Preparing for Surgery
Get Ready for Your Procedure with Christine Fisher MD in Austin
Congratulations on your choice! Dr. Christine Fisher is:
- Board certified in plastic surgery
- Associated only with accredited medical facilities
- Compliant with a strict code of ethics
- Committed to continuing medical education, including patient safety techniques
- Your partner in cosmetic and reconstructive plastic surgery
In preparing for your surgery, we have compiled all the information that you may need before, during, and after your procedure. Please read these instructions to guide you through this process. Our breast reconstruction patients may also download a PDF guide that contains procedure-specific information.
The links below will take you to the appropriate section, or you can simply scroll down to read them all.
- Medications to Avoid
- Supplements to Exclude
- Supplements to Include
- Pre-operative Instructions
- Post-operative Instructions
- Deep Vein Thrombosis and Pulmonary Embolism
Medications to Avoid Prior to Surgery
All patients scheduled for surgery should discontinue taking products containing aspirin, nonsteroidal anti-inflammatory agents, fish oil, and vitamin E supplements for two weeks prior to the procedure. These medications can cause bleeding problems during and after surgery. Also review the list below. The following is a list of medications to be avoided:
- Anaprox or Naproxen
- Arthritis pain formula
- Baby aspirin
- BC powders
- Cama Arthritis Pain
- Cama inlay tablets
- Children's aspirin
- Coumadin (discuss with your doctor)
- Darvon Daypro
- Flurbiprophen sodium
- Four Way Cold
- Indocin Indomethacin
- Max powder
- Monacet with Codeine
- Momentum muscle
- Norgesic or Norgesic Forte
- Pabirin buffered
- Pabirin buffered
- Sine-Aid or Sine-Off
- Soma with Codeine
- Soma compounds
- Stanback Powder
- Stero-Darvon with ASA
- SX65 compound
- Ursinus Inlay
Supplements to Exclude Three Weeks Before and Three Weeks After Surgery
Many of the following supplements will thin your blood and increase your risk of complications.
- Kava Kava
- Red Clover
- Vitamin E
- Dong quai
- St. Johns Wort
- Fish oil capsules
Supplements to Include Before and After Surgery
Supplements of Potential Benefit
Enhance Recovery After Plastic Surgery
There are many nutritional supplement options available to promote wound healing after surgery.
- Nutrition profoundly influences the wound healing process.
- Nutritional supplementation can have a positive effect on recovery and healing, including helping to reduce the length of your hospital stay, postoperative infections, and complications.
Start nutritional supplementation three weeks before surgery. Use one scoop of protein powder per day the first week, then two scoops per day the second week, and three scoops per day the third week. Continue at three scoops per day until three weeks after surgery. Protein powder may be mixed into a smoothie to improve its flavor.
Example smoothie recipe:
Protein powder (1-2 scoops, based on serving size)
8 ounces of fruit juice, water, milk, or nondairy milk such as almond milk
1 cup of fresh or frozen berry mix or other fresh fruit, such as banana
Handful of spinach or other greens
½ cup Greek yogurt (optional)
A successful surgery requires a partnership between you and your surgeon.
The following instructions are essential for a safe experience and an optimal outcome. If you cannot comply with these instructions, please notify our office.
Three or More Weeks Before Surgery
Plan your preoperative clearance and tests: If suggested by our team, arrange to see your primary care physician for a full history and physical. Additional tests such as a chest X-ray or an EKG heart tracing may be necessary depending on your age and past medical history. Make sure all tests are received by our office at least two weeks prior to your surgery.
Stop smoking or using ecigarettes or any nicotine delivery products four weeks before surgery: Nicotine greatly impairs your ability to heal. It compromises circulation by constricting blood vessels, which can lead to skin and fat death (necrosis) after surgery. It impairs the immune system by disabling white blood cells and reducing the oxygen-carrying capacity of red blood cells, increasing the chance of infection after surgery.
It is important that you are nicotine free for at least four weeks prior to surgery. E-cigarettes, nicotine vaporizers, nicotine patches, and nicotine gum are also nicotine delivery devices and will negatively impact your recovery after surgery for the same reasons.
