TOP SURGERY FAQ's

for Double Incision

Question: What is "Double incision" Surgery?

 

Answer: Double incision is a method of top surgery where a mastectomy (removal of the breast tissue and extra skin) is performed. One incision will lie on the chest in the pectoral hollow (the space underneath the pectoralis major, which is the big muscle in the chest).  The other incision is around the nipple and areola (the pigmented skin around the nipple) which will be both resized (made smaller) and reshaped to have less projection and placed on the chest in a more “masculine” position.  That placement is usually more lateral (to the side) than in the middle of the chest.

What is "double incision" surgery?

Question: Why is it called double incision?

 

Answer: This technique is called "double incision" because there are two incisions made, one beneath where the breast used to be and one around the new areola.

Why is it called a double incision?

Question: Do I have to stop taking T before the surgery?

 

Answer: No. There is no scientific evidence that indicates a need to stop taking this medication so I recommend you continue just as normal.

Do I have to stop taking T

before the surgery?

Question: Do I have to stop taking other medications?

 

Answer: In general, most medications are perfectly safe to take before, during and after your surgery.  We recommend you stop taking Aspirin and Aspirin containing products one full week before surgery, and all other medications will be reviewed and discussed.

 

Most Chinese medications should be stopped a week prior to surgery and for a week after.

Do I have to stop taking other medications?

Question: I am scared about anesthesia. What if I wake up during surgery?

 

Answer: It is very common to feel concerned about both surgery and anesthesia. This is especially common if you have never had either.  The morning before your surgery you will meet with the anesthesiologist and they will explain everything to you.

 

It is a very safe operation, and the anesthesiologists will monitor you constantly to make sure you are well sedated and do not wake up during the surgery.

I am scared about anesthesia. What if I wake up during surgery? 

Question: I heard that a lot of people have nausea and vomiting after surgery? Is that true?

 

Answer: There are some people who are prone to this (usually they have a history of this from prior surgeries) or a history of motion sickness.

 

If this is the case, during and after the surgery, we will give you medication to help prevent it. 

I heard that a lot of people have nausea and vomiting after surgery? Is that true?

Question: How long will surgery take?

 

Answer: Usually about 3 hours.

How long will the surgery take?

Question: How soon before surgery do I have to arrive?

 

Answer: Typically, you should arrive an hour and half before surgery.

How soon before surgery do I have to arrive?

Question: Will I have drains?

 

Answer: Yes, drains are important to help reduce your swelling immediately after surgery.

Will I have drains? 

Question: How long will the drains stay in?

 

Answer: Drains will typically stay in for one week.  Sometimes they need to stay in longer.  You and your caregivers will learn how to use the drains, how to empty them, and how to record the drainage. 

 

It’s not hard, and based on the amount of drainage we will know when the drains are ready to come out.

How long will the drains stay in?

Question: When I get the drains out, will it hurt? Where does this happen? Will I get anesthesia?

 

Answer: Most people are very fearful about getting the drains out and have read online that it is very painful.

 

The drains are taken out in the office and you will be awake and not need any anesthesia.  It takes just a few seconds and generally is not painful at all. 

 

Most people say that it feels “weird”, or it’s so fast that they do not feel anything at all.

When I get the drains out will it hurt? Where does that happen?

Will I get anesthesia?

Question: Will I have bandages? Do I have to change the bandages?

 

Answer: You will have a bandage over where the drain comes out for the body, sterile medical tape over the bigger incision and a bolster dressing sewn onto the body covering the nipple and the areola. 

 

For the first week, you do not have to change the dressings or bandages, you simply leave them in place.

Will I have bandages? Do I have to change the bandages?

Question: What is a “BOLSTER”? Does it hurt when it is sewn on to the skin?

 

Answer: A bolster is a special bandage that I use to help the areola and nipple heal quickly and well.

 

It is sewn onto the chest over the nipple and areola because it can be very tight to the chest and help the area heal well.  It does not hurt.

What is a “BOLSTER”? Does it hurt when it is sewn on to the skin?

Question: Will I have bandages? Do I have to change the bandages?

 

Answer: You will have a bandage over where the drain comes out for the body, sterile medical tape over the bigger incision and a bolster dressing sewn onto the body covering the nipple and the areola. 

 

For the first week you do not have to change the dressings or bandages, you simply leave them in place.

Will I have bandages? Do I have to change the bandages?

Question: How do I bathe when I can’t shower for that first week?

 

Answer: You just can’t get your chest immersed in water.  So you can shower from the waist down and you can take a bath (chest out of the water) and you can sponge bathe.

How do I bathe when I can’t shower for that first week?

Question: When can I shower?

 

Answer: You can shower in a week.  After a week you will come to the office and get the drains removed and the bolsters taken off (this doesn’t hurt either and then you can shower.

When can I shower?

Question: When can I take a bath and soak my chest?

 

Answer: Usually around 3-4 weeks post op, depending on your healing.

When can I take a bath and soak

my chest?

Question: When can I sleep on my side?

 

Answer: You can sleep on your side whenever you want! As long as it’s not uncomfortable you can sleep on your side immediately!

When can I sleep on my side?

Question: When can I sleep on my stomach? 

 

Answer: Usually around 1-month post op sleeping on your stomach is fine.

When can I sleep on my stomach? 

Question: Do I need to wear a binder? Most surgeons require binders, so I have heard.

 

Answer: You do not need to wear a binder.  A binder is used to create compression to help “flatten” the chest, but the drain is a “compression drain", so a binder is not useful. 

Do I need to wear a binder? Most surgeons require binders, so

I have heard.

Question: So many surgeons use binders, why don’t you? 

 

Answer: I try to do things in a scientific manner, and there is no scientific evidence that binders are helpful to reduce either seroma or swelling post-op, and most patients find them very uncomfortable. So, I don’t want to make my patient experience any unnecessary discomfort. 

So many surgeons use binders,

why don’t you?

Question: When can I get back to activities? When can I use my arms?

 

Answer: You need to walk the next day, and take short walks every day following surgery. You need to stretch your arms right away or you will get very stiff and have pain in your back, shoulders, and neck. The thing you don’t want to do is overexert yourself, lift heavy things (more than 10 pounds) and stretch too much in the first week.

When can I get back to activities? When can I use my arms?

Post Op Activity Schedule

Top-Surgery-Recovery-Flyer-Final-Adjuste

Question: I have heard that people’s nipples often fall off!! Yikes! How do we prevent that? 

 

Answer: I use a special technique that prevents this from happening. I have been using this technique for more than 15 years and it is very effective. 

I have heard that people’s nipples often fall off!! Yikes! How do we prevent that? 

Question: When can I get back to activities? When can I use my arms?

 

Answer: After the first week (when the bolster and drain are removed) you will be taught how to do a simple dressing change (bandage).  You can now shower, after you shower you will pat the area dry and then put a small amount of ointment (aquaphor works best) on the nipple and areola and the drain site (where the drain was removed) and cover with a small gauze or bandage.  The medical tape will generally stay on the incision and you do this dressing change once a day for approximately a week.

Do I have to do dressing changes?