I Want Top Surgery

the post-operative phase

Wound Care

• Keep the incision areas dry and clean: Follow your surgeon’s instructions on cleaning and changing dressings.
• Avoid touching the incisions: Minimize contact to avoid infecting the wounds as they heal.
• Apply antibiotic ointments: Use the recommended ointment as prescribed.
  • Avoid touching wounds by applying gently with a cotton swab
• Monitor for signs of infections: Including but not limited to increased redness, warmth, swelling or colored discharge. (See Complications and Concerns)

Support System

• Utilize your recovery advocate: You will not be able to many basic tasks in your first few days to weeks of recovery.
• Emotional support: Connect with supportive friends, family, and peers to discuss your emotions and feelings during recovery.
  • There is no one way to feel and often major procedures alongside pain medications cause a large range of emotions.
• Professional help: It can be tempting to forgo therapy appointments when you are in recovery.
  • If you work with a therapist, continue to see them virtually if possible.
  • If you do not have a therapist, consider speaking to one about emotional difficulties you experience during recovery.

Pain management

• Take prescribed pain medication: Follow the surgeon’s instructions for pain relief.
  • It might be tempting to ween off pain medication early based on the negative side effects like constipation and nausea.
• Utilize over-the-counter pain relievers: Use acetaminophen (Tylenol) and ibuprofen (Advil)
  • Not recommended to take at same time
  • Alternate as directed by surgeon
• Apply Cold Packs: Use cold packs as directed by your surgeon to reduce swelling and discomfort.
  • Longer, flexible packs are good for contouring to your incisions
  • Not recommended to leave on for more than twenty minutes at a time

Compression Garment

• Wear as directed: Your surgeon will likely recommend you wear the compression garment for at least two weeks after top surgery.
• Ensure proper fit: It should be snug but not so tight it cuts off circulation.
  • Depending on drain location, the garment might press again tubing
  • Regularly check they are emptying and are not kinked
• Reduce swelling and supports healing: The garment is designed to support the chest in a way that minimizes swelling and promotes overall healing.
• Remove for cleaning: Your surgeon will give you guidelines on when you are okay to remove the garment:
  • Wound care and showering
  • Visual checks of healing progress
• Check for irritation: Record and report and signs of irritation or sores during post-op appointments or by phone if the concern is immediate.
• You will be tempted to take the compression garment off for longer than suggested.
  • Stay the course, the garment will be a part of your distant past soon enough.
  • If you previously wore a binder, this could feel similar, but rest assured it is a vital component to your healing
  • Make the binder work for you and use it to hang drains from to keep them out of your way.

Comfort and Positioning

• Sleeping on your back: Lay in a supported and reclined positions using pillows and blankets to support your upper body.
  • If you are prone to rolling over, barricade yourself in on either side.
• DO NOT sleep on your stomach or side: This will put unnecessary, prolonged pressure on your incisions and may lead to healing complications.
• Wear loose fitting clothing: Avoid items that rub against or constrict your chest.
  • Shirts that button up the front make taking on and off easier
  • You will not be able to lift your arms, making regular, over-the-head shirts nearly impossible to put on without assistance
• Propped up couch relaxation: you want to stay as elevated as possible during the first few weeks of recovers.
  • Because of gravity, elevation helps promote proper drainage
  • Elevation promotes reduced swelling

Dietary

• Stay hydrated: Drink plenty of water to aid recovery.
• Eat a balanced diet: Continue your healthy diet and eating from the preparatory phase
  • Pain medication is not recommended to be taken on an empty stomach.
  • Focus on fruits, vegetables, protein-rich, and whole grain foods
• AVOID alcohol or smoking: These will increase the risk of complications.

Restricted Movement

• Limited arm movements: Your range of motion will be extremely restricted.
• Avoid lifting anything heavy: Refrain from lifting anything over 8 to 10 lbs., or the equivalent to a gallon of milk.
• Follow physical therapy plan: If you are recommended to do physical therapy, follow the PT guidelines and adhere to the exercise regimen to regain mobility gradually.

Drain Care

• Follow surgeon’s instructions: Your surgeon will give you specific instructions on how to care for drains.
• Empty drains regularly: Drains work under negative pressure creating suction.
  • The fuller they are, the least effective they will be
  • Track output, color, and any concerns in the Drain Log
• Check for blockages: Drains can get kinked or blocked.
  • Kinks can form, especially near the insertion site and along compression garment
  • Blockage can be caused by coagulated
  • Blockages can be massaged out to allow proper drainage.
• Drains can be fastened to your compression garment, shirt, or bottoms depending on your tube length and comfort.
  • Avoid attaching to something that could easily snag on something in your home.
• Cleaning the collecting drain insertion area and pods: Essential to keeping everything as germ and bacterial free as possible.
  • Wash your hands with antibacterial soap, clean the drain insertion site with fragrant-free antibacterial soap and water and dry with cotton swab or gauze, and resecure tube with surgical tape.Pinch tube a few inches below insertion site, remove plug in bulb to release suction, measure fluid volume and color in Drain Log, and empty into sink or toilet.Clean the plug on bulb with alcohol swab, rinse out bulb with water, squeeze bulb until it is flat to remove air, and put the plug back in.
  • A flatter bulb creates suction to pull more fluid in.
• A week or two after surgery, the liquid should become a paler, clearer pink fluid.
  • Drains are usually left in for ten to fourteen days but can be removed sooner if total drained fluid is less than 30 mL or less for two consecutive days.
  • Speak to your surgeon about moving up your drain removal date if noted.

Showering

• Shower as directed by your surgeon: You will need to wait a few days before showering.
  • Remove your compression garment, ace bandage, and gauze wrap.
  • Make sure the temperature and pressure of the water is desirable before getting in, it will be hard to adjust once you start showering.
  • Use a gentle, fragrant-free soap to clean your body and the incision area.
• Avoid submerging full in water: Do not allow for a direct stream of liquid on incision area until cleared to shower normally by your surgeon.
  • No baths or swimming until you are cleared.

Returning to Work

Timeline

Initial Recovery: You will need one to two weeks off

Full Recovery: You will need four to six weeks (or longer) of restricted duties

Types of Work:

• Desk Jobs: One to two weeks before returning to work with a modified schedule and duties.
• Physical Jobs: Ones that require heavy lifting or manual labor may require up to six weeks before you can return to work without compromising your recovery.

Recommendations:

• Consult with your surgeon: Before returning to work, get clearance from your surgeon to ensure it’s safe to do so.
• Working with your boss, come up with a tapered schedule that you feel comfortable with based on your status of healing.
  • If possible, start with part-time work
  • Slowly increase to full-time as you feel ready to do so
• Having your arms even resting on a desk can cause mild discomfort for extended periods of time.
  • Ask for modified duties with no heavy lifting
  • Take more frequent breaks
  • Work remotely, if possible
• Continue to take pain medication: Have a pain management plan in place.
  • Modify work that would be prohibited while taking pain medication
  • Let your boss know your limitations
• Comfort and clothing: Loose, comfortable clothing as well as your compression garment if needed.
• Let work colleagues who you are comfortable with know your situation so they can provide support.
• Most importantly, listen to your body and pay attention to how you are feelings.
  • If you are in pain or fatigued, take a break and consult your surgeon if needed
  • Prioritize your health and well-being to promote a speedy recovery

Next page: recovery and scar care