I got a load of good info from Karidis' surgery once my surgery had been booked, but I didn't get these Gynecomastia post-surgery instructions and I have been onto their website and I notice it's not included there..
I called and asked them about massage info as Alex Karidis mentioned to me they would be putting out a new document with massage info on the day of my surgery, perhaps this is the document unless others have already got it?
Post Operative Instructions:
Gynecomastia correction
• Try and arrange to have either a friend or family member to pick you up and to stay with you for the first 24-48 hours in order to help you get settled in around the house.
• Everyone recovers from their anaesthetic differently. Some people feel no side effects while others are more noticeably affected, feeling tired and even sick for the first couple of days. Eat lightly with small meals throughout the day to minimise sickness. If necessary, cut food into small bitesized pieces to facilitate chewing and digestion. Salty foods can contribute to fluid retention and swelling so limit these in the first 7-10 days. In order to avoid constipation, eat plenty of fresh vegetables and dried fruits. Overall, try to eat a balanced diet to ensure your body is getting all the important nutrients it needs in the immediate postoperative healing period.
• Drink plenty of fluids (about 8 glasses of water daily during the first 48 hours) after surgery in the form of water and fresh juices, in the first few days after surgery. Avoid caffeine and carbonated drinks in the first few days. Dairy products in the first 72 hours after surgery can upset your stomach and make you feel sick and therefore it would be sensible to keep these to a minimum.
• Do wear comfortable front opening and loose clothing at night and in the day. Due to the fact that there is likely to be some degree of soiling or staining from the incision sites, try to use old bed and pillow linen.
• Should you experience any pain, you may take one or two pain relieving tablets (such as paracetamol or distalgesics) as required up to 4-hourly. DO NOT TAKE ASPIRIN OR PRODUCTS CONTAINING ASPIRIN as well as any of the other preparations mentioned in the DO'S & DON’T'S section. These products will prolong or recommence bleeding.
• Remember to take your Arnica tablets for two weeks after surgery. The bruising and swelling usually peaks at day 3 or 4 will gradually start to subside after about 2 to 3 weeks, and most of the obvious swelling is gone within 4 to 6 weeks. Arnica cream can be rubbed gently into bruised areas from week 1, or once all incisions have healed.
• You may recommence any regular medication that you normally take (i.e. blood pressure tablets) as soon as you are able to drink, unless specifically instructed not to or is mentioned in the DON'TS section of your information booklet.
• Continue to avoid smoking and alcohol for the first week after surgery. Also do not allow anyone to smoke in your presence, either.
• You may drive after 48 hours.
• You will have a pressure garment applied to the area involved. Please continue to wear it for up to 14 days (unless otherwise instructed), day and night and then reduce this either 8 hours of the day or night for an additional 1 week. Having said that you can remove the garment for a couple of hours during the day, as respite, if you really feel you would like to have some relief from the pressure.
• After 2 weeks the garment should be worn either during the day or at night time for another 2 weeks maximum.
• Occasionally some people, particularly those who have had large volumes of fat removed or who have chronically low blood pressure, can experience light headedness, faintness or dizzy sensations when rising from a lying down position. Similar sensations can also be experienced when the garment is removed for the first or second time and subsequently the patient stands. This is called orthostatic hypotension (standing low blood pressure). The best way to avoid any such dizziness is to sit by the side of the bed for a couple of minutes after you have been lying down (or if you have just removed garment) and then slowly stand up. Basically, avoid standing up too quickly in the first week!
• Expect significant oozing of bloody fluid from the small incision sites during the first 24-36 hours. This occurs because the incision sites are not sutured and therefore remain open so they can freely drain any fluid developing immediately after surgery. The incision sites seal off after this time and fluid build up decreases.
• You may shower after 24 hours. Do not however have a bath (there is always the risk of germs from the bathtub getting in through the incisions if you sit in a bath before the incisions have completely healed up). You will of course need to remove your compression garment and any sticky dressings. On the incision sites apply a waterproof dressing such as Elastoplast Aqua Protect strips or Boots own name brand of waterproof dressings (all are usually available at Boots). These are usually quite effective, and should remain stuck on the incisions for about a week. If in the interim they do peel off then just reapply another one. In general its best to leave these on for about 7 days before discarding them. Re-apply the garment as necessary afterwards.
• Bathing is allowed after 10 days, or when the wounds have sealed off.
• You will be bruised for up to 3 or 4 weeks and obviously swollen for up to 6 or 8 weeks. However, even after this time there will be subtle (and sometimes not so subtle-read further!) swelling present in the operated areas for up to 6 or 9 months.
• You must understand and be prepared for a rollercoaster ride following your surgery with respect to the appearance of your chest! This is because your chest will change a lot in appearance in the first 3-6 months. THIS IS BASICALLY DUE TO THE HEALING PROCESS WHICH CONSISTS OF SWELLING AND FIBROSIS OR SCAR TISSUE. THIS IS A NORMAL BODILY RESPONSE FOLLOWING SURGERY. FURTHERMORE, YOU MUST REMEMBER EACH PERSON HAS A DIFFERENT HEALING RESPONSE AND TIME FRAME FOR THIS. Of course in the grand scheme of things, everything does improve week by week and month by month, however it is a slow process that ultimately needs time. Furthermore, within the overall healing period there will be small periods of time whereby progress would seem to stall and even go backwards and look worse just when things start to look better. Again, do not panic! This is the normal healing process which is ongoing and can occasionally have a stop/start nature about it and gives rise to untoward effects. However, ultimately, given time this settles.
• Immediately after the surgery when you remove your garment you will experience euphoria because you will usually-but not always (depending on your swelling) - see your chest very flat. In fact it might be over-flat. This is a temporary state of affair and is due to the compression gauze and dressings. This will “spring” back into a more normal appearance within a few days.
• It is advisable to begin massage to the areas from about 2-3 weeks after surgery. There is no point in massaging before this time, as the area will inevitably be quite tender to press and therefore any massaging attempted will be ineffective. Massage, when begun, is an important integral part of the treatment. Massaging helps decrease swelling by increasing the circulation and activating drainage activity. It also helps stimulate the collagen in the skin into tightening and therefore improve the final result.
• Massage should be firm and consistent using a circular motion. However, it should never lead to pain or obvious intense redness or irritation afterwards. It is also best to use some lubricant/oil to avoid any friction effects on the skin. It is advised to massage for short durations i.e. 5 minutes at a time, 3-4 times a day, but only after 2-3 weeks provided it is not too uncomfortable, and continue for up to 2 or 3 months. Professional massages, can also be initiated, after about 2 or 3 weeks. The usual type of professional massage that is helpful is called a lymphatic drainage type massage.
• After the first 2-3 weeks you will experience a frustrating alternating period of hardening, tightening and lumpiness of the skin and tissues which were treated. This is scar tissue - or fibrosis as its formally called - that is developing within the area. Furthermore, there is always some residual blood and swelling present within the area which adds to this phenomena. DO NOT PANIC THEREFORE. More vigorous massage (but again taking care to avoid obvious redness or irritation), when appropriate, will help overcome this, however ultimately this may take up 69 months or even more to fully subside.
• Sometimes patients may observe lumpy, flattened or even “sunken” in areas on their chest. This is because swelling can be patchy and not always uniform. Therefore you can get areas of elevation or swelling, next to seemingly “sunken” in areas. As the swelling subsides however the level then equals the “sunken” area thereby levelling off the overall appearance. This however can take up to 6 months or longer to consolidate and complete.
• It is quite common for the incisions at the lower border of the areola to sometimes look indented, or even “not quite healed” in the first few weeks after surgery. This is due to a combination of scar tissue which pulls in the scar and makes it look “tethered” as well as swelling in the immediate surrounding area which makes the edges of the incision look as though they have come apart. In fact the incisions will be healed - this can be confirmed by gently pressing on the area around the incision which will show a dry sealed wound. Of course, in time the scar tissue and swelling abates and the area settles.
• Occasionally, in the first few weeks after the surgery some degree of “puffiness” in the areola can be evident and some people worry that the gland is growing back. This is simply not the case. As 98-99% of the gland is removed during the surgery there just isn’t any capacity for this to occur. Any puffiness that does appear is just due to scar tissue forming behind the areola. This will eventually subside leaving a flat looking areola.
• In the first few weeks, occasionally the areola as well as the skin around the areola and the skin in the lower part of the chest, can feel and look a little wrinkled and even boggy. This is due to the inherent and natural drainage of the skin tissues being impaired due to the formation of scar tissue leading to patchy or even larger scale swelling. Eventually the drainage of the skin finds new channels to sort this out, however it is a slow process which can take up to 6 months or more. Local massage will help resolve this. If the swelling gives you a discomfort or untoward sensation or feeling then it may help to wear your compression garment during such time.
• Moderate your activity during the first week and slowly increase your physical activity after 10 days. In general, many patients can return to the gym after 10-14 days. However, do remember that your chest will still feel very tight and somewhat tender when you pursue any exercises that stretch the chest area. Which is why its best to listen to your body and do things that you generally feel comfortable with and build up from there.
• Some patients can experience sensory changes (i.e. numbness or hypersensitivity) in the areas treated. This settles with time, and in fact starts to improve significantly with massage.
• Avoid ultraviolet exposure (sun & sunbed), of the treated areas for 6 weeks. After this time apply appropriate sun protection.
• You should contact us if any of the following occur:
fever greater than 100º Fahrenheit or 38.5º Celsius;
pain not relieved by 2 pain relieving tablets;
significant discharge from the incision sites or any other area of the skin after 48 hours.
Topic: Karidis journey - from start to 12 months with lots of photos (Read 33825 times)
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