Practice proper fitness: Walking, jogging, or swimming and low weight strength training several times per week can help enhance your strength and improve your postoperative recovery.
Good nutrition: Eat well in the weeks prior to surgery. Crash or fad dieting, overeating, or high alcohol intake can greatly affect your health and wellbeing. Eat a diet high in protein, drink plenty of water, and consider adding a multivitamin with iron to your diet.
Pre-operative nutritional supplement: Take a multivitamin with iron, or use an approved nutritional supplement daily. Start a protein powder supplement as described in detail in this guide.
Prepare and plan: Schedule time off of work and arrange any support you may need in the days following surgery. You may need help with housework, childcare, shopping, and driving. Make sure a responsible adult will drive you to and from surgery, and that one can stay with you in the first week after surgery.
Order postoperative garments: Wearing an appropriate support garment after surgery reduces swelling and improves healing. We can recommend specific products that provide proper support and ease of use. In preparation for breast surgery, you should order at least two front-opening cotton sports bras without an underwire, two inches larger than your normal band size. If undergoing breast reconstruction revision surgery, liposuction, or tummy tuck surgery, we will recommend specific compression garments to wear.
Be healthy before surgery: In the weeks before surgery, maintain the best of health and hygiene. A lingering viral illness such as a cold or other illness could result in your surgery being rescheduled. Please address illnesses immediately, and let our office know if you have an illness or change in health in the weeks before your surgery.
Enjoy life and relax: Stress and anxiety negatively affect your surgery experience and recovery.
Christine Fisher, M.D.
- Known for natural-looking aesthetic results in breast reconstruction and cosmetic surgery.
- Elected by her peers for inclusion in Texas Monthly's Texas Super Doctors®: Rising Stars listing.
- Reconstructed over 1,500 patients, including more than 500 DIEP flap reconstructions.
- 4.9-star average rating over hundreds of reviews for cosmetic surgery.
Two to Three Weeks Before Surgery
Prepare and plan: Put your schedule together for the day before, the day of, and the first few days following surgery. Share your plan with your key support people.
Fill prescriptions: If given prior to surgery, fill your prescriptions to have at home ready for you before your surgery day. You may receive the following:
Percocet, Vicodin or Tramadol
1-2 tablets every 4-6 hours as needed
Keflex, 500 mg every 6 hours, or
Clindamycin, 300 mg every 6 hours (if allergic to penicillin)
Ondansetron, 4 mg every 6 hours as needed, and/or
Scopolamine patch, 1.5 mg applied behind the ear, lasting 72 hours
Miralax, ½ capful on the night before surgery and for 7 days after surgery to prevent constipation, which can be caused by pain medications.
Pre-operative clearance and information: If instructed to get a medical clearance prior to surgery, be sure to undergo ALL pre-operative testing that was ordered. Make certain all test results are received by our office two weeks prior to your surgery. If medical clearance is not received, your surgery may need to be cancelled or delayed.
Fitness: Exercise reasonably, at least walk several times per week. Avoid new strenuous activities that could potentially injure or sprain your shoulders, back, pectoral muscles and arms, or upper body.
Good nutrition: Continue taking your supplements as directed. Stay hydrated with unsweetened beverages.
NO SMOKING: No nicotine products, including e-cigarettes and nicotine gum. Stay away from second-hand smoke, too. Your healing depends on this.
Lead a healthy lifestyle: Practice good hand-washing and avoid large crowds or individuals who are ill. Do not risk catching a virus or cold: Avoid exposure to others with symptoms of viral illness.
Refer to the given list of medications and herbal supplements to avoid. STOP taking the mentioned medications three weeks before your surgery. Common examples of medications that cause bleeding problems after surgery:
- Aspirin and products containing aspirin
- Ibuprofen and other over the counter anti-inflammatory agents (for minor pain, you may use Tylenol)
- Garlic supplements
- Green tea and green tea extracts
- Vitamin E
- Estrogen supplements, Tamoxifen
- St. John's Wort
One Week Before Surgery
Make plans for the day of surgery: Plan to arrive two hours before surgery. There are comfortable waiting areas for your friends and family members.
