BEFORE SURGERY Avoid sunbathing for 2 weeks prior to surgery. Quit smoking at least 2 weeks prior to surgery as nicotine can impair and delay healing. Stop all aspirin containing products, medications that contain blood thinners (motrin, advil etc.) vitamin E and herbal supplements 2 weeks prior to surgery. You can take 1 multivitamin a day. Let the doctor know of all medications taken daily. Make sure all requested labs, mammogram and doctors clearance are delivered to our office on time. THINGS TO PURCHASE BEFORE SURGERY Medications. Garment. You will be provided with a surgical bra immediately after surgery. You should also have two other support bras available in a cup size you are anticipating going to or slightly larger. The bra should fit snug around your chest. Silicone Sheets. Silicone sheets minimize scarring and are a must postoperatively. Go to www.makemeheal.com and purchase 1 set of silicone sheets. Gauze. Make sure to have a box of 4x4 gauze. You can purchase this at drug store. Arnica (Optional) - www.alpinepharm.com - may decrease bruising, or help it to go away faster. Clients with high blood pressure should not take this herb. THE DAY OF SURGERY Do not eat anything for 8 hours and drink for 6 before surgery. You may shower and shampoo your hair the night before or morning of your surgery. You may brush and rinse your teeth, but do not eat or drink anything. Do not wear makeup or moisturisers on your face or eyes. Do not bring any jewellery or valuables with you on the day of surgery. Wear comfortable, loose-fitting clothes, preferably button up or zipped up top. Wear flat, comfortable shoes. Remove contact lenses, dentures and nipple rings before surgery. Someone must drive you home and stay with you the first night. Take 2 pills of Zofran and 2 pills of Celebrex at 1-2 hours before surgery. Anesthesia We work only with certified anaesthesiologists to make sure you have the best anaesthesia possible. The anaesthesiologist will discuss with you what type of anaesthesia is best for you. He/she will take into consideration your medical history, the procedure, and your personal wishes. Normally, general anaesthesia is required when performing breast reduction to make sure the client is completely comfortable throughout the procedure. THE PROCEDURE The procedure itself will take approximately 3-4 hours. AFTER SURGERY Get plenty of rest and limit yourself to light activities the first 10 days after surgery. Sleep and rest with head slightly elevated for the first 3 days. You may take a cool shower the day after surgery. Make sure you have someone helping you. Put your bra back on. Let water run gently over the drains exits. Dab dry. Place gauze over drain exit. At 2-3 weeks after surgery take your steri-strips off. Re-apply silicone sheets twice a day for two months. Sutures will dissolve on their own. Do not drive for the first week or while on pain medications. Do not do heavy housework and do not work out at all for the first 3 weeks, no upper body workout for at least 8 weeks. Avoid lifting anything heavier than 5 pounds for 2 weeks. Wear a surgical bra 24 hours a day for 8 weeks unless the surgeon instructs you differently. Avoid direct exposure of incision to sunlight for at least 6 weeks. After 6 weeks, apply sunscreen (at least SPF 15) to the area of the incision, if you will be in the sun for extended periods of time. Do not smoke for at least 1 week after surgery. Do not use aspirin-containing products for at least 1 week. You may take Tylenol or pain medication as prescribed. You may apply ice or frozen peas or corn on the breast for the first 48 hours to decrease swelling. Do not apply it directly on your skin. Be sure to use all you medications as directed. It is not uncommon for a small part of incision to open up and look like a pimple at 4-8 weeks. This is called a Stitch Abscess - it is caused by a suture that is expelled by the body. Simply wash it with soap and water and apply Neosporin or Polysporin on it. If the redness is larger than a dime call the office. WHAT TO EXPECT AS YOU RECOVER Immediately after surgery, some clients feel groggy or nauseous. These feelings normally subside by the next day. Many clients experience some pain for the first 3-4 days and soreness for the first 2 weeks Most of the time the breasts are very swollen and tight for about six weeks. Do not be concerned as they will drop with time. At your follow up appointment we will show you how to massage them to make sure your positioning is appropriate. The body heals asymmetrically. One breast might be swollen, hurt more and appear higher or lower than the other, do not be concerned. Swelling and bruising usually clear up within 2 weeks. Pink scars will eventually fade to an unnoticeable colour. It may take up to a year for the scar to fade to its minimal colour. Some firmness may develop. Once the tenderness subsides, you may begin to massage the breasts to help soften them. After 3 months you should massage your breasts daily during your shower for 30 seconds for the rest of your life. Your nipples might become hyper sensitive or lose sensation for the first 3 months. This usually goes away. WHEN TO CALL US Post surgical complications are rare and are often easily solved by the doctor if you notify us. Call us if you experience any of the following: A temperature of 38 C or higher, increased local redness or warmth, chest pain, shortness of breath, legs swelling, calf pain, or if you feel that anything might be wrong. In addition, call if you have continuous discharge from the incision line, if one of the breasts appears significantly larger and more tender, if the pain increases instead of decreasing after 5 days or the breasts become red. POST-OP VISITS AND CARE SUMMARY

Blood Clot It is important to walk at least every 2 hours while you're awake to prevent blood clotting- do not over do it. Right after surgery you will be instructed to walk around every 1 hour. Pay specific attention to Leg Swelling. If you notice swelling on only one leg or calf pain contact the office. Drain Function Make sure that your drains are functioning. Empty drains every 8 hours or when they become more than half full and write down amount of drainage. Do not be concerned if the fluid from the body comes around drain. You may need to milk the tube if it appears to be clogged. Drains come out at about 2-3 days, depending on amount of drainage. Note - the drain is always uncomfortable but it is absolutely necessary to prevent fluid accumulation. Constipation If you are constipated at day 2 stop taking Vicodin or Darvocet. Encourage walking, drinking a lot of fluids, consider laxative (Ex-lax or Correctol). Fever Make sure to cough and breath deep as fever is usually in lungs for the first 3 days after surgery. Activity You can take a cool shower the day after. Dab dry. Make sure you have someone helping you. Walk every hour while awake for the first day and then every 2 hours Sleep at 45 degree angle for the first 3 nights. Begin massage after the first post-op visit. Regarding exercise: If it hurts don't do it. Wait for your body to tell you what you can do. You can exercise areas other than your chest at 2 weeks. You can work out your chest at 8 weeks. Wound Care Make sure your bra is on as directed Keep surgical area clean and dry at all times. At 2-3 weeks after surgery take you steri-strips off. Apply silicone sheet twice a day for two months.

Recovery time Some people with sedentary jobs go back to work after 1 week. If your job, however, requires aggressive arm movements it may take as long as 4 weeks to return to work. Most people return to work after 2 weeks.