Breast Fat Transfer Recovery Tracker Form
Please complete this form to help monitor your recovery after breast fat transfer surgery. Your responses assist your care team in tracking your healing progress.
Full Name
*
First Name
Last Name
Date of Surgery
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Recovery Day (e.g., Day 1, Day 2, etc.)
*
Pain Level (0 = No pain, 10 = Worst pain)
*
No pain
0
1
2
3
4
5
6
7
8
9
Worst pain
10
0 is No pain, 10 is Worst pain
Swelling or Bruising Status
*
None
Mild
Moderate
Severe
Tenderness at Surgical Site
*
None
Mild
Moderate
Severe
Condition of Incision/Surgical Site
*
Normal (healing well)
Redness
Discharge
Opening or separation
Other
Current Body Temperature (°F or °C)
*
Have you taken your prescribed medications as directed?
*
Yes, all doses taken
Missed one or more doses
Not applicable
Mobility and Activity Level
*
Moving as usual
Limited movement
Mostly resting/bed-bound
Other Concerns, Symptoms, or Notes for Your Care Team
Submit Recovery Report
Should be Empty: