Decreasing the Recovery Time from Breast Augmentation: Changing the Mind-Set of the Patient, the Technique of the Surgeon, and the Postoperative Care

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Introduction: Dr John Tebbetts first described his 24-hour recovery from breast augmentation in Plastic and Reconstructive Surgery in 2002. His original article describes the inframammory approach, using direct visualization, implants ranging in size from 220 to 350 cc, and postoperative exercises. Dr Tebbetts limited the administration of muscle relaxants to the intraoperative period and did not administer narcotics in the postoperative period. Critics of Dr Tebbetts' work have stated that his ability to return patients to normal daily activities in such a short time is, in large part, due to his use of smaller implants. Although other articles have been written on augmentation recovery, the goal of our study was to institute Dr Tebbetts' ideas with our patient population, without limiting the size of the implants used or limiting the procedure to augmentation, and to analyze the results. Materials and Methods: We instructed 100 consecutive primary breast augmentation patients on postoperative exercises, limited the administration of narcotics, immediate postoperative use of ibuprofen, and encouraged the mentality of an earlier return to normal activities. Our patients were administered a survey on postoperative day 7. Results: The overall ability to return to work was 4.0 days after surgery. The use of narcotics was least in the groups where dissection was completed using direct visualization. Ninety-five percent of all patients thought that the postoperative exercises decreased their pain. We did have 5 patients (5%) who developed hematomas requiring evacuation, which was an increase for the practice, but still fell within the national average of 1–6%. Discussion: Our conclusions are that early postoperative arm exercises and encouraged activity, coupled with dissection under direct visualization, does allow for limited use of postoperative narcotics and an earlier return to normal activity. We observed an increase in the number of hematomas, which may suggest that ibuprofen in the immediate postoperative period affects the patients' platelets.