Preparing for Surgery
Preparing for surgery is an essential part of the equation to ensure you have a smooth operation. Before the day of your surgery you may want to print this page to reference the guidelines that we have found to be the most beneficial. Depending on the procedure you are having performed, some of these guidelines may not apply to you.
It is important to follow the instructions given to you at the time of your pre-operative appointment. These may include but are not limited to having blood tests, a chest x-ray, and an EKG. You will be asked to stop taking aspirin as well as any blood thinners, medications containing vitamin E and any non-steroidal anti-inflammatory medications such as those containing ibuprofen. You may be instructed to take a stool softener. Narcotic pain medication tends to cause constipation, and taking a stool softener twice a day for a few days prior to surgery may prove to be quite beneficial.
Risks of Smoking
If you are a smoker, your plastic surgeon should have already talked to you about the risks associated with smoking and reconstruction. Some plastic surgeons will not operate on a smoker, because it will negatively affect the healing process after surgery. Smoking produces nicotine and carbon monoxide which will cause the blood vessels in your skin to constrict, resulting in poor wound healing. In the setting of a tissue expander, skin on the breast will be compromised and could result in loss of the tissue expander. TRAM flaps in particular are more likely to have complications such as fat necrosis. Also, smoking increases the risks related to anesthesia. It is essential to quit smoking as soon as possible after your diagnosis, to allow as much time as possible for your body to recover from the effects of smoking prior to surgery.
Preparing Your home
The most important thing you can do to ensure a smooth transition from the hospital to the comfort of your home is to prepare as much as you can in advance. Lifting restrictions apply to every type of reconstruction. It is essential that you adhere to all of the lifting restrictions given to you by your surgeon. A good rule of thumb is that if it is heavier than the Sunday New York Times, then you should not be lifting it during your first week home from the hospital. If you have pets, you will be unable to lift large bags of pet food or kitty litter. You should prepackage these items into smaller containers that are no heavier than 2-3 pounds. If your family consumes a lot of juice, or drinks water by the gallon, you may want to consider getting juice boxes or smaller bottles of water for easier lifting. Planning meals in advance, or having friends assist with meals can be very helpful. You should not vacuum or do laundry, and you should avoid repetitive motion like scrubbing pots and pans. While it may be nice to get a break from regular household duties, some women have a hard time allowing their house to get a little messy, or to let others do the chores (because as we all know, women do it best), but this is no time to be Superwoman. These lifting restrictions are in place for a reason, and you do not want to do anything to compromise your reconstruction.
Comfort After Surgery
Another way to prepare for surgery is by garment shopping ahead of time. Most patients, especially those undergoing bilateral surgery, will not be able to pull a shirt over their heads. For this reason, you want to get some soft, oversized button down shirts, or a front zipper sweatshirt. There are sweatshirts you can find at your local discount stores that have pockets on the insides, which are great for pinning or tucking surgical drains into. Patients having TRAM flap reconstruction, or any abdominal microsurgery, may want to purchase loose fitting pants as well. Pants that have an elastic waistband may pull on the already tender scar line from surgery. Many women find that oversized cotton, snap down pants work very well. You can pin or tuck the hip drains into the pant pockets, and because they are one or two sizes too big, they will not cause any abdominal discomfort. You may want to purchase shoes and slippers as well. After surgery, most patients find it uncomfortable to bend over to put on shoes or sneakers. Having a slip-on mule or sandal will be helpful. At home, you may want a slipper with a grip on the sole to ensure that you don't slip when you get out of bed, or go to the bathroom. You should pack these garments, or have your caretaker bring them to you on the day of discharge. If your caretaker drives an SUV, you may have trouble climbing in and out of it. Having a sedan may be more comfortable. Bring pillows to support your back and neck, especially if you have a long drive home from the hospital. You can use a pillow to press against your abdomen when you laugh, cough, sneeze, or when you put the lap belt over yourself in the car.
You should also set up your bed and bedside table in advance, so that when you arrive home from the hospital, all you have to do is climb in and relax. You will need a lot of pillows on your bed, including extra pillows for behind your back and under your legs. These will keep you in a position with you hips and knees flexed while you are in bed. You may want soft pillows for under your arms as well. On your bedside table you should have (all within arms reach), a hand held mirror, a tube of Bacitracin or Aquaphor ointment, your phone (if portable then take the charger), antibiotics, and pain medication. The remote control, and a few good magazines or books are great too. In the bathroom you should keep the measuring cups your doctor gives you to empty your drains into, and a pad and pen to write down the volume that the drains put out every time you empty them. You also may want to arrange for someone to drive you to your follow up appointments with your plastic surgeon. You will generally see your doctor on a weekly basis until all drains are removed, and you may not be able to drive for 2 to 4 weeks, until you are no longer taking narcotic pain medication.
It is normal to feel anxious before surgery. Getting your house in order, enlisting friends and family to help you care for children and help with household chores can let you relax. The most important thing is that after surgery you get plenty of rest in order for your body to heal. Knowing everything is taken care of in advance will give you the peace of mind that you need.