Second Stage Breast Reconstruction Following Autologous Tissue Transfer

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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 (prescribed pre-op)
    • Night before:
      • Scopolamine patch placed behind ear
      • Shower with Hibiclens for couple days before surgery 4% topical chlorhexidine soap.
    • At check in for surgery with a sip of water:
      • Tylenol 975mg PO x1
      • Gabapentin 600mg PO x1
      • Celebrex 400mg PO x1
  • 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):
      • NS or LR 500 mL
      • Ropivicaine 300mg
      • Clonidine 0.3mg
      • Dexamethasone 4mg
    • 1g Ancef and 1g Vancomycin reconstituted into 10mL syringes to “squirt” from off the field to on the field – into the fat graft solution before Dr. Brown injects the fat.
    • Liposuction Tumescent Solution (PHARMACY TO PREPARE, IN PRE-OP ORDERS)
      • LR or NS 1L + 2mg Epinephrine (2 amps of 1:1000)
      • Please warm in towel/blanket warmer
  • 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)
  • Bed Attachments
    • Arm boards, Ulnar nerve pads, Kerlex
  • Patient Warming
    • Lower Body Bair Hugger – start at mid-thigh
    • IV fluid warmer
  • DVT Prophylaxis
    • Bilateral SCDs in OR. ON and working BEFORE induction of anesthesia.
  • Foley Catheter
    • Yes – have tubing run down leg and secured in SCD
  • Instrument Sets
    • Breast & Body
  • Surgical Packs 
    • Breast
  • Surgical Prep
    • Chloraprep x4. Place in fluid warmer prior to use.
  • 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 1000cc Normal Saline
  • Blades
    • 11 x 2
    • 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 4
    • 2-0 PDS Large Cutting x 4
    • 3-0 VLOC long, large cutting x 2
    • 4-0 Plain cut cutting x 1
  • Additional Supplies
    • Marking pen, Paper Ruler x 4
    • Implants ordered (should be provided by facility – pre ordered)
    • ADM ordered (should be provided by facility – pre ordered)
    • Revolve fat grafting – have in room BUT DO NOT OPEN
  • Dressing
    • Mastisol
    • Wide Long Steri strips
    • Kerlex – fluff out across chest an then put on bra
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