S: 1 week status post S/M (submuscular) BAM (bilateral augmentation mammaplasty)
This is the first post-op visit for this 21 year old white female without significant PMHx
who presents for 1 week follow up appointment for bilateral submuscular breast
augmentation with silicone gel implants. She is currently complaining of bilateral breast
tenderness; rated 2 out of 10 (with 10 being the worst pain ever experienced). The breast
tenderness is located in lateral aspects of both breasts and continues to the nipple line
bilaterally. Pain sensation is described as a mild “burning” sensation with intermittent
“sharp jabs,” that are exacerbated with movement and removal of ACE bandage at time
of showering. She is also complaining of bilateral breast swelling, mild bruising along
both medial breasts. Her implants are sitting high bilaterally accompanied with fullness
in the superior aspects of the breasts. She denies a major complaint of breast pain –
patient has discontinued use of narcotic pain medication; she is currently using OTC
Acetaminophen every 6 hours. She also denies c/o fever, chills, nausea, vomiting or skin
changes such as erythema, warmth, tenderness or purulent drainage from incisions.
Sensory distribution is intact throughout per patient. She is now wearing a soft bra and
ACE wrap to bilateral breasts as directed. She is massaging breasts as instructed per her
discharge instructions. She denies any c/o headache, dizziness, chest pain, shortness of
breath, cough, change in bowel/bladder habits, lower extremity edema/calf tenderness.
PMH: Denies CAD, HTN, DM, CVA
SH: She is a single college student currently living with her parents. She denies history
of cigarette smoking and IV drug abuse. She drinks ETOH occasionally 2-3 beers on
weekends.
Meds:
Ortho Tri-cyclen
Multi-vitamin (One a Day)
Phenergan 25 mg 1 tab po q 8 h prn n/v. Disp: #20
Percocet 5/325 mg 1-2 tabs po q4h prn pain. Disp: #60 No refill
Duricef 500 mg 1 tab po BID x 5 days Disp: #10
Acetaminophen 325 mg 1 tab po q 6 hours prn pain
Allergies: NKDA
Objective 1 week post-op
VS: Temp 98.6F Pulse 70 Resp 16 BP 126/74 Weight 130 Height 5’6”
GEN; Alert oriented white female in no acute distress
SKIN: Skin turgor brisk, cool to palpation.
LYMPHATICS: Negative supraclavicular, infraclavicular axillary or epitrochlear
lymphadenopathy noted on palpation
BREASTS: Breasts with good symmetry, shape, contour.
Implants sitting high bilaterally.
Implants soft with good mobility (bilateral Baker I).
Mild breast tenderness on massage.
Incisions are clean, dry, and intact without erythema, warmth, tenderness or
purulent drainage.
Breast and NAC sensation intact to light touch and pressure sensation throughout.
CVS: S2>S1 base, regular rate rhythm, PMI localized @ 5th ICS MCL. No S3, S4, or
murmurs noted.
LUNGS: AP/Lat chest ratio 2:1, no deformities or accessory muscle use. Percussion
reveals resonance throughout. Clear to auscultation with vesicular breath sounds in the
bases. No wheezes or rhonchi.
ABDOMEN: Soft and flat without visible masses, scars, or rashes. Normoactive bowel
sounds heard in all 4 quadrants. Generalized tympanic percussion notes heard
throughout. Liver span 6cm at the right MCL. No masses, tenderness, or organomegaly
noted. No rebound or Rosving’s.
MUSCULOSKELETAL: Neg calf tenderness bilaterally, Homan’s sign is negative. No
effusions, erythema, or decreased ROM in any upper or lower extremities. Spine without
tenderness and ROM full.
A:
1 week S/P submuscular breast augmentation with silicone gel implants
P:
1. Gentle shower QD-BID with soap and water.
2. Apply Topical antibiotic ointment (Bacitracin) or Polysporin to bilateral
inframammary fold incisions TID for 5 days.
a. Wash hands before and after use
b. Try not to touch the tip of the tube to anything.
c. Do not use your medicine more often than directed.
d. Interactions are not expected.
e. Possible side effects include: Allergic reactions like skin rash, itching or hives,
swelling of the face, lips, or tongue, breathing problems, burning, stinging, and pain-if
you experience any of these symptoms report to your doctor or health care professional as
soon as possible.
3. Begin scar massage with reconstruction cream with hyaluronic acid BID after 5 days
of Bacitracin use (D/C Bacitracin after 5 days)
a. Massage reconstruction cream thoroughly into the scar incisions.
4. Patient to massage breasts TID as directed. (Capsular massage, upward/inward,
downward/inward massage, and 5 squeezes bilaterally TID with 5 sec hold)
5. Wear soft bras until 3 months post op to facilitate descend of implants.
6. May D/C ACE wrap - wear breast band to apply downward/inward pressure to breasts
and facilitate proper implant descent for the next 3 weeks.
7. May return to light cardiovascular exercise while wearing supportive, soft bra (sports
bra).
a. Avoid chest, back, shoulder exercises, overhead lifting and straining until 6
weeks post-op.
b. Avoid excessive CV activity, ie excessive running or intense cardio workouts
c. Physical restrictions discussed with patient. No heavy bouncing.
8. Follow-up appointment in 3 weeks for follow-up or prn sooner should problems arise.
a. Call 724-933-1800.
9. Patient has been educated on S/S of infection, seroma, and hematoma formation.
a. Infection signs and symptoms include malaise, lethargic, fever (101F or more
should be reported), hot incisions, swelling/hardening of the incision, drainage from the
incision, and increase or worsening pain
b. If you experience any of these symptoms notify the office or other health care
provider as soon as possible
c. Hematoma signs and symptoms include marked swelling, black and blue,
increasing pain, and uneven breasts
d. Seroma signs and symptoms include swelling at or near the incisions and
leakage of clear or yellowish orange color fluid through the incision. The area may be
painful.
e. If you experience any of these symptoms notify the office or your health care
provider as soon as possible
Tracie George PA-S