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Frequently Asked Questions for

Tissue Expander Breast Reconstruction


1. Is there anything I need to avoid prior to surgery?


Please do not take any blood thinners such as non steroidal anti-inflammatory medications like Ibuprofen (Advil), Naproxen and others, Aspirin or Coumadin prior to surgery. 


Please stop your birth control pill 2- 4 weeks prior to surgery as this may increase the risk of blood clots.


We recommend discontinuing all herbal medications prior to surgery. Specifically, the following herbal medications may cause blood thinning, cardiovascular instability or interact with other drugs given to you for anesthesia:

  • Ginko Biloba

  • Garlic in pill form

  • Ginseng

  • Fish Oil

  • Dong Quai

  • Feverfew

  • Ephedra

  • Kaya

  • St Johns Wort

  • Valerian Root

  • Licorice

  • Echinacea

  • Goldenseal

  • Large Dose of Vitamin E


Recreational Drugs or Alcohol should not be used 24 hours before and after surgery. These may interact with your anesthetic or post operative pain killers and cause serious complications.


Do not smoke for 1 month prior to and 1 month after surgery. Nicotine in cigarettes will cause problems with healing, increased risk of infection and the possibility of dead skin after surgery.


Get 8 hours of sleep per night in the two weeks prior to surgery. This will boost your immune system.


You will not be able to have anything to eat or drink the night before surgery. The surgery centre will call you with specific instructions.


Please call our office immediately if your health condition changes (flu, urinary tract infection, cold, fever) before surgery.

2. Will I see Dr Macadam on the day of surgery?


Yes, Dr Macadam will see you and mark you for surgery right before the surgery occurs.

3. What will happen after the surgery?

You will go up to the Plastic Surgery Ward at either UBC Hospital or VGH. You will be given pain medication by the nurses. You will have tapes on your incisions and then another bandage over the tapes. You may not shower as you will have drains and this may cause infection. You will stay in hospital for 1 day.


4. What will happen when I leave the hospital?


You will have tapes on your incisions and then another bandage over the tapes. You may not shower as you will have drains and this may cause infection. 


You will have prescriptions for an antibiotic to prevent infection and a pain killer (Empracet). Take the Empracet every 4 hours for the first 48 hours and. After the first 48 hours try to use only the Empracet as needed. Some patients will buy Colace or Senekot at the pharmacy to help with constipation. You are not allowed to ingest caffeine for one month after surgery.

5. When will I see Dr Macadam after surgery?


Our office will usually make your postoperative appointment prior to your surgery date. If this hasn’t been done please call the office to book an appointment for one week after surgery.

6. What should I avoid after surgery?


You may not lift anything heavier than 5lbs. Do not exercise. Exercise is restricted for 4 weeks because of the risk of bleeding.  

7. How do I manage my drains?


You will need to open the drain and empty the fluid every 12 hours The fluid may be dumped in the toilet. Please record how much is in the drain before you dump the fluid. You can do this by looking at the lines on the bulb and recording how many milliliters of fluid are present every 12 hours. Your drains will be removed when the drainage is less than 30cc/24 hours. You will need to bring in your record of drainage to your first postoperative visit. Please add up the 24 hour totals for each day so Dr Macadam knows if your drains are ready for removal.


Specific Instructions on drains:

  1. Wash your hands thoroughly before emptying your drains.

  2. Unpin the drain from your clothing. 

  3. Read the side of the bulb and record the output.

  4. Open the top of the drain. Turn the drain upside down and squeeze the contents of the bulb

  5. into the toilet. Be sure to empty the bulb as completely as possible. 

  6. If you have more than one drain, remember to record the drainage from each drain separately.

  7. To prevent infection, do not let the top of the bulb  touch any surface.

  8. Use one hand to squeeze all the air from the drain. With the  drain still squeezed, use your other hand to replace the top. This creates the suction necessary to remove fluids from your body.

  9. Pin the drain back on your clothing to avoid pulling out accidentally. 

  10. Wash your hands again before and after the procedure to reduce the risk of infection.

*Please remember to strip the drain, as instructed, each time before emptying the drain or as needed throughout the day. 

Notify the office for any of the following:

  • The reservoir cannot be flattened

  • The drain falls out

  • The drainage fluid in the reservoir becomes foul smelling

  • You have a fever

  • There is an increased redness, swelling and abnormal drainage from the drain site

  • There is an air leak, fluid leak or any other malfunction in the system

  • The drain is not collecting any fluid


9. What are things to look for after surgery?


After you are discharged from the hospital, there are a few things to watch during your healing process. If you see any of the following try calling Dr Macadam. If you cannot reach her please call VGH at 604‐875‐4111 and ask to page the plastic surgeon on call:

  • Change in color of your breast skin

  • Leg Swelling

  • Shortness of Breath

  • Redness around your incisions

  • Swelling of the breasts

  • Increasing in your breasts

  • Increasing pain around the incision

  • More than 50cc of blood in the drains per hour for 2 hours in a row

10. When can I drive?


Every patient is different. We recommend that you be off of all narcotic medications prior to driving. You will need to feel comfortable enough to make a sudden turn of the steering wheel. For most patients this is at about 10-14 days after surgery.

If you have any other questions during your post‐operative course, feel free to contact our office or email Dr. Macadam at

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