Review your prescription orders and instructions: If given prior to surgery, check your prescriptions for accuracy. Be certain all medications are filled.
Continue to practice healthy habits, nutrition, and fitness: No strenuous exercise. No saunas, hot tubs, steam baths, or mud wraps. No smoking or alcohol consumption.
Find your comfort zone: Locate the most comfortable place where you can gently recline and recover. You don't want to be testing locations or pillows the day of surgery. Shop for magazines, books, music, and other items to keep you busy and entertained in the one to two weeks following surgery.
Wax or shave your underarms, legs, or other areas: A week before surgery, shave the surgical area. Shave your underarms if you are having breast surgery and the hair on your upper pubis if undergoing a DIEP flap. Do not shave the day before surgery, as it can increase your risk of infection.
Prepare and freeze meals for one to two weeks: Consider quick snacks: protein shakes, soup, frozen dinners, yogurt, oatmeal, cottage cheese, juice. Be sure to have adequate protein; the body needs it for proper healing. Consider limiting high-sodium foods to reduce swelling.
Shower preparation: Consider a hand-held shower head and bathroom chair.
One Day Before Surgery
Pack your bag for the day of surgery. This should include:
- All paperwork — remember to bring ID and insurance cards.
- Updated list of prescription medicines and supplements.
- Reading glasses, if used.
- Warm, clean, cotton socks and non-slip house shoes.
- Loose fitted, comfortable clothes. Pants should have a soft waistband and tops should fasten in the front.
- Book to read, DVDs, laptop/iPad (Wifi is available).
Confirm your route to and from surgery with the responsible adult who will drive you.
The night before: Use any gentle, fragrance-free soap. Shampoo your hair. Do not use any hair gel or other styling products, scented skin creams, or moisturizers. Do not use hair spray, perfume, cosmetics, or deodorant. Remove all finger nail and toe nail polish. Do not shave within 24 hours of your surgery.
Do not eat or drink anything for eight hours before the surgery: Anything more than a small amount of water as needed for brushing teeth or swallowing medication may result in the need to cancel surgery. This includes candy, gum, mints, and coffee.
On the Day of Surgery
NOTHING by mouth: Anything more than a small amount of water as needed for brushing teeth or swallowing medication may result in the need to cancel surgery. This includes candy, gum, mints, and coffee.
Do not wear cosmetics, jewelry of any kind, contact lenses, hair clips, body piercing(s): If there is something you cannot remove, let the admitting nurse know right away.
Wear comfortable, clean, loose-fitting clothing: Wear only a top that zips or buttons up the front. Do not wear pullovers, turtlenecks or any tight-fitting top or bottom. You may bring a robe or pajamas. Wear slip-on shoes.
- Caregiver: It is very important to have someone who can assist you with getting around and taking your medications for at least a few days after you go home.
- Nausea: You may experience nausea during the first three to four days. To reduce this, take your nausea pill one hour before taking your pain medications or antibiotics and take your pain tablets with food.
- Compression Stockings will reduce your risk of a blood clot forming in your legs. Try to wear a pair for the first 5 days after surgery. TED anti-embolism stockings, closed toe, are recommended. These can be purchased at most pharmacies or online at Amazon.com
- Pain Medication: Your post-op discomfort can be controlled by prescribed painkillers. Take pain tablets with a snack to reduce the possibility of nausea. Do not take narcotic pain medicines (Percocet/Norco) with Tylenol.
After discharge, transition to over the counter pain medications, such as Motrin/ibuprofen (up to 600 mg three times a day) OR Aleve/naproxen (up to 440 mg twice a day). These over-the-counter medications can be taken with Tylenol as written on the label for added benefit.
- Healing: It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. You may feel more tired than usual. Rest or nap daily to further improve your healing.
- Dressings: Leave dressings in place until instructed by our office. Replace the ACE bandage/abdominal binder/compression garment, if applicable.
- Shower: Remove any dressing, sponges, and gauze pads 48 hours after surgery. You may then take a shower with help; no soaking baths or hot tubs. After showering, simply pat your incisions dry. If needed, place a dry dressing such as a gauze pad or maxi-pad to absorb drainage. Replace your abdominal binder or compression garment. Your compression garment may be hand washed and hung to dry. Purchase two so you always have one to wear.
Special note: If you have a breast implant with a drain in place, you may not shower. Only sponge bathe while the drain is in place, and keep the drain site dry. There is a special antimicrobial Biopatch dressing at the location where the drain enters your skin which will be changed weekly in the office while the drain is in place.
- Bruising: There will be bruising in the surgical site. Bruises usually move downward due to gravity, and can thus affect adjacent or dependent areas. Sun tanning immediately after surgery can cause these bruises to become permanent skin stains.
- Swelling may take three months or more to subside.
- Driving: Do not drive a car until you are no longer taking pain medication as your reflexes and alertness may be altered.
- Light Activity/Walking: Dr. Fisher recommends light activity to reduce swelling and prevent leg blood clot formation. Light exercise includes walking and stretching your legs while sitting. It is important to start walking as soon as possible, typically the day after surgery. You should limit the use of your arms to less than 90 degrees. If you feel pain or pulling from the scar area, cease the movement.
- Activities: During the first two weeks after surgery, avoid strenuous activities that raise your blood pressure. This could cause a tear or bleeding at the operative site, which could result in a hematoma (collection of blood). Walking is the safest exercise, especially during the first week. Avoid exercises that directly stress the area of your surgery for a full four weeks. After this period, if cleared by your provider, cardiovascular activities such as riding a stationary bike or brisk walking can be initiated. Avoid heavy lifting, contact sports, and jogging for six weeks. Six to eight weeks after surgery, you will be nearing your preoperative level. Avoid pulling at the surgical area to maximize healing and minimize wide scarring. Even though the skin is closed, the healing process takes nine to 12 months to be complete.
- No smoking: Smoking reduces the oxygen in your blood and can greatly impact your ability to heal. While it is advised for your overall health that you quit smoking entirely, it is imperative that you do not smoke whatsoever until your incisions have fully healed. You should also avoid exposure to second-hand smoke, which can also impair wound healing.
- Scarring: Every person's body is different, and many factors contribute to scar healing. Your scars will be firm and pink for several months. Non-smokers have a better chance of rapid healing and thinner scarring. Sun exposure thickens and darkens scars, so use a gentle zinc/titanium-containing sunblock (even on scars under your swim suit). Expect to wait at least nine months before your scars lighten in color and become as flat as the rest of your skin. Although they will never disappear completely, scars will not show under most clothing, even bathing suits. We can also discuss other scar treatments after your wounds have healed.
- Garments: When you wake up from your procedure, you might be in a binder or compression garment. You should plan to wear your abdominal binder for four weeks following abdominal surgery. After liposuction, wear the compression garment for a total of four weeks: day and night for the first two weeks, and during the daytime and when active for the next two weeks. You may remove your compression garments to shower.
- Numbness: All surgical areas stay numb for four to eight weeks. Light massage will help desensitize your skin in order to avoid hypersensitivity or skin irritation.
- Sexual Activity: You should resume sexual activity only when all of your incisions are healed, waiting a minimum of six weeks after breast or abdominal surgery.
- Follow Ups: Regular check-ups protect against complications. If you have a problem or a concern, please call the office right away. Dr. Fisher and her mid-level providers will see you in the hospital and within one to two weeks of your discharge home. Please call to schedule your first post-operative appointment if you do not make one at your pre-operative appointment with us.
If you have a drain, drain care is required several times per day immediately following surgery. Follow these instructions exactly and record drainage. You will be asked to provide your doctor with your drain log at each post-op visit.
- Always wash hands or use a gel sanitizer before caring for drain.
- Hold the tubing securely at the skin site with one hand. With the other hand, pinch the tubing between your thumb and index finger and apply firm pressure as you strip the tubing toward the bulb.
- If the tubing and bulb come apart, wipe the ends with alcohol and reconnect. Squeeze the bulb again and replace cap.
- Measure the drain output using clear cups two to three times per day or at any time the drainage bulb is more than 1/3 full and record on your drain log. Be sure to record each drain separately.
- Always dispose of drainage in the toilet.
- Squeeze bulbs tight to create suction and replace cap.
- If instructed to leave the drain site uncovered, wash daily with soap and water. Do not clean the drain site with peroxide or rubbing alcohol.
- Always secure the drain using a Velcro belt (if provided by the hospital), or safety pin the bulb to your clothing so there is not tension on the drain at the incision site.
- Do not cut the drains.
- Check that the bulb is always depressed (flat).
- Occasionally, drains may get pulled out. Do not panic. Do not try to reinsert the drain. Cover the drain site with a 4x4 gauze pad, apply pressure, and call the office immediately.
- Call if there is any increase in bright bloody drainage, purulent (pus-filled) drainage, increase in pain, loss of suction (bulb not depressed), leaking around insertion site, or clogged bulb.
Incision and Suture Line Care
Incisions and suture lines are a necessary part of surgery. These lines take many months to fully heal. There is no guarantee as to what a scar will look like once it has fully healed, however these instructions are important to achieve good outcomes.
If Dermabond (skin glue) was used on your incision, leave open to air. Do not place ointment on top of medical glue without discussing with your doctor. The glue will eventually fall off on its own. If Steri-Strips or glue tape was used, leave in place.
Unless otherwise instructed, you may shower 48 hours after a surgical procedure. You should refrain from tub bathing until the incision site is completely sealed. Do not swim in any lake, ocean, swimming pool, or other water until after your incision lines have fully sealed (about six weeks after the surgery).
Special note: If you have a breast implant with a drain in place, do not shower. Only sponge bathe while drain is in place, and keep the drain site dry.
Most of your sutures are absorbable and are placed internally. They will be absorbed over the course of two to six months. However, a few stitches may be placed externally at times. These typically are removed one week after surgery.
Once your incision lines have closed at about two weeks, you may wish to apply a gentle skin moisturizer with sunscreen to the suture line. This aids in softening the scar and may alleviate any itching in the surgically treated area. Choose something fragrance free and free of glycolic acid, retinoid, or other possible irritating ingredients.
Once your incision lines have sealed at about four to six weeks, you may apply scar therapy treatments, silicone ointments, or silicone sheets to the incision. These can be purchased at a pharmacy or through our office.
Avoid any vigorous physical activity over the following six weeks. Direct trauma and physical stress may result in a separation of the suture edges or a wide scar.
The First Year
In the 12 months following surgery, you should apply a waterproof sunscreen with at least an SPF 30 at all times on the surgically treated area and the suture line. Use sunscreen even where your incision is covered by your swimwear. Apply at least 30 mins before any prolonged sun exposure is expected. Protective clothing is highly recommended. New scars are very sensitive to sunlight and, if unprotected, may result in permanent changes in scar color to either a darker, lighter, or discolored shade.
Rarely, a scar will take on a nodular, bumpy, raised, or thickened appearance; the scar formation may be hypertrophic or keloid. If this should happen, please contact our office. There are medications that may be effective to flatten and improve the scar as it is forming.
Deep Vein Thrombosis and Pulmonary Embolism
DVT: What is it?
DVT stands for deep vein thrombosis. This is a serious condition, and it can cause injury or death. A venous thrombus is a clump of blood cells, platelets, and fibrin (clot) which attaches to the inside walls of veins, can grow in size, and can break off to travel downstream from the clot. If the clot stays localized, it can cause swelling and vein irritation. If part of it breaks off, then it can cause blockage downstream, may travel to the lungs (pulmonary embolus), and can result in serious illness or even death. In some circumstances, deep vein thrombosis may also contribute to other serious medical problems such as heart attack and stroke.
