By Dr. Christine Fisher
Dr. Christine Fisher is a board-certified plastic surgeon passionate about taking care of breast cancer patients and safely creating long-lasting and natural-looking reconstructive results. She specializes in state-of-the-art breast reconstruction techniques that optimize the aesthetic outcome. She graduated medical school with honors from the University of Texas Medical Branch at Galveston, completed her residency in plastic and reconstructive surgery, trained in microsurgical perforator flap (such as the DIEP flap) breast reconstruction at Magee Women’s Hospital, and completed a Regenerative Medicine Fellowship studying the healing properties of stem cells optimizing fat graft technique. She also studied microsurgery and vascularized lymph node transfer to treat upper extremity lymphedema in Paris, France. She is medical school faculty at The University of Texas at Austin and has performed over 800 DIEP flaps and over 2,000 breast reconstruction procedures in Austin since 2013.
Facing a breast cancer diagnosis, many women feel overwhelmed as life becomes about battling the cancer. While there’s a lot you can’t control about the diagnosis, for women who desire breast reconstruction after a lumpectomy or mastectomy there are many safe and natural-looking options. A successful surgery requires a partnership between you and your surgeon. No matter what type of reconstruction you choose, the following information is intended to help you prepare your body and mind for surgery. Specific questions or concerns should be directed to your surgeon.
PREPARE YOUR BODY
IN THE MONTHS AND WEEKS BEFORE SURGERY: Practice proper fitness – Exercise reasonably, at least walking several times per week. Avoid new strenuous activities that could potentially injure or sprain your shoulders, back, pectoral muscles and arms or upper body. However, if you do regularly exercise, walking, jogging or swimming and low-weight strength training several times per week can help reduce stress, engage an “anabolic” physiology with enhanced metabolism, and improve the postoperative recovery experience.
SIX WEEKS BEFORE SURGERY: Avoid all sources of nicotine – I cannot stress enough the importance of nicotine avoidance. The single most important thing to avoid is exposure to nicotine, including second-hand smoke. Smoking or even vaporizing nicotine during the weeks before and after surgery is very harmful, as it dramatically reduces your body’s ability to heal. Nicotine causes constriction of blood vessels and impairs your immune system. This causes tissue weakness or death along incision lines and increases risk of infection. Popular products that people use to help with smoking cessation such as e-cigarettes, nicotine patches and nicotine gum also cause wound healing complications after surgery. Second-hand smoke also causes increased nicotine metabolite levels in the blood and can also cause complications after surgery. I tell my patients that if you are a smoker (or e-cigarette user), or live with someone who smokes, it is ideal to avoid exposure to all forms of nicotine for at least six weeks before and after surgery.
THREE WEEKS BEFORE SURGERY: Increase your protein intake and take a daily multivitamin – Protein is required for new cell growth and tissue repair, and is a building block for wound healing. This has been demonstrated in very well-designed clinical studies. Nutritional supplementation can have a positive effect on recovery and healing, including helping to reduce the length of your hospital stay, postoperative infections, and complications. Increase your protein intake from foods and nutritional supplements to 150 grams per day in the three weeks before and after surgery. Most patients benefit from taking a daily multivitamin with iron for at least three weeks before and after surgery to help promote wound healing.
TWO WEEKS BEFORE SURGERY: Avoid these medications and supplements – Discontinue taking products containing aspirin, nonsteroidal anti-inflammatory agents (NSAIDs, such as ibuprofen), fish oil and vitamin E supplements for two weeks prior to surgery. These medications can cause bleeding problems during and after surgery. If you take any of these regularly, be sure to let your plastic surgeon know. It is important to disclose any other medications or supplements you are taking at your consultation and pre-operative appointment.
PLAN AHEAD
IN THE WEEKS BEFORE SURGERY: Schedule time off work, arrange for support and find your “comfort zone” – You may need help with housework, childcare, shopping and driving to post-operative appointments. Make sure a responsible adult will drive you to and from surgery, and that someone can help you for at least the first few days after surgery. Locate the most comfortable place where you can gently recline and recover. Shop for magazines, books, music and other items to keep you busy and entertained in the 1-2 weeks following surgery. Consider a hand-held shower head or even a bathroom chair for convenience while showering.
TWO WEEKS BEFORE SURGERY: Order post-operative garments – not just bras, but easy-to-use button or Velcro-down-the-front tops and elastic waistband pants/skirts (for DIEP flap patients). Clothes should be loose-fitting and comfortable. Order front-closure bras that are one to two band sizes larger than what you normally wear to account for post-operative swelling.
ONE WEEK BEFORE SURGERY: Fill prescriptions and prepare and freeze meals – The last thing you want to worry about when you leave the hospital is getting your prescriptions filled! Ask your surgeon to prescribe them ahead of time so they’ll be ready at home for you before your surgery day. Some patients prepare and freeze meals for after surgery. Consider quick snacks: protein shakes, soup, frozen dinners, yogurt, oatmeal, cottage cheese, juice. Be sure to have adequate protein; the body needs it for proper healing. Consider limiting high-sodium foods to reduce post-operative swelling.
THE DAY BEFORE SURGERY: Pack your bag – This should include: ID and insurance cards, updated list of prescription medications and supplements, reading glasses (if used), comfortable clothing (tops should fasten in the front and bottoms should have soft waistbands), and items to entertain you (books, laptop/iPad, DVDs).
THE DAY OF SURGERY
Take a deep breath – the day is here. Remember the following items:
Do not eat or drink anything for eight hours before surgery: Anything more than a small amount of water as needed for brushing teeth or swallowing medication may result in the need to cancel surgery. This includes candy, gum, mints and coffee. Unfortunately, drinking or eating anything can cause safety problems that can lead the anesthesiologist to delay or cancel your surgery.
Do not wear cosmetics, jewelry of any kind, contact lenses, hair clips, body piercing(s): If there is something you cannot remove, let the admitting nurse know right away.
Wear comfortable, clean, loose-fitting clothing: Wear only a top that zips, velcros or buttons up the front. Do not wear pullovers, turtlenecks or any tight-fitting top or bottom. You may bring a robe or pajamas. Wear slip-on shoes. Leave jewelry and piercings at home.
LEAN ON THE BREAST CANCER RESOURCE CENTER
At my practice, we make sure every breast reconstruction patient is aware of the Breast Cancer Resource Center. Remember that BCRC is an invaluable resource, no matter what stage in your reconstruction or treatment plan you may be. You can contact BCRC directly for help, or ask your surgeon to refer you.