Breast Fat Grafting

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  • Dr. Brown:
    • Gown – XL, XL Length
    • Gloves – 8 Indicator glove, 7.5 Biogel glove
  • Dr. Chandler:
    • Gown – L
    • Gloves – 5.5, 6 if no 5.5 available
  • Sean Kirby PA-C:
    • Gown – XL
    • Gloves – 7.5 under glove, 7 over 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.
    • In pre-op holding ~1 hour before surgery:
      • 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 (PHARMACY TO PREPARE, IN PRE-OP ORDERS)
      • NS or LR 500 mL
      • Ropivicaine (Naropin) 300mg
      • Clonidine 0.3mg
      • Dexamethasone 4mg
    • Liposuction Tumescent Solution for Fat Graft harvesting:
      • LR 1L + 2g Epinephrine (2 amps of 1:1000)
      • Warm in towel warmer
    • Ancef 1g and Vancomycin 1g 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.
  • Post-operative Medications (Prescribed pre-op)
    • Tylenol 650mg PO q6 hours scheduled
    • Gabapentin 300mg PO q6 hours scheduled
    • Celebrex 200mg PO BID
    • Cephalexin 500mg PO q6 hours scheduled for 4 doses starting after surgery
    • 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).
      • Facility provides bra for insurance cases.
      • Dr. Brown provides bra for cosmetic cases.
  • Bed Attachments
    • Arm boards, Ulnar nerve pads, Kerlex
  • Patient Warming
    • Lower Body Bair Hugger
  • DVT Prophylaxis
    • Bilateral SCDs in OR. ON and working BEFORE induction of anesthesia.
  • Foley Catheter
    • No
  • Instrument Sets
    • Breast & Body
      • Need Tebbetts double ended breast retractor & Long skinny breast retractor (these are in Breast & Body Set)
    • Small Volume Fat grafting equipment (all in Breast & Body instrument set)
      • Infiltration/Infusion cannula
      • Small liposuction cannulas
      • Small collection cannister
      • Small fat injection cannula
  • Surgical Packs
    • Breast
  • Surgical Prep
    • Chloraprep x4.  Place in fluid warmer prior to use
  • Irrigation Solutions
    • Standard irrigation solution (PHARMACY TO PREPARE, IN PRE-OP ORDER SET)
      • NS 1L
      • Ancef 2g
      • Gentamicin 160mg
      • Betadine Paint (10% Povidone-Iodine) 100mL
  • Blades
    • 10 x 2
    • 11 x 2
  • Bovie
    • Short Protected ENT tip x 1
    • Long Proctected tip x 1
    • Cut pure 40
    • Coag fulgarate 40
  • Suture
    • 4-0 Monocryl Large cutting x 2
  • Drains
    • None
  • Additional Supplies
    • Marking pen, Paper Ruler
    • Infusion tubing (to pump in tumescent fluid)
    • Liposuction tubing
    • Infusion/Peristaltic Pump (to pump in tumescent fluid)
    • 60mL Toomey syringes x 4
    • Davol Sputum Catch or Leukins Trap
  • Dressing
    • Mastisol
    • Wide Long Steri strips
    • Kerlex fluffed in a bra
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