Pre Op & Post Op Instructions – Implant Based Reconstruction

Pre Operative Instructions

If you have any questions concerning your recovery, CONTACT US via email with your questions or call the office 713-441-6102.

Two or More Weeks Before Surgery

FMLA and Short-Term Disability Paperwork: Please submit your FMLA or Short Term Disability paperwork to the office as soon as possible, as it may take up to 2 weeks to be finalized.

Pre-register for surgery: You will need to pre-register for your surgery with the hospital by contacting registration at 713-394-6805.

Pre-operative appointment: Make an appointment with the Anesthesia Preoperative Assessment Center 3 weeks prior to your surgery by calling 713-441-6504, option 3. This is when you will have your pre-operative blood work and other testing that needs be performed prior to your procedure.

Pre-operative Labs: Lab work must be obtained and reviewed prior to surgery. The lab work will need to be completed 3 weeks prior to surgery. You may also be requested to do a cardiac work-up before your surgery.

Mammogram: You will need to have an updated mammogram within the last 6 months.

Medications: Do not take any aspirin containing medication including cold formulas for at least 2 weeks prior to surgery. Please let us know if you are taking or have been taking any herbal supplements or vitamin E. These will need to be discontinued also. Please refer to the Medication List located in your surgical packet for some frequently used medications that contain aspirin or an anti-inflammatory. These compounds have a tendency to decrease the average clotting capacity and increase bleeding during surgery. Tylenol may be used instead as it does not have these untoward effects. If you are on Tamoxifen or Anastrazole, you need to stop taking this medication 3 weeks before surgery. It is ok to continue your Femara (Letrozole).

Smoking: Nicotine compromises blood flow by causing spasm of blood vessels and significantly increases the risk wound healing problems and infection. Therefore, DO NOT SMOKE or use nicotine patches/gum for at least 8 weeks before and 6 weeks after surgery. This also applies to second hand smoke – avoid any room or car with cigarette smoke.

Iron: Iron supplementation with a vitamin C supplement should be started as soon as possible prior to surgery. Red cells contain a large portion of the body’s iron stores. Therefore, supplementation should be started immediately and continued for at least 2 weeks after surgery. There are several iron supplements available without a prescription. All may cause some gastric distress or constipation, although individual reactions may differ. You may tolerate 1 product better than another. Taking iron supplements with food decreases such symptoms although all are better absorbed on an empty stomach. Avoid taking supplements with milk or calcium supplements, which decrease iron absorption. Some examples are:

• Ferrous Sulfate: usually the least expensive form, well absorbed, can cause gastric distress or constipation (e.g. Slow Fe, Feosol, Fer-In-Sol)
• Ferrous Gluconate: slightly more expensive but causes less gastric distress (eg. Fergon)
• Ferrous Fumarate: similar to ferrous gluconate (eg. Ferro-Sequels), contains stool softener.

Social Support: Set up your home support system. You will need help when you return home for the first few days. You will need friends and family to help you with household chores and errands during your recovery period for the first 3-4 weeks.

Post operative garments: You will be provided with a surgical bra from the hospital. You will be given information regarding transitioning from the surgical bra at your post operative appointment.

One Week Before Surgery

Hibiclens™ Soap: Use Hibiclens™ (over-the-counter antibacterial skin cleanser) in the shower instead of soap for 3 days prior to surgery. Apply the minimum amount of Hibiclens™ necessary to cover the skin from shoulders to thighs and wash gently. Rinse again thoroughly (be careful not to get the product on your face, eyes, or ears). You do not need a prescription for this and it can purchased at most drugstores or grocery stores.

Notification of Illnesses: Notify our office promptly if cold, fever, or any illness appears before surgery. Call in any allergies, medications, or conditions you may have forgotten to tell us about.

Night Before Surgery

Medications: Your current medication list will be reviewed with anesthesia at your pre-operative evaluation appointment. Anesthesia will discuss with you which medications you should take the night before or morning of surgery, and which medications should not be taken. If you have any questions regarding this, please contact our office.

Eating and Drinking: Do not eat or drink anything after midnight the night before surgery. This includes gum, candy and water. Failure to comply with these instructions may result in cancellation or delay of your operation. If you are diabetic and take insulin you will be instructed how to take your medication and discuss this with your anesthesiologist during the preoperative visit.

