Explore Plastic Surgery - Dr. Barry Eppley

Contemporary recovery after breast augmentation is designed to be short with minimal disruption of one’s lifestyle. Anti-inflammatory medications and early physical therapy of the arms (the attachments of the pectoralis muscle) are the mainstays of an aggressive recovery program after the placement of breast implants. Gone are the need for bulky dressings and restrictions on physical activity after surgery which had been the hallmarks of breast imoplant surgery in the past. The less pain a patient has, the more physical therapy they can do to further expedite their return to normal activities of daily living. In an effort to control pain after breast augmentation, I often employ pulsed electromagnetic therapy using ActiPatch topical patches devices. To determine whether this was actually beneficial or just a psychotherapeutic concept, a prospective clinical study of breast augmentation patients was done.

A prospective clinical study of fourty-eight  (48) women undergoing breast augmentation was conducted from November 2007 to November 2008. Women underwent breast augmentation with either saline or silicone breast implants through a transaxillary (saline) or inframammary (silicone) incision. Patients were aware that they would receive Actipatch therapy as part of their postoperative protocol. At the completion of surgery, Actipatch devices (crescent-shaped) were placed over the medial and superior aspect of the breasts (over the pectoralis muscle) and taped into position inside their surgical bra. For the first twenty patients, the device was activated (activating tab pulled)  on the left breast and on the opposite right breast the device was not activated. (activating tab was trimmed but not pulled) The patients were not informed which devices were which. In the next twenty-eight patients, the device locations were reversed. Patients were instructed to wear the devices for the first seventy-two hours after surgery after which they were to be discarded. Patients were given a sheet to complete at the time of discontinuing their ActiPatch therapy so that they could rate their postoperative pain on a simple scale (1 - 10) and, most importantly, compare and rate the pain between the two breasts at that time period.

In the first twenty patients, fourteen rated the active device breast as less uncomfortable than the control patch side. In the next twenty-eight patients, twenty-one rated the active side less painful. In total, thirty-five patients (73%) reported less pain and uncomfortability on the breast that received pulsed electromagnetic therapy than on the control side.

Pulsed electromagnetic therapy has been around for a long time and its potential benefits are based on creating an anti-inflammatory effect. Actipatch provides a simple, low-cost method of delivery of this potential healing technology. In this breast augmentation study, Actipatch demonstrated less pain within the first few days after surgery. Given its ease of use and lack of any potential for creating any adverse problems, its use as part of a breast augmentation recovery protocol appears to have offer patients some real benefits.

While all pain studies are flawed, and this one is no exception, it certainly suggests that pulsed electromagnetic therapy (PEMT)should be further explored. A change in the design of the device so that it ‘fits’ the breast better may be even more useful. A large round loop that would fit around the circumference of the breast is more likely to deliver the effects of PEMT to the breast ina more even distribution although I could argue that the pain after breast augmentation is muscular rather than ‘breast’ in origin.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www,ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Breast augmentation is a highly successful operation that was performed about 330,000 times in 2007 in the United States. While many wome desire breast enlargement, they may be fearful of the amount of pain after surgery and that they may have a long recovery until they can get back to their normal activities. Breast augmentation, however, should involve none of these problems today and our goal as plastic surgeons is to get you back to a near normal schedule within days of the surgery.

 
The most common method of breast augmentation, known as submuscular implant placement, involves lifting up the pectoralis major muscle (chest muscle) and putting the implant underneath it. It is important to realize that the breast implant is never completely under the muscle or it would be positioned too high and the nipple would be pointing downward. Nonetheless, recovery after a breast augmentation is really muscular and represents nothing more than a big pulled muscle.. From a physical therapy standpoint, how do you recover from a pulled muscle? The answer is…..use it and use it early! Moving and stretching of the pectoralis muscle through arm exercises is the key to a faster recovery after breast augmentation. You can’t hurt the breast implant by using your arm and chest muscles and early movement will not be responsible for an implant moving out of the pocket and being malpositioned. This is what I call a Rapid Recovery Breast Augmentation program. I start my breast augmentation patients on range of motion arm exercises beginning the night of surgery as well as 800mg of Ibuprofen. The goal is to get patients off narcotic pain medication in 24 hours, if possible, and be able to get out of the house for dinner or shopping the next day. While not every patient achieves this exact timeline, this aggressive physical therapy approach helps make a breast augmentation recovery easier than ever.

 
There are some variables in breast augmentation that will cause more or less pain and recovery and they are the following:

 
1) The larger the breast implant placed, the more pocket dissection that needs to be done. This
will cause more pain after surgery. In very large breast implants, expect more pain and
swelling.
2) The tighter the breast skin, the more pain the patient will likely have. Women that have
loose breast skin and sagging breast tissue seem to have less discomfort after surgery.
3) The transaxillary (armpit) approach, which I use for saline implants, seems to cause
slightly more pain than other incisional approaches as more pectoralis muscle is being
dissected and lifted.
Regardless of these slight differences in breast augmentation techniques, aggressive physical therapy will make for a more Rapid Recovery!

 
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Return to Normal Quickly after Breast Augmentation – Dr Eppley’s Approach in Indianapolis

Breast augmentation is both a popular and highly successful procedure that is done over 300,000 times per year in the United States alone. Some women, however, fear the procedure due to the belief that there is a lot of pain after surgery and that their return to work or normal activities may take several weeks. Breast augmentation surgery today, however, can put the patient back to a near normal schedule within days.

Breast augmentation, from a simplistic standpoint, is really a big ‘pulled muscle’. In this
case, the pectoralis muscle on the chest is ‘pulled’. Breast augmentation, in most cases, is the lifting up of this muscle and placing an implant partially underneath it. No breast implant is completely under the muscle or it would be positioned too high and the nipple would be pointing downward. As the pocket into which a breast implant is placed controls the final shape of the breast, recovery after breast augmentation is really muscular. From a physical therapy standpoint, how do you recover from a pulled muscle? Do you not move it…or bind it up and keep it from moving? The answer is…..use it! Early moving and stretching of an injured muscle is the key to a faster recovery after breast augmentation. You can’t hurt the breast implant by using your arm and chest muscles and early movement will not be responsible for an implant ‘getting out of position’.

In Indianapolis, the approach to a no recovery breast augmentation program begins in the operating room. A dose of steroids is given at the start of surgery and a bioelectric device, known as Actipatch, is placed over each breast before the patient leaves the operating room. This device, which is worn for 48 hours after surgery, helps control pain and swelling. I then start my breast augmentation patients on range of motion arm exercises beginning the night of surgery as well as 800mg of Ibuprofen also. The goal is to get patients off narcotic pain medication in 24 hours, if possible, and be able to get out of the house for dinner or shopping the next day. While not every patient achieves this exact timeline for a ‘no recovery’, this approach helps make a breast augmentation easier to go through than ever before.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis