Breast Implant Exchange with 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 only if 5.5 not 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.
- 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
- 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

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.

DVT Prophylaxis
- Bilateral SCDs in OR. ON and working BEFORE induction of anesthesia.

Instrument Sets
- Breast & Body
  - Need Tebbetts double ended breast retractor & Long skinny breast retractor
- Small Volume Fat grafting equipment (all in Breast & Body instrument set)
  - Infiltration/Infusion cannula
  - Small liposuction cannulas
  - Small collection cannister
  - Small fat injection cannula

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

Bovie
- Short Protected ENT tip x 1
- Long Proctected tip x 1
- Cut pure 40
- Coag fulgarate 40

Suture
- 3-0 Monocryl Large cutting x 2
- 3-0 v-Loc (absorbable) Long, Large Cutting x 2
- 2-0 PDS large taper x 2
- 5-0 Fast Gut Large, Cutting x 2
- 2-0 Nylon large cutting x 2

Drains
- 10mm perforated flat JP drain on tracer (if available), 100mL bulb suction

Additional Supplies
- Marking pen x 4
- Paper Ruler
- Implant funnel (Dr. Brown to bring, do not open)
- Breast Implants and sizers that were ordered.
  - Facility to order and purchase if an insurance case.
  - Dr. Brown to order and purchase if cosmetic case.
- 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

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