Bilateral Breast Augmentation
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- Dr. Brown:
- Gown – XL, XL Length
- Gloves – 8 under glove, 7.5 over glove
- Dr. Chandler:
- Gown – L
- Gloves – 5.5, 6 if no 5.5 available
- Sean Kirby PA-C:
- Gown – XL
- Gloves – 7.5 Indicator Glove, 7 Nonlatex Glove
- Pre-operative Medications
- Night before:
- Scopolamine patch placed behind ear
- Shower with Hibiclens for couple days before surgery 4% topical chlorhexidine soap.
- In pre-op holding ~1 hour before surgery:
- Tylenol 975mg PO x1
- Gabapentin 600mg PO x1
- Celebrex 400mg PO x1
- Night before:
- Intra-operative Medications
- Ancef 2 grams IV (ok if allergic to Penicillins). Vancomycin 1g IV (if allergic to Ancef)
- Infiltration Solution (Dr. Brown will inject at beginning of case):
- NS or LR 500 mL
- Ropivicaine 300mg
- Clonidine 0.3mg
- Dexamethasone 4mg
- Epinephrine 2mg
- Post-operative Medications (Prescribed pre-op)
- Tylenol 650mg PO q6 hours scheduled
- Methocarbamol 1500mg PO q6 hours scheduled
- Gabapentin 300mg PO PO q6 hours scheduled (if not too expensive)
- Cephalexin 500mg PO q6 hours scheduled for 4 doses starting after surgery
- Celebrex 200mg PO BID scheduled (if not too expensive)
- Pericolace 1 tab PO BID scheduled
- Phenergan 25mg PO q8 hours PRN nausea
- Oxycodone 5mg tabs, 1-3 tabs PO q4 hours PRN pain
- Ibuprofen 600mg PO q6 hours scheduled, starting 48 hours after surgery
- Anesthesia
- Anesthesia choice
- Patient Position
- Supine, Able to sit up 90 degrees (make sure bed can do this)
- Bra underneath patient with folded chux pads on top (see photo below)
- Wide silk tape to position arms
- Bed Attachments
- Arm boards, Ulnar nerve pads, Kerlex
- Patient Warming
- Lower Body Bair Hugger – start at umbilicus
- DVT Prophylaxis
- Bilateral SCDs in OR. ON and working BEFORE induction of anesthesia.
- Foley Catheter
- No
- Instrument Sets
- Breast & Body
- Surgical Packs
- Breast
- Surgical Prep
- Chloraprep x 3
- Irrigation Solutions
- Warmed Normal Saline
- Sterile water in basin for washing instruments
- Iodine/Antibiotic Solution:
- Ancef 2G
- Genamycin 160mg
- 100mL of full strength 10% stock providone-iodine (THIS IS PAINT, NOT SCRUB)
- Mixed into 880cc Normal Saline
- Blades
- 15 x 1
- 10 x 2
- Bovie
- Short Protected ENT tip x 1
- Long Proctected tip x 1
- Set at coagulate 40 fulgurate / cut 40 pure
- Suture
- 3-0 Monocryl Large cutting x 3
- 2-0 PDS Large Cutting x 2
- 3-0 VLOC long, Large Cutting x 2
- Additional Supplies
- Marking pen, Paper Ruler x 4
- small tegaderms x 2 to cover nipples
- Dressing
- Mastisol
- Wide Long Steri strips
- Kerlex – fluff out across chest and then put on bra
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