Fat Grafting: Breast Reconstruction – Prep, Packing and Pre-op
Fat grafting for breast reconstruction requires prep, packing (if you will be traveling to your plastic surgeon) and a pre-op routine before your surgery and the morning of your surgery. This was my personal experience for my most recent fat grafting. There may be subtle differences as each plastic surgeon has their own protocols but there will be similarities to give you a sense of what you will need to do.
This was my second fat grafting. Insurance does not always cover the cost of a second fat grafting in breast reconstruction. This will depend on the amount of fat grafting that needs to be done, areas that need to be addressed to achieve symmetry, and of course your insurance coverage. It is getting challenging for plastic surgeons to cover additional fat grafting beyond the first one that is done after phase one. However, since I was delayed DIEP flap and because of my insurance coverage, mine was covered this second time. I cannot guarantee that yours will be and I want to be clear about that. We all know insurance is getting to be a challenging road to navigate. All I can suggest is to bring it up with your plastic surgeon to see if it is a possibility. A second fat grafting may or may not be able to be covered by insurance but it never hurts to ask.
Pre-op Appointment: Time: 30-40 minutes
You will likely have a pre-op appointment with your plastic surgeon’s office. I did with my plastic surgeon’s nurse. Since I had to travel for all of my procedures, this appointment was done by phone. We discussed the time of my surgery, how long it would last (in my case: 3-4 hours), where to park at the hospital, medicines, supplements and food items to stop one week prior surgery, if I would need to stay overnight (fat grafting is considered day surgery or a 24-hour watch) and the tests required prior to surgery. Hint: Be sure to call about your tests as soon as you can and make sure you allow time for all of them to be faxed back to your plastic surgeon in time for surgery. My nurse is so helpful in faxing all those orders to my PC but it was my responsibility to call my PC to set that appointment up.
Pre-op test Prep: Time: Approximately an hour
The tests required will likely be a CBC (complete blood count), CMP (complete metabolic panel) and a 12-lead EKG. I went to my primary care for all of these tests. She did a quick but thorough exam. You will have to disrobe from the waste up so they can place the simple leads for the EKG on your torso area. You will then be ask to lie very still while the EKG is done. It’s painless and quick and the report is in the form of a print out. I then went to the lab for my blood work. I wanted to give you the time involved if you are working. Also know that there will be a cost involved with co-pays or fulfilling your deductible, again, depending on your insurance.
- You will need a shirt that buttons up the front to wear home from the hospital that day.
- Wear easy to pull up pants, loose yoga or draw-string. ‘
- Slip on shoes to wear home from the hospital work well. You will likely go home in some sort of compression garment or abdominal binder so this makes it easier so you don’t have much bending over to do.
- A button-front sweater or zip-up hoodie is always a good idea in case you chill easily.
- You will only need a couple of day’s worth of clothes if you are traveling since you can arrive 24 hours prior to surgery and leave within 48 hours after surgery. This may vary but ask the question about how long you are required to stay if you have to travel for fat grafting.
Pre-surgery Prep 24 hours before and the morning of surgery
You will be required to fast from food and water from midnight on the night before surgery. Luckily, my surgery was first thing in the morning so I didn’t have the hungry feeling that I would have if it had been scheduled around noon. Even still, I have a good healthy meal at noon the day before surgery and then eat light for dinner; a cup of yogurt and piece of fruit with lots and lots of water. I was called by a nurse at the hospital to go over pre-surgical health information the Friday before my Monday morning surgery.
I was asked to shower with Hibiclens anti-microbial soap the evening before surgery. YUK! It is bright pink liquid and I personally don’t like the fragrance but all for the greater good, right? I shaved and did grooming the night before as well. The morning of, same routine with the Hibiclins and I also washed and styled my hair. No make-up, deodorant or lotions at all for surgery, ladies. We can’t look “glam” all the time!
Pre-op Prep at the Hospital
Bring your insurance card and ID for check in. Bring a form of payment if you have a deductible and co-pay. I got a call from the hospital the Friday before my Monday morning surgery reviewing expenses so I knew what they would be that morning.
You will go to a holding area for a bit and then taken back to get undressed and ready for surgery. I went back alone for this while my husband waited in the holding area. They will give you a bag for your belongings. You will be asked to put on a Bear Paw. This is the blue gown that has an attachment for a hose that blows warm air into the Bear Paw gown. This is to warm up those blood vessels for surgery.
A nurse or tech will place compression socks on you to avoid blood clots during surgery. They will start your IV. I wanted to take some photos so they allowed me to keep my cell phone until I was taken back to the OR. They will then wheel you to the surgery holding area for further prep. This is where I joined my hubby to have a discussion with my plastic surgeon.
Pre-op Details with your physicians ~ approximately 30 minutes.
You will see your anesthesiologist first. She went over my past history dealing with nausea, looked at the opening of my mouth and throat and placed an anti-nausea patch behind my ear. I will discuss recovery from anesthesiology after fat grafting in another blog. The IV placed during the prep will be used to start the anesthesia prior to wheeling you into the OR. I just know that once they started those meds, Versed, I was a “gonner” and don’t remember anything until recovery.
My plastic surgeon walked in next to discuss his plan for the surgery and I was able to ask any questions I had about the fat grafting planned. He helped me hop off the table so he could exam the optimal areas of my body to extract the fat from. My husband jokingly said he almost snapped a photo of my plastic surgeon down on his knees marking me up. He remarked that he doesn’t think he’s ever seen a doctor down on his knees for a patient… light-hearted, funny moment. My plastic surgeon then marked the areas on my breast that needed some fill and symmetry. After snapping those photos….
Off I went to surgery to wake up in recovery!