Post-Surgical Gynecomastia Instructions:
I’ve handwritten these post-operative gynecomastia instructions for my Grade I/II/III, where the gland is removed thru an incision in the areola. Follow these gynecomastia recovery instructions to help you along the healing process and ensure the best quality results.
The postoperative period is important in ensuring that you get the best results possible. To make it easier to concentrate on what is important, I ‘ve divided it into two sections, that can be read independently. The first section is a summary of the time periods, so that you can read what’s important during that period for you instead of being overwhelmed by information. In the second section, I will focus on specific topics and common questions that arise. The sections together will give you an idea of what is important during the healing period, and we will distill it down to info you can process rather than overwhelm you with info.
Healing is a time dependent process. The initial ten days are what I consider most critical and the period in which your actions must follow the instructions as much as possible, as during this time inadvertent actions can lead to complications, including bleeding and disruption of the sutures and cosmetic results.
Section One: A time table of instructions:
A) Right after surgery…..Congrats!
Congratulations! You did it. Now just take it easy and don’t do too much. You should go home and rest. Your chest will feel sore, and you can take the prescribed pain medication as needed, but try not to over use it. A bit of soreness is OK and will remind you not to be too active. You have layers of bandages on, these are explained below, and you should not be touching or removing anything.
Wear the compression that we put on you. There are pads that we use the first three days that have to stay below the compression to provide extra protection and pressure. We also wrap your arms with a ace bandage to provide shoulder adduction/too much arm movement.
Gentle pressure helps prevent swelling, and helps prevent venous oozing, so wear it around the clock. Compression should feel snug in the chest, but it should not be painful. If it is too painful, it can be loosened, but you will need help in undoing it and redoing it. The pads are thick, and you shouldn’t have any visible leakage thru them. You may have minor oozing/leakage from the tiny numbing access point near the arm pit, an you can reach and change the bandages there if needed.
Eat and drink normally. You can walk around the house normally. Main thing to watch out for is dizziness, so take it easy and if you feel lightheaded, dizzy, nauseated, warm/flushed, just lay down and rest
First 24 hours after Gynecomastia Surgery:
Eat/drink: normal, but no alcohol
Movement: upper arm restricted by bandage wrap, strict
lower body: walking only
dressings: do not touch /change.
shower: no shower, sponge bathe only
Driving: No driving yet
The dressings you have on:
Before we get to the next time period, I think it is helpful for you to know what exactly you will find underneath your bandages, and what to do with it:
Let’s start with your incision: you will have a cut around the areola, typically on the underside. you may see some strands of sutures exiting the skin around that area, all the sutures are absorbable, and leave the strands alone. You may have some creasing /folding in the beginning due to those sutures. Typically, your incision is going to be covered by a steri strip unless your chest is super hairy (in which case the strips won’t adhere and we won’t use them). You have also a tiny 2 mm incision that is left unsutured near the axilla, where the numbing was inserted. you may see some leakeage from there.
The steri-Strip: this is a small strip of white tape that will be placed on the incision itself. It will typically cover all the incision, but you may see strands of sutures exiting your skin beyond the sterip strip itself. Leave the steristrip alone as it is protecting the incision from rubbing and will ensure good healing. Typically you can expect the steri strip to stay 10-14 days, and just like an old bandaid starts falling off, when it is ready to come off the edges will start peeling and you can remove it at the 10-14 day mark.
Gauze: we like plain gauze , and you will place that gauze on the incison and over the steri for about 14 days to protect from rubbing and for catching any drainage.
Padding: we will use either blue pads or ABD pads to create extra bulk right over the surgical site. this helps ensure adequate and more even compression. these pads need to stay on a minimum of the three day mark (the timeframe in which you do not touch anything). After the three day mark, they may be thrown away.
Compression vest: this is the compression vest that you will wear 2-3 weeks. If you had minimal lipo, 2 weeks is enough. If you had more lipo on the sides, shoot for three weeks.
Arm wrap: ace bandage or other wrap. Your arms are wrapped around your body. this is a gentle reminder not to move the shoulders away from the chest too much. We want to avoid stretching the arms away from the chest as this pulls/slides the chest skin off the pectoralis muscle and can disrupt internal sutures or reactivate bleeding. Just remember, “T-REX ARMS”
B) Time period: 24-72 hours after surgery:
Not much new will happen here, other than you will feel much less discomfort past the 24 hour timeframe. In this period of time, you can start taking walks outside the house. you can return to work on a computer as long a you are off the pain medications and your brain is not foggy. The pain beyond the first day should be very light, and you can transition to plain tylenol at the 24 hour mark. You can start using advil (ibuprofen) 48 hours after surgery. You can stop the narcotics. At this point, you are still not touching or changing the dressings. The ace bandage is reminding you not to be too active with the arms. Again remember, “T-REX Arms” for arm movement, and you will be fine.
