Top Ten “Before Surgery” Preparations
July 15th, 2009
Preparation for surgery is essential to make the post operative course for patients easier and safer. Both pain and risk of complications can be reduced. I can’t stress more strongly the importance of patience responsibility in regard to these instructions. Following these guidelines can significantly reduce both pain and risk of complications. Here are my Top 10 recommendations for our patients, although it is important for patients to follow whatever instructions their chosen surgeon provides. Surgery by and large is safe. Complications are always an inherent risk, however you can help in reducing post-operative risks by doing these simple recommendations before surgery.
- Stop all aspirin and NSIDs. Both of these drugs affect platelet function in the blood. The result is a reduced ability to clot the blood when tissue is divided in surgery. This can lead to unwanted bleeding and bruising after surgery. These effects last for two weeks. Stop taking these medications two weeks before surgery.
- Take A Shower. Any time you shower, the number of bacteria on the skin is reduced. Taking a shower the night before and the morning before surgery can go a long way in reducing the risk for infection. Regular soap is fine for the task.
- A Dose Of Celebrex. Pain after surgery is inevitable. We do everything we can do to reduce the post operative discomfort. One of the most dramatic changes has been the institution of a single oral dose of Celebrex immediately before surgery. This alone reduced the need for strong pain pills after surgery in my practice by 30%! Of course, this is not a choice if a patient is allergic to the medication or related medications. This must be given by the physician or their staff at the surgical facility. This must not be done yourself.
- Do Not Eat or Drink Before Surgery. Eating solid food before surgery is dangerous. It can lead to vomiting during surgery which can result in aspiration. Aspiration pneumonia is very serious and can result in death. Always know the recommendations regarding how long before surgery you are not supposed to eat or drink. Generally this 8 to 12 hours before surgery.
- Avoid Health Store Medications. Unfortunately, natural medications can be variable in preparation and strength. Some of the lead to unsafe increased blood pressure during surgery. Excess intake of some vitamins can interfere with clotting. For this reason, consider only taking a single multivitamin for two weeks before surgery. Stop taking other over the counter medications as directed by your surgeon. Continue taking prescription pills. Make sure you tell your surgeon and your anesthetist all the drugs you have been taking before anesthesia and surgery.
- Stop All Illicit Drugs. Illicit drugs can be dangerous. Their formulation and content is unknown. Their interaction with anesthetic drugs is serious and can lead to death during and after surgery.
- Stop Smoking and Alcohol. The nicotine in tobacco products and in “stop smoking” aids makes blood vessels smaller as a result of its action on the blood vessel muscle. Many plastic surgery procedures (face lift, tummy tuck, breast reduction) reduced blood flow to the skin. The risk of skin loss and bad scarring is increased ten-fold when these two effects are combined. Smoking tobacco or weed also increases the chance of coughing after surgery. Coughing can lead to unwanted bleeding. It is best to quit all nicotine containing products two to four weeks before surgery.
- Drink A Gallon Of Water. The day before surgery drink a gallon of water. Drink water before you go to bed. This will insure you are well hydrated the morning of surgery. This will make it easier to start your IV if necessary and it will help stabilize your blood pressure during the anesthetic.
- Arrange To Have Someone Stay With You. The first 24 hours after surgery are critical. You may need help to get around at home after surgery. In addition, emergencies can occur and you safety will be assured by having assistance. Home nursing care is also an option. We provide this service for all our face-lift patients.
- Read All Your Materials. Most physicians give written instruction prior to surgery. We provide before surgery instructions, after surgery instructions, a list of medications to avoid, and the surgical consent. Go over these things a couple of times and make sure you understand everything. If you have questions, call and get them answered.
In summary, follow all Before and After Surgery Instructions. This bears repeating! When in doubt or unclear about something, contact your surgeon to check. Surgery by and large is safe. Complications are always an inherent risk, however you can help in reducing post-operative risks by doing these simple recommendations before surgery.
Nippin’ Out
July 9th, 2009
I just do not know how else to describe the recent article in Allure Magazine. Quoting a London Daily Mail article about Victoria Beckham, they show a photo of her is a fitted top. The photo prominently displays the shape of her nipples and areola. The article claims surgical enhancement to create this appearance is becoming more popular.
The breast can be separated into three profile components. First is the breast mound, which accounts for the majority of the breast size. Traditional breast enlargement surgery enhances this through placement of an implant beneath the breast and/or muscle. The center portion of the breast is highlighted by the nipple and areola. This is the eye point or where a person looks when they look at another person’s (man or woman) chest. The nipple is the central portion of this area. It projects out from the breast normally. The nipple represents the termination of the breast milk ducts allowing breast feeding. The darker skin around the nipple is known as the areola. Its color varies widely with genetic background and past pregnancy history. The areola is usually flat in relation to the surrounding breast mound. Sometimes this projects above the breast mound to add another contour to the breast. This is apparent in the Allure photo.
There are a variety of cosmetic nipple surgeries. The most common procedure in the past has been correction of inverted nipples. In this condition, the normal milk ducts are too short and cause the central part of the nipple to be drawn inward thus reducing the nipple projection. Correction of inverted nipples eliminates the ability to breast feed and can interfere with nipple sensation. It is important to understand nipple inversion can be a sign of breast cancer. The internal mass can cause scarring of the milk ducts which draw in the nipple. If a patient experiences this inward movement after having normally projecting nipples, they must be evaluated for a possible breast tumor.
Some women are self conscious of nipple prominence. It embarrasses them when they wear clothing. For those women I suggest the use of clear plastic adhesive dressings which flatten the nipples. The dressings are imperceptible beneath clothing.
Other women are requesting increased nipple and sometimes areola projection. There are implants available but these are generally reserved for nipple reconstruction after breast cancer surgery. In addition, there are many reconstructive nipple procedures which use the remaining skin and fat after the cancer surgery to make a new nipple. The potential scarring resulting from these procedures require that they generally keep those surgeries in the realm of reconstruction surgery.
Women considering increased nipple and areola projection might consider temporary fillers like Restylane ® or Juvederm ®. These will be reabsorbed after six to nine months. If there are any reservations regarding the appearance, nothing need be done. A more permanent solution is fat graft injections. Fat taken from another area of the body is transferred with injections to the areola and/or nipple. The result can be permanent but some of the initial improvement will be lost as the body absorbs some of the transferred fat.
Just like clothing and hair styles, this fashionable trend may only be popular only for a season or two. I think temporary solutions to increase nipple and areola projection are the best choices. Any surgery is serious business and it should not be considered frivolously.
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