Risk Factors with DVT
Patients taking certain medications or those with specific medical conditions are at a higher risk for DVT (see below). Medications that can alter normal blood clotting mechanisms, affect blood flow, or can cause blood-vessel damage can lead to DVT. Physical immobility for an extended amount of time, such as after surgery or in airplanes, can increase your risk of DVT as well.
Conditions Associated with Increased Risk of DVT
- Increasing age or smoking
- Heart Disease
- Recent surgery
- Personal/family history of DVT
- Blood clotting disorder
- Use of oral contraceptive
- Use of hormone therapy
Symptoms of DVT
Symptoms may not occur every time when a DVT is formed. If it were to occur, the symptoms may include swelling, pain and redness in legs and calves. Difficulty breathing and severe chest pain indicates that the blood clot has moved to the lungs. If you are concerned, please be evaluated by a physician immediately.
Reducing Your Risk of Deep Vein Thrombosis
When DVT develops, it is often undiagnosed, therefore the definite methods to prevent it are still uncertain. In order to reduce the risk of developing DVT, patients are advised to follow these guidelines:
- Wear elastic compression stockings after surgery. Closed-toe TED anti-embolism stockings are recommended and can be purchased at most pharmacies or online.
- Trying to walk about 100 feet every three hours with help. Also, when you can, try to sit in a chair and attempt leg exercises as recommended below.
- Alter your position by stretching your legs and feet. Every hour do leg exercises such as ankle circles, knee lifts, lifting your knee to your chest, and pumping your feet.
- Avoid crossing your legs at the knee or ankle.
- Loose-fitting clothing is recommended.
- Keep yourself hydrated. Drink non-diuretic fluids, such as water, milk, and juice. Minimize your caffeine and alcohol intake.
Exercises should not be done if they are causing pain in your calves, or if you are advised not to continue with your exercises by your surgeon.
Pumping Your Feet: Keeping your heels on the ground, point toes and foot as high as you can. Hold for 30 seconds and then put both feet flat on the floor again. Lift your heels off of the floor, while keeping the balls of your feet on the floor, and hold for 30 seconds.
Ankle Circles: Holding your foot in the air, draw a circle with your toes for 30 seconds. Change direction and continue for another 30 seconds. Put your foot down and then repeat with the other foot.
Knee Lifts: Sit down and march your legs, contracting each thigh muscle. Make sure you stay seated during this exercise. Continue for 30 seconds.
Lifting Your Knee To Your Chest: Raise your left knee and bring it to your chest region. Hold this position for 10 to 15 seconds. Return your leg to the floor in a slow motion. Alternate legs 10 times.
Travel-Related Deep Vein Thrombosis
There is increasing evidence that immobilization in a car/airline seat for long trips puts people at risk for deep vein thrombosis (DVT). There are a number of ways to reduce the risk of travel-related DVT.
- Always drink plenty of water to avoid dehydration.
- Do not drink alcohol before or during the travel, as this can compound dehydration.
- Try to keep your thighs clear of the edge of your seat. Use foot rests as far as possible.
- Take a brisk walk for half an hour before travel.
- If being driven, stop every hour and walk for about 5 minutes.
- If on a flight, regularly go for a short walk to the restroom to keep your legs moving.
- Try a few simple exercises to keep your legs moving: rotating your ankles, alternating pointing your heel and toe, and lifting your knees while seated for a short period every hour.
- Try to tense your leg muscles as regularly as possible throughout travel.
- Wear elastic compression stockings especially designed to reduce the risk of DVT. These are readily available at most pharmacies.
- Take a low dose of aspirin (81 mg daily), starting the day before travel and continuing until three days after finishing travel.
Some discomfort is expected following your surgery. Call the doctor immediately if there are any signs of infection:
- Temperature greater than 101˚
- Significant swelling
- Tender, red, swollen, warm areas, pus, yellow or green drainage
- Swollen/painful or darkened skin
Seek immediate medical attention if you experience shortness of breath, chest pain, or unusual heartbeats.