Upper Body Excercise

[t-rex]

To the Supporting Doctors, Good day! I would just like to know when to exactly start exercising post-op. I am  taking the advise of most of the postings here and that of fellow patients, but I am tempted to start walking to lose weight. Since I did the surgery, i have gained 5.5 kg and my waist line looks terrible. Prior to surgery, I   did slow jog about once or twice a week and martial arts on the weekends. If would really like to go back to this routine. Is it okay to do upper body exercise without affecting healing?

[Dr. Elliot Jacobs]

For my patients, I request that they abstain from strenuous physical exercise -- of any kind-- for a minimum of four weeks after surgery.  Reason?  Isn't exercise good for you?  The problem is that when you exercise, you also increase your blood pressure.  And it is the elevated blood pressure, along with the exercise that can result in added swelling and/or open a small blood vessel under the skin which may have been sealed during surgery.  Result can be a late hematoma (I have seen this happen).

I usually recommend that my patients slowly return to exercise after four weeks -- and slow down if there is any pain.  Sure, there will be pulling and tightness -- that is expected.  But pain is a sign that you are not fully healed and you should back off a bit.

However, during your recovery, there is nothing wrong with watching your diet so that you don't gain weight.  You can also take some long, slow walks to burn calories while not elevating your blood pressure too much.  There is no need to gain weight after surgery if you are careful.

And once you are fully healed, then hit the gym hard!

Dr Jacobs

[t-rex]

Thanks for your advise, Dr. Jacob. I will do as you say. Better safe than sorry.

Dr. Jacobs, I have another concern: after the removal of the sutures at the right areola, the lower portion "gaped" accdg to the surgeon who removed the stitches. Also, the skin of the nipple and areola shed off. Any comments? Would this resolve in time? I'm particularly worried about the "gaping". The lower areola overlapped the adjacent chest tissue below.

[Dr. Elliot Jacobs]

Obviously I cannot speak specifically about your situation, especially without any photos.

However, in general, if a wound gapes open slightly after the sutures are removed, it is usually no big deal.  Keep the wound treated with antibiotic ointment and it should close by itself within a few days -- usually with a reasonably good scar as well.

When the outer layer of skin of the areola peels off, it is akin to a sunburn and should heal quite well underneath.  However, you must make sure that the underlying skin is nice and pink.  If it is dark purple, then see your surgeon ASAP.

Dr Jacobs

[t-rex]

Thank you for your reply, Dr.Jacob. Your advices really help a lot. Yes, peeled areola skin revealed a pink tissue, Doc, so I am not worried coz of the good circulation. What I am worried about is that the gape I am referring to overlapped with the skin below it. The right areola which peeled overlapped above the skin below it. This occurred after the sutures were remove. The surgeon however placed Fucidin intertulle to avoid infection before the application of tegaderm over the areola/nipple.

[Dr. Elliot Jacobs]

It sounds as if your surgeon is on top of everything.  Give it time for your wounds to heal and settle down.

Dr Jacobs

[t-rex]

Good day, Dr. Jacobs! I would just like to iterate my concern. I did my routine cleaning this afternoon and saw that the in right areola, the suture line isn't visible already because it is healed and that the skin of the areola has overlapped the skin beneath it. the overlapping areola is raised to about a few millimeters from the chest and is quite visible that it is elevated. Is there any solution to this? Would this require a revision?

[Dr. Elliot Jacobs]

I would recommend waiting for several months before considering anything.  If the wound still does not lie flat, then you might consider discussing a scar revision with your surgeon.  It is a quick, simple procedure performed under local anesthesia.

Dr Jacobs

[DrPensler]

My exercise routine varies on the specifics of the individuals surgery. I have had a patient go skiing the day after surgery. I have the patients in general increase activity two days after surgery over one to two weeks.

[Litlriki]

I tend to be more aggressive than Dr. Jacobs in getting my patients back into their workout routine, but that's mostly because I know that they will ignore me completely if I tell them not to exercise for four weeks.  I tell them to not engage in any strenuous activity for the first week.  After a week, they can start cardio, and after two weeks, I allow them to do resistance training or weights, but no chest for four weeks.  I review certain exercises that are better in the early phase and others that should be avoided until three or four weeks.  Taking this approach, I've had no early or late activity related complications in nearly twenty years. 

That said, the first person you should discuss your post-op plan with is your surgeon, since he or she might have specific concerns related to your specific procedure. 

As for the wound--I agree completely with Dr. Jacobs...allow it to heal and see how the scar progresses before doing anything.

Good luck.

Rick Silverman

[t-rex]

Thank you, Doctors, for the reply.

@ Dr. Jacobs & Dr. Silverman: I will follow your advice and let this wound heal. I intend to do what you said about scar revision if it doesn't sit flat 6 months from now. As for the excercise, I think long, leisure walks would keep off the weight gain?

[Dr. Elliot Jacobs]

You can avoid weight gain by specifically watching the calories you take in.  If you have a certain period of decreased activity, then reduce your food intake accordingly -- you should not gain weight.  Long, slow walks are just fine.

Dr Jacobs

[Litlriki]

No exercise will prevent weight gain if you overeat.  Weight management is achieved through a combination of diet and exercise.  If you are limited in your ability to exercise for any reason, then you need to adjust your food intake accordingly.  This is simple mathematics--calories in need to equal calories out if you're trying to maintain weight. 

RS