Day of Surgery

Arrival at Hospital: On the day of surgery, please report to Walter Tower – 6551 Bertner Avenue, 1st floor Registration Desk. You will be given your arrival time a few days prior to your surgery date. Please be prompt. If you are running late, please notify them by calling 346-238-7840.

Prescriptions: Your prescriptions will be called into the Scurlock Walgreens Pharmacy at the hospital on the morning of your surgery.

Post Operative Instructions

If you have any questions concerning your recovery, CONTACT US via email with your questions or call the office 713-441-6102.

Medications

• Antibiotic – To be continued until all drains are removed, or as otherwise specified by our office
• Celebrex – anti-inflammatory, can be taken twice daily as needed for pain
  Gabapentin – nerve medication, can be taken three times daily as needed for pain
• Pain Medication – To be taken as needed for pain, as soon as you feel comfortable you may start weaning off of the pain medication and using Tylenol for pain. Remember this medication might make you feel groggy and constipated and cannot be mixed with alcohol
• Colace – Stool softener to be taken as needed for constipation
• Flexeril – Muscle relaxant to be taken as needed for back discomfort or muscle spasm
• Iron– continue same dose as taken before the surgery
• Zinc– supplement 50 mg daily, recommend for wound healing
• Selenium – supplement 200 mcg daily, recommended for wound healing

Drains

You will also be discharged home with your drains in place. There are usually 2 drains in each operated breast. It is necessary to record total daily output for each drain. Strip the drain tubing 5-6 times per day. Empty the drain 2-3 times daily and record on drain output log. Once your drain output is less than 25 cc total, per drain in 24 hours, that drain will be removed in clinic.

Sleep Position

We recommend that you sleep on your back for at least the first 6 weeks postop.

Incision Care

Most incisions are closed with absorbable sutures under your skin. You do not need to place anything on your incisions.

Swelling

After surgery, your breast(s) will feel swollen, especially at the end of the day. This is normal and usually takes at least a month or more to resolve.

Surgical Garments

You will be fitted for a surgical bra at the time of your surgery. We recommend that you wear the bra day and night. We will transition you to a different bra when we feel you are ready, which is typically 3-4 weeks postop.

Showering

You will be able to shower on the second postop day. We will have you shower with the water to your back for the first few weeks. If you breast or incisions get wet, you can pat them dry, please do not scrub your breast(s).

Activities

You are able to walk but we want you to restrict your arm activities. No pushing, pulling, lifting greater than seven pounds.

Driving

You may start driving after you have stopped all your pain medication and one week after all drains are removed (pending approval from the office).

Work

You will be able to return back to a desk job, or light duty at 4 weeks after surgery.

Smoking

ABSOLUTELY NO SMOKING for 6 weeks after surgery (this includes staying out of the room with smokers).

Scars and Massage

Will discuss scar therapy at 4 week postop appointment, will most likely start scar therapy at 8 weeks postop.

Scar Therapy

Silagen

Silagen is a silicone sheet made with the highest quality medical grade silicone. It creates a protective barrier over the scar, which increases hydration and provides an optimal environment to normalized collagen production. This will help flatten and soften your scar, and reduces redness, discoloration, itching and discomfort. You will start using Silagen approximately 8 weeks after surgery as long as there are no open areas or scabbing. You can place it on your incision(s) and wear it for 6-24 hours. Silagen can be washed and reused for 4-6 weeks. You will begin to see results in as little as 2-3 weeks.

Week by Week Guide

1 Week Post Op Appointment:

• Bring drain log to appointment
• Possible removal one drain from each breast
• Able to increase arm range of motion to 90 degrees
• Continue surgical bra
• Continue zinc and selenium
• Continue antibiotics
• Continue surgical bra
• Restrictions: No household chores, arm restrictions

2 Week Post Op Appointment:

• Bring drain log to appointment
• Possible removal of remaining drain(s)
• Continue arm range of motion at 90 degrees
• Continue surgical bra
• Continue zinc and selenium
• Restrictions: No household chores, arm restrictions

3-4 Week Post Op Appointment:

• Able to increase arm range of motion to 180 degrees
• Okay to start driving
• Continue sleeping on back
• Start taping incisions for total of 8 weeks postop
• Transition from surgical bra to supportive bra
• Return back to desk job or light duty
• Restrictions: No lifting/pushing/pulling greater than 5-7 lbs with your arms