24-72 hours post Gynecomastia surgery:
Eat/drink: normal, alcohol up to two drinks daily OK at the 72 hour mark. do not mix with narcotics.
movement: upper arm restricted by bandage wrap, respect that. “T-Rex Arms”
lower body: walking only, may start walking outside
dressings: do not touch /change.
shower: Those around you may want you to, but remember no shower, sponge bathe only
driving: OK at 48hrs if off narcotics
Meds: take your antibiotics. Take pain meds only as needed.
C) Three days after surgery: The big Unravel…..
At the three day mark, you can remove the compression and bandages for the first time. Remove all the layers one by one until you reach the steri strips. The steri strips stay in place. You may throw away everything except he compression vest. You may wash and dry the compression vest. You can take your first post surgery shower, which will feel great. Arm movement can now be increased, but should remain gentle and limited. After the shower, you may place a small layer of clean gauze on the incisions/steri strips. Replace your compression vest alone, without the pads this time. this will feel less snug, and it is OK at this point.
You may look in the mirror but do not touch the incision, press on the nipple, etc . things are still healing and we don’t want to disturb anything
D) Day 3-day 10:
To me this is a tricky time because patients feel great, but I have to remind them that excess motion or activity can disrupt the tissues still at this early point. Most important is to avoid excess range of motion of the arms until day ten. your job is to keep the T-rex arms as much as you can, even though the arm wrap is gone. You may feel great, but your skin is still not firmly attached to the muscle, and the small vessels around the surgical sites are still sealed only by fresh clot. Excess motion is the number one cause of hematomas, as the sutures can rip, causing a muscle bleed ooze, or the vessel small clots can rub off due to motion, causing an ooze. You may feel good, but your job is to constantly remind yourself not to do too much , espeically with the arms.
As far as the incision itself, it is covered by steristrips, so no creams /savs can be applied, and they are not necessary at this point.
as far as activity, you may go on walks. You may walk uphill on a treadmill to get the heart rate slightly elevatged, or do light stationary biking. Again, we are thinking about getting the heart rate up , to a certain degree, but not overdoing it still.
Day 3 to Day 10:
Eat/drink: normal, alcohol up to two drinks daily
movement: may start moving more, including arms. No more arm wrap, but take it easy
lower body: walking, stationary biking, elliptical
dressings: may shower. plain gauze on top of steristrip/incision then compression wrap
shower: may shower, pad incision dry
Meds: antibiotics should finish around day 4-5. may take advil for pain
E) 10-20 days after surgery…made it past the first critical period.
Once you hit the ten day mark, I feel that now you have reached an important milestone where enough healing has occurred that we can relax the above rules a bit.
you may start doing some light cardio and moving the arms more liberally.
Around 10-14 days postop, if the steri strips edges start loosening and it seems they are ready to come off, go ahead and pull them. you may cut any strands of sutures under the steristrips flush with the skin layer. don’t worry about having to pull the sutures out, all the sutures are absorbable.
you may apply mederma scar cream or a silicone scar cream once daily on the incision for the next 30 days as a preventative measure.
continue to wear the compression. If you didn’t have much lipo, you can stop the copression at the 14 day mark. if you had some liposuction in the lateral chest, you may remove the compression at the 21 day mark
movement: may start moving more
lower body excercise OK, limit upper body exercise
dressings: may remove steri strips, place gauze on incision. may place mederma scar cream on incision.
compression: off at the 14 day mark unless you had significant amount of lipo
shower: may shower, pad incision dry
Meds: no meds needed
Massage: Gentle Massage only, starting at day 12, start stretching the arms at day 12
Massages After Gynecomastia Surgery: the purpose of a roller or deep massage is to mechanically break up the normal biproducts of surgery consisting of coagulated blood, fat debris and slight fat necrosis. Left alone, your body is biologically (macrophage cells) breaking up that debris during the healing process, but a little help from the outside can accelerate this process, and minimize the amount of internal scar build up that can occur during the clean up. The key here is to wait long enough so that your external massage is not disrupting the internal sutures or even worse, causing bleeding or fluid build up that negates any positive effects. For this reason, I advise the massages to start at the twelve day postop mark, and to be limited in duration and intensity. For the duration, spending 3 minutes, twice daily, should be enough for you to cover the areas adequately. For intensity, this should be medium intensity, and you can test this out on your thigh to get a feel. it should be light like a swedish soft tissuue massage rather than a deep tissue/muscular massage. As far as tools, you can use a roller if you want. Don’t use the electric massage guns as these are too vigorous.
Stretching: at the 12 day mark, start stretching the arms above your head, side to side, and backwards, to move and glide the chest skin from the underlying muscles. The T-rex rules are officially extinct.
F) the 21 day mark and beyond:
at this point, if you are doing well and feel well, you can try to resume your normal exercise regimen, including full upper body. You should stop the compression vest. You may continue massaging any hard areas. You can stop massages around 8 weeks postoperatively.
come to your follow ups and contact us with any questions or problems. One set of instructions does not always fit all, so come to your follow ups and alert us of any potential issues so that we can ensure you get the wonderful results that I want you to get!
I consider you pretty much all healed at the 60-90 day mark as far as what you need to be doing, however slight remodeling and improvement may still occur however for another few months.