But those instructions are a recipe for soreness, nausea and a longer recovery period, Dr. Van Natta tells Cosmetic Surgery Times . Instead, patients can be up and about within just a day of surgery under a radically different post-op regimen that was first developed and advocated by Dallas surgeon John B. Tebbetts, M.D.
HEALING IN MOTION The key to the approach is keeping the pectoral muscles in motion as much as possible following the procedure in order to prevent the stiffness that launches the cycle of a drawn-out recovery, contends Dr. Van Natta.Instead, even before they go home, he has patients do an overhead stretch with their arms. Patients are then instructed to go home, take a two-hour nap, get up, have a bite to eat and take 800 mg of ibuprofen. After about 20 or 30 minutes to allow the ibuprofen to take effect, patients are told to then take a shower, wash their hair, blow it dry and get dressed and go out.
Patients are also instructed to perform a set of five overhead arm stretches every hour. At the end of the day, Dr. Van Natta has his augmentation patients lie face down on their breasts for 15 minutes for a last good stretch of the pectoral muscle. "The main idea is to keep the muscle from contracting and becoming painful," Dr. Van Natta explains. "It's a similar concept to stretching when you have a charley horse."
"The 'old school' [and still predominant] post-op instructions are to be bound up after surgery, take it easy, and don't lift your arms far away from your torso," he explains. "This leads to the cycle of swelling, stiffness and pain." Regarding the instructions to lay face down for 15 minutes, Dr. Van Natta says the process tends to get easier. "It can be a little uncomfortable at the start, but it gets better the longer the patient lays on their breasts, and each time they do it, it seems to get better," he says. "Some patients lie on their breasts four to five times a day and love it," he adds.
LIGHT ON PAIN MEDS Importantly, Dr. Van Natta discourages narcotic use during recovery and instead instructs patients to take ibuprofen — 800 mg, three times a day, in order to reduce pain without causing nausea. "As long as the patients follow the program and are up and about, there is usually nothing more than a sense of tightness [like engorgement]," Dr. Van Natta says.
"They get along great with just the ibuprofen," he adds. "I did more than 220 augmentations last year and only one patient called and asked for something stronger." The exercises, combined with the gentler pain relief regimen, combine to give patients a far less uncomfortable breast augmentation experience, Dr. Van Natta says. "With the 'old school' approach, patients typically made statements like 'it was worse than childbirth,' and said they couldn't drive for seven to 10 days or longer. Meanwhile, our patients are going out to lunch, shopping, going to school functions and even stopping by the office on the day after surgery. They drive the kids to school or soccer the next day and virtually all are back at their jobs within a couple of days."
Size matters In addition to reducing recovery time, Dr. Van Natta says he is able to keep his re-operation rate much lower than average by simply taking the approach of limiting the implant size within reason. "The bottom line is, we don't exceed an implant size that is greater than what the patient's existing soft tissue can handle, regardless of whether or not they want something bigger," he notes.
"As a result, our capsular contracture rate is a fraction of 1 percent, even though the national average is 13 percent at four years. And whereas the national re-operation rate at four years was 23.5 percent, ours was 3 percent to 4 percent for the same time period." Despite the reports of faster recovery by numerous plastic surgeons who say they follow Dr. Tebbetts' approach, many are skittish about putting the muscles in motion so soon after surgery for fear of causing hematomas, but Dr. Van Natta says he has not encountered that problem.
PATIENT LIBERATION "Many doctors fear that if the patient starts moving the arms it will cause bleeding," he says. "I can say that in the past 15 years, we've only had about four hematomas that we've had to bring back to the operating room, and [only] one was in the past three years [when the practice adopted Dr. Tebbetts' approach]. So doing this procedure has not increased the hematoma rate or changed capsular contraction rate at all."
"What it has done is absolutely liberated these patients," Dr. Van Natta says. "They really appreciate not having to take time to take off."
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