Dear PytOnDuty,Exciting times for you!Bottomline: Call your Plastic Surgeon. We all have special instructions.The following are my personal instructions. Specifics, additions or deletions may vary depending on your surgeons preferences. I will break it down into three peri operative time periods:I. PREOPERATIVEa. 30 Days Before1) start iron pill 325 mgm (over the counter) a day (builds up blood). May turn stools black and cause constipation.2) start multivitamin (provides nutrients for healing) no mega E can cause bleeding.3) stop any hormonal birth control or post menapausal female hormones (increase risk of blood clots).4) stop any over the counter supplements (can cause unknown problems).5) if you have had Bariatric surgery (weight loss surgery) start on 100 grams of proteinper day.6)stop smoking. No exceptions.7)if over age 45 or medical issues our surgery center recommends a preoperativeclearance by your primary care phyiscian with basic labatory data.b. 14 Days Before1) if over age 45 or medical issues provide preoperative clearance letter with labatory data for your surgeon.2) visit with your Plastic Surgeon who will provide prescriptions (for before and after surgery), counseling and educational materials. Discuss what medications are ok to continue or stop. Bring list of questions.3) stop shaving around pubic area (razor blade shaving causes small cuts that canharbor bacteria and increase infection rate).4) NO aspirin, Alleve, Motrin (can interfere with normal clotting) use only plain Tylenol (will not interfere with normal clotting) or pain medication prescribed by your Plastic Surgeon.5) make arrangements for drop off, pickup and child care.c. 4 days before1)start bromelian and arnica as directed (anti brusing and swelling).2) purchase 2 large bags of frozen peas or corn (Costco size). Can have one in pillow case and place over abdomen and change out with second one (in freezer) when thawed.3)purchase any needed food, supplies and verify with your postoperative support teamyours/their schedule.4) no shaving of pubic area (can increase infection rate) Operating Staff will clip pubic hair if needed.d. 3 Days Before 1) start anti bacterial decolonization showers 2) topical antibioticsd. Day before1)have precscriptions filled.2)bed, recliner, pillows, foam wedges etc ready.3)make sure you location of surgicenter, see if you can obtain any of Surgicenters required preoperative paperwork to fill out prior to arriving on the day of surgery.4)call surgicenter for you expected time of arrival5) have or purchase bell to ring (if you need assistance after surgery) to notify your support team e. Night before1)make out a list of any "last minute" questions, your needs, wants, desires and expectations of the surgery.2)I have my patients complete a preoperative ennema (decreases fecal load)for postoperative constipation (from pain meds) and potentially reduces risk of blood clots (hard stool pressing on intra abdominal viens during tightening of the muscles).3)take a shower with antiseptic solution and scrub entire body well.4) no alcohol containing drinks.5) nothing by mouth after midnight or 8 hours prior to surgery (unless instructed so by surgicenter).II Operative day1)awake and take second shower and scrub the surgical area2)check your list (bring model photos demonstrating your desires).3)place anti nausea patch behind ear (prevents nausea).4)take all necessary medications with sips of water.5)if anxiety may take 5 mgm of Valium with a sip of water.6)remove all piercings, jewelry, "booby pins" from hair and body.7) no make up and remove nail polish (intraoperative monitoring).8) button down or zipper blouse/shirt, sweat pants or stretchable pants.9)go over your list with Plastic Surgeon and Anesthesia provider.10) reaffirm with surgicenter when your postoperative care provider should be at the surgicenter for postoperative education and instructions.11) ask to have deep vien precautions (DVT). I personally give 5,000 units heparin,TED hose, and sequential compression device (before, during and after surgery).III Postoperativea) immediate1) communicate with your recovery room nurse (pain, nausea, etc).2) do what you are asked to do.3) I provide a abdominal binder (check with your surgeon for their preference).b) discharge1) anti DVT program: leg/foot exercises, TED hose, and (I send home with) portable SCD device to be used for two weeks after surgery. Get out of bed and walk around house every 1-2 hours while not sleeping. Leave SCD on while sleeping or resting for next two weeks.2)incentive spirometer every hour after surgery (improves breathing after general anesthesia.3) if drains used measuring cup and chart for recording out put as directed.4)Foley catheter: I personally send home with and have patient remove 6 hours after surgery (some patients develop urinary retention while general anesthesia wears off and will require re-cathederazation. 5) walking in haunched over position. I provide a walker for my patients.6) bed position "lazy boy" postion (use recliner, hospital bed or pillows/foam wedges).7)diet progressive to prevent nausea: clear liquids (gatoraide, broth, tea) for first8 hours, liquid diet next 8 hours (soups,pudding,yogurt), soft diet for next 8 hours (well cooked oatmeal or pasta) after 24 hours regular diet.Start stool softeners and anti constipation program.8)Pain management: I personally inject long acting local pain reducers into the surgical area and provide a postoperative non narcotic pain reliever that lasts several days. It is ok to start using aspirin, Alleve, Motrin after surgery and alternate with oral narcotics. Do not take pain medications on a empty stomach.Crackers before and after medications (to prevent nausea and upset stomach).9)incentive spirometer: helps open up the small breathing units found within the lungs that collapse during general anesthesia . Use once an hour while awake until you are abel to obtain preoperative values.b) first four post operative days.1) wear SCD's 24 hours a day, anti DVT excercises every hour2) use incentive spirometer (it opens up small breathing units in your lungs) once a hour until you reach your preoperative values3) walk hunched over (use walker provided) and sleep in the "fetal position" using recliner or wedges/pillows.4)if unable to have a bowel movement start over the counter laxatives and stool softeners.c)5 th day to two weeks1)no restrictions in sleeping postion or standing up straight. Use walker only as needed.2)non narcotic pain pump to be be removed3)may shower but keep incision and drain exit sites dry (let shower spray back side and sponge bath front side.4)may remove SCD during ambulation but wear at all times when not 5)progressive ambulation and stretching to point of pain and fatigue 6) wean off narcotic pain pills and replace with Tylenol, Motrin or Aspirin like over the counter medications.7)may drive as tolerated (must be off narcotics)8) may switch from provided binder to "spanks" like garmet for comfort and support.9) may return to work as tolerated d)after two weeks1) excercise to point of pain or fatique2)SCD not required (may continue) 3) report to office when individual drainage less than 25 cc in a 24 hour peroid for serial removal). May shower without restrictions when drains are all removed.4) start anti scar programs: start Embrace and silicone gel strips.e) after six weeks1) no restriction on excercise (use good judgement).2)cont to wear "spanks" like garmet for support and swelling (only as needed).3) it will take 2-3 months for the majority of the swelling to be gone.4) it will take 9 + months for the scars to "mature" (soften and lighten)5) enjoy your new body.I trust you have chosen a experienced Plastic Surgeon who is Certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).My best wishes,Dr. R. A. Hardesty, MD, FACSDiplomate and Certified by the Am. Bd. of Plastic Surgery
