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One of the most common concerns about top surgery is minimizing scars. In addition to following Dr. Mosser’s scar prevention guidelines that include wearing sunscreen and using a silicone-based scar gel, we have previously advised patients not to raise their elbows above their shoulders for the first 6 months of healing. Image 1 depicts the typical maximum height for arms and elbows for the first 6 months of healing, just under shoulder height, no matter the orientation of the arms (in front, out to the side, etc.). However, because some patients (especially those over 50 years of age or with a history of shoulder injuries) have reported shoulder tightness and a decrease in mobility after the 6-month recovery milestone, we are revising this instruction for certain patients.
Shifting your post-op recovery priorities to shoulder mobility will likely result in wider and darker top surgery scars. Therefore, we only recommend shoulder mobility exercise for patients who have had a previous shoulder injury, anyone who experiences shoulder tightness (which is not uncommon for people beyond middle age), or patients undergoing physical therapy for their shoulders.
One way to assess your shoulder mobility before surgery is to lift your elbows above your shoulder and point them straight up, as seen in Image 2. This can also be done once a month at most during your recovery to periodically check on shoulder mobility. Obviously, this violates the general post-op movement restriction, so one should one do this if they know they are prone to shoulder tightness or experienced shoulder pain before surgery.
If this exercise causes pain or tension we will need to order physical therapy for your shoulder either through our office or your primary care provider, even though there may be a detrimental effect to the healing of surgery scars. Note: If you experience pain or tightness, do not push yourself to reach your arms all the way up.
If you have a good range of motion and do not experience tightness or pain in your shoulders, then you can continue the activity restriction of having the elbows below the shoulders at all times.
As always, the more information you are able to provide regarding pre-existing shoulder injuries with us during your virtual and/or in-person consultations, the better equipped we will be to help tailor a recovery plan to fit your needs.