Below, we’ve asked a leading dermatologist, a wound care specialist, and a breast surgeon to share their skin-care tips. Read on to learn more about this important part of thriving after surgery.
Let Your Body Heal
To protect your skin post-surgery, make it a goal to avoid any lifting, pushing, and pulling for several weeks, says Donna Hart, MD, a dermatologist in Austin, Texas, who was recently diagnosed with breast cancer herself. The more you move, the more likely you’ll have problems with your drains, “the narrow tubes placed in the chest and underarm that allow accumulated fluid to escape following surgery,” Dr. Hart says. Though your skin may look purple, red, or bruised after surgery, you want to avoid using any topical creams in or around your sutures, she notes. If your doctor suggests it, you can use petroleum jelly, Aquaphor, or an antibiotic ointment once or twice daily right away. Your healthcare provider may also recommend that you use silicone gel — some are available in strip form — to treat any wound once the skin is fully healed. “These gels help the scar soften, since scar tissue can often be quite firm,” she says. Also, avoid using antibacterial creams and ointments, such as Neosporin or Bacitracin, directly on the wounds. And, if you’ve had radiation, your healing process may be further compromised. In this case, be sure to discuss skin-healing options with your doctor, including postsurgical gels. “There are also emollients you can use to avoid radiation dermatitis and treat post-radiation burns,” she says. Whatever the reason, report any skin changes to your surgeon immediately. This includes pus coming out of the wound or an area that has taken on a black color, which could mean skin necrosis (or not enough blood supply) to the wound. “With necrosis, you want to look out for skin tenderness that tends to be black or red, but in a person of dark skin that might look like a purple change in color,” Dr. Brem says. “Always compare these changes to the other breast.” Act quickly and be sure to email photos of the skin to your surgeon, and if necessary, book a telemedicine appointment so your surgeon can see the area in question. And, while breasts are “favorable” to good wound healing, Brem cautions that there can be issues related to the moisture that pools in the underside or lower part of the breast against the chest wall — which can lead to fungus. “If you’ve been put on antibiotics after surgery this can predispose you to antibiotic resistance,” he says. Luckily, there are treatments that can assist with wound healing, notes Brem. These include such topicals as MediHoney, a gel wound and burn dressing, and Iodosorb, an antimicrobial gel. Other options include FlexHD Structural, a biologic that is derived from human tissue; collagen treatments that support new blood vessel formation and the removal of damaged tissue from a wound; and there’s even the possibility of receiving allograft tissue, tissue that is transplanted from one person to another, to help you heal. The quicker you report any wound issue, the better your results. This may mean you’ll need to consult with a specialist, depending on how complicated the issue is. “You want to be sure to see someone who sees a lot of wound issues,” Brem says. “Most gifted plastic surgeons probably don’t see a lot of complicated wound healing issues, so you want to find the best person to help you — as fast as possible.”
Be Gentle With Your Skin
If you opt for breast reconstruction with implants, you want to be on the lookout for issues such as skin thickening and stiffness. “Otherwise known as capsular contracture, this occurs because the rim of skin and fat is so thin and the implant underneath is firm and it’s nonliving tissue,” says Lisa Schneider, MD, a board-certified plastic surgeon in New York City, who specializes in complex reconstructive and aesthetic procedures, including lymphedema and breast surgery. “This then causes the skin and scar to tighten around the implant. When you don’t have healthy living tissue underneath you will always be fighting the tendency of the skin to contract and harden.” To treat the skin itself, Dr. Schneider urges waiting several months before applying any topical product on your incisions. “I always tell my patients to treat that skin like a baby,” she says. “Avoid any perfumes, dyes, or anything irritating. You wouldn’t want to do anything involving a peel or a scrub on that skin for sure.” To protect the skin near your drains, pad the area around them to avoid any pulling and tugging or pressure sores from the drain tubing compressing the skin. “I send my patients home in a surgical bra with a pocket for their drains, and you can also pin your drains to your clothing,” she says. In addition, keep the skin as dry as possible and consider tucking a square of a clean cotton T-shirt around the entry point for your drains for further comfort and to help avoid irritation. “The skin is very sensitive after breast surgery,” she says. “You want to make it a goal to treat the entire area as gently as possible.”
