a front closure device (preferred)
  • Sports bra without a front closure device
  • Regular bra with no underwire
  • Bandeau top bra


Most sutures are placed under the skin and will dissolve on their own. Occasionally, some of the dissolving sutures will “spit” through the wound as the body attempts to dissolve them. They may need to be removed in the office as they appear. Sometimes I will intentionally place the sutures so that one end of it sticks out from each end of the incision. Those are clipped in the office on the three week visit.

Showering and Bathing:

You may shower and gently wash your wounds with soap and water the same day following surgery (See Recipe for Recovery, below). It is recommended not to submerge your wounds in bath water for three weeks. For your first shower, please have someone nearby, as you may be dizzy and lightheaded.

Your wounds have Dermabond, a type of glue which serves to seal the wound and prevent infection. You should not rub the wounds, however, you can create soapy suds on the top of your breasts and let the suds fall to the underside of your breasts. With your fingers, you may very gently run the suds across your breasts, then let the water from the shower hit the top of your breasts and run downward over the wounds. If you have a hand-held shower massager, you may run a gentle stream of water over the wounds to clean them. Once out of the shower, you may gently pat the wound with a dry, fresh, clean towel. Do not put any ointment of any kind on the Dermabond dressing or it will dissolve the Dermabond.


Small amounts of oozing and bleeding are very common. You may place a gauze pad over any area that is oozing. If this entails more than slow staining of the gauze, apply firm pressure for 20-30 minutes before calling the office. Should heavy bleeding occur from the wound (very rare), apply firm pressure and call the office immediately at 631.689.1100 or call the emergency answering service at 631.476.3457.

Should one of the breasts suddenly increase rapidly in size, usually over an hour or two, then there may be bleeding into the breast. Please call the office immediately at 631.689.1100 or call the emergency answering service at 631.476.3457 or go to the nearest emergency room.


When the skin is cut across the breasts, the nerves, blood vessels and lymphatics are cut. When the nerves are cut, this can lead to numbness of portions of the breast. This may or may not be permanent. What is often of concern is the swelling. The lymphatics are tiny channels similar to blood vessels, but rather than carry blood, they carry tissue fluid from the breast tissue to the the lymph nodes. When the lymphatics are cut, tissue fluid builds up in the skin of the breast since it cannot be carried away to the lymph nodes. This will persist for several weeks, sometimes even a few months until the body can naturally create new ways to carry away the fluid.

Exposure of scars to sunlight:
Scars take at least one year to fade. During this time, you must protect them from the sun. Even through a bathing suit, a good deal of sunlight can reach the skin and cause damage. Wear sunscreen with a skin-protection factor (SPF) of at least 15 at all times when in the sunshine. Be extremely careful if areas of your breast skin have reduced sensitivity.


Do not return to heavy aerobic exercise or lifting for 3 weeks. You are encouraged to walk immediately after surgery.


You may lift up to 25 pounds after surgery.


You may drive when driving does not cause pain and you can drive defensively. This may occur as soon as the next day if you have a car with power steering.

Scar Care:

Please begin scar massage and the use of a topical anti-scar agent (i.e. SkinMedica Scar Recovery Gel) four weeks after surgery. For the first year, if you will be exposing the scars to sunlight then use a sunscreen with an SPF (Sun protection factor) of 30 or higher.

Protecting the Implants:
If you will be undergoing a dental, gynecological, urological or gastrointestinal procedure including endoscopy, we strongly advise you to alert your doctor to the fact that you have breast implants. It is recommended that he/she prescribe antibiotics for at least 72 hours that will cover the types of organisms consistent with that anatomical area being treated.

Postoperative Appointments:

After surgery, you will need to be seen on the following schedule:

1 or 2 days after surgery: A general inspection of the breasts and photographs. PLEASE RETURN THE BREAST SURGERY SURVEY INCLUDED IN YOUR INSTRUCTION BOOKLET AT THIS VISIT.
3 weeks after surgery: Wounds checked.
4 months after surgery: A general inspection of the breasts and photographs, 3D imaging post operative photos.
1 year after surgery: A general inspection of the breasts and photographs, 3D imaging post operative photos.

Return annually for a general inspection of the breasts. This is not a cancer screening visit, but rather to assess the results of your breast augmentation and your implants. This should not replace annual breast surveillance for breast cancer as performed by your primary care physician or gynecologist.

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