Post-op information
Pain control
Doctor Urzola does his very best to control the pain in all of his patients, however the surgery that you have scheduled will not be a pain free surgery. You should expect to have moderate pain for a few days after surgery and then it begins to taper off lasting for a few weeks. It’s important to take note that in Costa Rica narcotics are administered in a different fashion than many other countries. They are available in Costa Rica, but patients should know that they are very expensive and come pre-packed therefore you cannot be prescribed less than 30 pills which increases the cost.
Post-op garments
After your surgery you will be fitted into a surgical garment that will provide adequate compression. Your post op garments should be worn for 30 days after surgery, 24 hours a day other than when you take a shower. Your garment will help to reduce edema, bruising and pain.
Drains
Dr. Urzola determines if you will need drains based on several technical factors. If you have drains you can review drain instructions at: explantcostarica.com/drain-instructions
Follow-up appointments
You will see Dr. Urzola several times during your visit to Costa Rica. Your first visit will be around 2-3 days after surgery and your last visit will be the day before you depart Costa Rica. Should you need a follow-up after your departure you are welcomed to set up a Skype appointment or set up an in-person appointment.
What if I have complications after departing Costa Rica
Dr. Urzola does not abandon his patients after their departure from Costa Rica. He is committed to your full recovery. Should you run into complications after your departure Dr. Urzola will see you through them.
Post-op massages
Post-op lymphatic massages are not required for explant but if you desire to have one they will begin 2-3 days after surgery. These appointments will be made for you and will be performed at Dr. Urzola’s office. Do not massage the breasts.
Hyperbaric chamber
Hyperbaric Chamber treatments are not required for explant but if you desire to have one, your first Hyperbaric Chamber Therapy (HBOT) should be scheduled the morning after your surgery and the rest of the sessions should be scheduled the 2nd and 3rd day after your surgery for the most benefit. If you are claustrophobic speak with Dr. Urzola to devise a plan for your situation. HBOT has been shown to aid in wound healing, stimulate growth of the new blood vessels, improve circulation and speed up the injury recovery process. To schedule your HBOT appointment send an email to [email protected] or call (506) 2253 1628.
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Post-op Medications
THIS MEDICATIONS ARE SUBJECT TO CHANGE. EACH PATIENT MAY PRESENT AN ALLERGY TO THE MEDICATIONS. MEDICATIONS WILL BE PRESCRIBED INDIVIDUALLY DEPENDING ON THE MEDICAL HISTORY AND MEDICAL CONDITION OF EACH PERSON.
Antibiotic and Pain Control after the first 24 hours (This has to be purchased by patient)
Antibiotic
Zamur 500 mgrs: Every 12 hours for 5 days (8:00 a.m. – 8:00 p.m.). This drug is used to prevent infections and is used in combination to an intravenous antibiotic administered 30 minutes before we begin your surgery.
Blood Thinner
(anticoagulant) Badiket (Bemiparin Sodium) 3500 UN, subcutaneous application (6hrs post-surgery and every 24 hours for 10 days). This drug is used to avoid blood clots in your legs .and prevent Pulmonary Thromboembolisms.
Pain
Berifen (Diclofenac sodium) 100mgs capsules. Take one capsule every 24 hours for 7 days. This drug is effective for treating acute or severe pain after surgeries, fever and inflammation.Enantyum (Dexketoprofeno Trometamol) 25 mgs capsules. Take one capsule every 8 hrs. For 7 days (7:00 a.m. – 3:00 p.m. – 11:00 p.m.). This drug is used to treat mild to moderate pain, such as muscular pain, painful periods (dysmenorrhea), toothache and inflammation.
Tramacet (Paracetamol-Tramadol) 325-37.5 mgs capsules. Take one capsule every 12 hours by mouth for 7 days (8:00 a.m. – 8:00 p.m.). This drug is used to treat moderate to severe pain and inflammation.
Nausea (antiemetic):
Dislep 25 mgs every 12 hour for 5 days (8:00 a.m. – 8:00 p.m.).
Gastric Protection:
Zoltum 40 mgrs 15 minutes before breakfast for 7 days (7:00 a.m.).
General post-op instructions for explant surgery
Activity
- No driving for 1 month after surgery
- No sexual activity for 1 month after surgery
- No exercise for 1 month after surgery (yoga, pilates, running)
- No high-impact exercise for 3 months after surgery
- Avoid lifting of objects heavier than 4lbs for 1 month
- No bending with shoulders down for the first 15 days after surgery
- No tanning for 3 months after surgery
- No hiking or touring while recovering here in Costa Rica (this includes but is not limited to beaches, mountains, volcano’s or downtown markets in San Jose after your surgery, this will increase your risks for infection.
**When you get an explant procedure, it is important to know that you have an open pocket that needs to close when your implants are removed. Until this pocket is closed you are at more risk for a seroma or hematoma. This is why it is crucial to follow your post-op directions and limit your activity. Too much activity to include but is not limited to moving your arms too much and walking too much greatly increase your risk of a hematoma and/or seroma.
Diet
- No alcohol for 4 weeks after surgery
- Drink plenty of liquids to keep yourself well hydrated
- Eat a healthy diet with a high protein content
Wound Care
- Your stitches are dissolvable /removable. If removable, take them out in 12 days (this may change according to your wound healing)
- You may begin to apply scar cream 1 month after surgery
- Do not raise your hands above your head for 2 weeks after surgery. This could injure your muscles or compromise the incisions
- Do not emerge your body into water (pools, hot tubs, bathtubs, lakes, etc.) until 1 month after surgery to make sure the wound is completely healed
- You may remove the surgical tape 3 weeks after the procedure if you want to keep it longer, you can, but it might produce allergies. Use a blow dryer or gently pat dry after taking a shower until the tape is dry. A wet tape can increase the risk of infections.
- You cannot be near pets for 1 month after surgery (pets have bacteria and microorganisms that may cause an infection).
- Incision sites should be protected from the sun to avoid scarring and hyper-pigmentation
- Do not smoke (or inhale secondhand smoke) for 3 months after surgery, as smoking delays healing and increases the risk of complications by up to 30%
- Do not apply ice or heat to breasts for 1 month after surgery
- Remember, your hands can carry bacteria. It is crucial to keep your hands clean at all times and do not touch your surgical wounds unless your hands are spotless. The use of hand disinfectants is strongly recommended.
Garments
- Wear your compression bra and body for 1 month after surgery
- The compression garment must be worn AT ALL TIMES for at least 1 month after surgery, day and night 24/7. (except for taking a shower)
Medications
- Please take all medication carefully and as directed; not taking the medications indicated might put your health at serious risk.
- No Vitamin E and non-prescribed anti-inflammatory products by Dr. Urzola for two weeks following surgery. All other medications and supplements need to be discussed with Dr. Urzola.
Drain Care
- If drains were placed, empty drains as they become full
- Record drain output
- Keep your insertion site and the area around it clean and dry
*There is more detailed information on the website
Messages
- Do not massage your breast if you received the U-Flap procedure
- Massage to the surgical sites will help increase circulation and alleviate the hardness felt underneath the skin. Massage on surgical sites might begin 1 month after surgery if you did not have the U-Flap
When should I call Dr. Urzola’s office?
- If you have increased swelling or bruising
- If swelling and redness persist after a few days
- If you have increased redness along the incision or it looks open
- If you have severe or increased pain not relieved by medication
- If you have an oral temperature over 100.4 degrees (It is not uncommon to have a few tenths of a fever for a day or two)
- If you have any yellowish or greenish drainage from the incisions or notice a foul odor
- If you have nausea, vomiting, rash, or shortness of breath
- If one of your legs is swollen or painful
Would you please not hesitate to call Dr. Urzola’s office at any time if you have questions or concerns?
