Chest Masculinization Post Op
Patients generally are discharged home or to a local hotel with whom we have arrangements (see Fly-In page) several hours post-operatively. More often than not, they are seen within 1-2 days back at the office to check nipple perfusion and for evidence of bleeding (hematoma, usually heralded by increasing pain, firmness, bruising and bloody drain output). The entire surgical dressing may be removed (around the lateral drains) on POD (post-operative day) #1 or (ideally) POD #2, after which the patient may shower, and then replace light gauze at the drain sites only (although if there is spotting centrally, gauze may be placed here as well – these gauze dressings are usually not necessary after POD#3). A 6″ ace wrap should then be placed circumferentially, over the drain dressings.
The ace wrap should be worn for 2 weeks more or less around the clock (except when showering), and 2 more weeks when active/during the day for 2-4 more weeks thereafter(especially after the drains are out), to prevent seroma formation/fluid build-up. Bathing/soaking or swimming should be avoided for at least 2 weeks.
Medications: With regard to pain/limitations, most patients are pleasantly surprised at how little discomfort they experience (usually a heaviness or general soreness; most discomfort is in the underarm area, as the central breast skin is relatively numb for several months). Patients are usually sent home on a moderate strength pain medications and 5-day course of oral antibiotics:
- Vicodin is prescribed as 1-2 tablets every 3-4 hours/as needed for pain, or
- Norco ” ” ” 1-2 tablets every 3-4 hours/as needed for pain, and
- Keflex (standard antibiotic) is prescribed as 500 mg 4x/day (#20 total), or
- Clindamycin (an alternative) ” ” ” 300 mg 3x/d (#15 total), or
- Levaquin (serious infections) ” ” ” 500 mg ONCE a day (#5-10 total)
It is OK to start taking XS Tylenol (1-2 tabs every 4-6 hours, maximum 8 tab/2400 mg/day) or ibuprofen on POD #1 (600 mg with food, up to 4x a day – caution if peptic ulcer disease – again with a maximum dose of 2400mg/day).
Drain Care: It is important to regularly monitor/strip, and empty/record the drain output. You just need to write down the time and amount removed (each holds 100cc, therefore ¼ or the first line represents 25cc). Drains cannot be safely removed (with respect to fluid build-up/seroma) until they are putting out approximately 30cc a day or less (therefore, if the output from a drain is greater than 30cc at for the 24hrs by 8 am on the day of your appointment, you generally should wait an extra day or two until it is below this level). It is OK if a bit of white plastic (the inner part of the drain) is showing at the skin level, but you should notify Dr. Steinwald if it is not holding suction, if there appears to be a clot and/or very low (or high) output, or if the skin suture comes loose.
One-Week Follow-Up: You should follow-up back in the office by approximately 7-10 days post-operatively, to have the drains removed (as appropriate; they rarely are left beyond 14 days even if the output is on the high side). At that time, a single (high-tension) external black nylon “anchor point” suture at the lower mid-chest will be removed, and all Steri-Strips will be replaced lengthwise along the incisions (including a diamond-shape around the nipple).
Incision Care (First Months): These Steri-Strips (or the one-inch medical grade paper tape we provide) should not be replaced daily, but only when necessary (i.e. when soiled, or peeling off). If any areas are moist or draining or a deeper suture erosion develops, over-the-counter antibiotic ointment (with a band-aid or small dressing) should be used 2-3 x a day until resolved and/or you are reassessed in the office. Moisturization or “scar reduction” creams (including sunblock) should generally not be used directly on the incision until at 4 weeks minimum, and tanning beds should be avoided (in general). Alternatively, silicone-based scar taping may also be of use for people with a history of red or prominent scarring.
General Activity Limitations:
- 5-7 days: may engage in ADL’s (“activities of daily living”; light housework, etc, provided not lifting more than 20-30 pounds)
- 7-10 days: may consider RTW (“return to work”, again with the above lifting limitations
x 4-6 weeks)
- 2-4 weeks: may engage in light exercise/extra activity (dog-walking, etc)
- 4-6 weeks: may engage in moderate exercise (bicycle or treadmill, but no full exertion)
- 6+ weeks: full activity (including heavy lifting/jogging) generally OK
Generally, most people are back to their normal routine by 2-4 weeks. Overall, it generally takes 3 months for significant swelling to go down and 6-12 months for scars to mature/fade.