We want to facilitate your healing process, and we are here to help. You may contact Dr. Victor Urzola at
(646)-363-6923
(506)-2241-5686
(506)-2208-8851
Drain Instructions
JACKSON-PRATT SYSTEM
The Jackson-Pratt system has a soft plastic bulb with a stopper. A catheter is attached to it (Figure 1 below). The drainage end of the catheter is inserted near your incision. When the bulb is compressed with the stopper in place, a vacuum is created. This causes a constant gentle suction, which helps draw out fluid that collects under your incision. The bulb should be compressed at all times, except when you are emptying the drainage. How long you will have your Jackson-Pratt depends on your surgery and the amount of drainage you’re having. Drainage is very individual; some people drain a lot, some only a little. The Jackson-Pratt is usually removed when the drainage is 30 mL (30 cc) or less over 24 hours. Your doctor and nurse will know how much your Jackson-Pratt is draining because you will record this at home in the drainage log in this guide. It’s important to bring the log with you to your follow-up appointments.
CARING FOR YOUR JACKSON-PRATT AT HOME
- Milking the tubing to help move clots
- Emptying it twice a day and recording the amount of drainage on the Jackson-Pratt Drainage record if you have more than 1 drain, make sure to measure and record the drainage of each one separately. Do not add them together.
- Caring for your insertion site, the area where the catheter enters your skin
- Recognizing when there is a problem.
MILKING THE TUBING
These steps will help you move clots through the tubing and keep the drainage flowing. Do this before you empty and measure your drainage.
- Wash your hands thoroughly with soap and warm water. Dry them completely.
- Look in the mirror at the tubing. This will help you see where your hands need to be.
- Pinch the tubing close to where it goes into your skin between the thumb and forefinger of your hand.
- With the thumb and forefinger of your other hand, pinch the tubing right below your other fingers. Keeping your fingers pinched, slide them down the tubing, pushing any clots down toward the drainage bulb. You may want to use alcohol swabs to help you slide your fingers down the tubing.
- Repeat steps 3 and 4 as necessary to push clots from the tubing into the bulb. If you are not able to move a clot into the bulb, call your doctor or nurse.
- The fluid may leak around the insertion site if a clot is blocking the drainage flow. If there is fluid in the bulb and no leakage at the site, then the drain is working.
HOW TO EMPTY YOUR JACKSON-PRATT AND RECORD THE DRAINAGE
You will need to empty your Jackson-Pratt in the morning and in the evening.
Equipment needed
- Measuring container given to you by your nurse
- Jackson-Pratt Drainage Record included in this section
Instructions
1. Prepare a clean area to work on and gather your equipment.
2. Wash your hands thoroughly with soap and warm water. Dry them completely.
3. Unplug the stopper on top of your Jackson-Pratt. This will cause the bulb to expand. Do not touch the inside of the stopper or the inner area of the opening on the bulb.
4. Turn your Jackson-Pratt upside down, gently squeeze the bulb, and pour the drainage into the measuring container (see Figure 2).
Figure 2: Emptying the bulb
5. Turn your Jackson-Pratt right side up.
6. Squeeze the bulb until your fingers feel the palm of your hand.
7. Continue to squeeze the bulb while replugging the stopper.
8. Check to see that the bulb stays fully compressed to ensure a constant gentle suction.
9. Pin the collar of your Jackson-Pratt securely to a piece of your clothing or feed it through the Velcro® straps attached at the bottom of your surgical bra, if you have one. Do not let the drain dangle. A fanny pack or belt bag may be helpful to hold the drain.
10. Check the amount and color of drainage in the measuring container.
11. Record this amount and the color of drainage on your Jackson-Pratt Drainage Record.
12. Flush the drainage down the toilet and rinse the measuring container with water.
13. At the end of each day, add up the total amount of drainage for the 24-hour period and record it in the last column of the drainage record.
14. If you have more than 1 drain, measure and record each one separately.
CARING FOR THE INSERTION SITE
Once you have emptied the drainage, wash your hands again. Check the area around the insertion site. Look for tenderness, swelling, or pus from the insertion site. If you have any of these symptoms or a temperature of 101° F (38.3° C) or higher, you may have an infection. Call your doctor or nurse.
Sometimes, the drain causes redness the size of a dime at your insertion site. This is normal. Your doctor or nurse will tell you if a bandage should be placed over your insertion site.
