The Pre-Operative Consultation
For most plastic surgery procedures it is advisable to have two consultations with your surgeon. These are elective procedures, so there is no urgent medical need for the operation. Unlike emergencies such as appendicitis, it is the patient, not the doctor who determines when and by whom the surgery will be performed. Therefore it is imperative that the surgeon outlines all the possible approaches to your needs and their potential complications.
To have sufficient time to consider this information, a patient should therefore usually be offered two consultations. A few weeks between visits allow ‘cooling down’ time, to give the surgeon’s suggestions due consideration.
To best address your needs, it is essential that you inform the surgeon of your complete medical history, including:
- all medications currently taken, especially those which may affect blood clotting
- any significant past medical history
- previous operations
- allergies, including to drugs, sticky tapes or latex
Doing everything that you can to optimize your physical condition prior to surgery will also help to minimize the risk of complications. In particular, smoking increases the risk of:
- Healing problems
- Blood clots
Stopping even a few weeks prior to the procedure will improve this situation.
During the consultation the surgeon will emphasize his/her commitment to you, but also reiterate a patient’s obligation to themselves. This includes maintaining your health and availing yourself of all available information about the procedure from websites, literature and support groups. The surgeon may also have the contact details of previous patients who are happy to talk to you about their experiences of the operation and recovery. It may also be helpful to obtain a second opinion from another surgeon. It is, however, important to remember that different surgeons have different approaches to the same problem and sometimes too much advice can lead to confusion.
Between the Consultations and Surgery
Once the decision has been made to go ahead with surgery, your doctor will decide which preoperative health checks are necessary. Below is a list of frequently performed investigations, although not all people need all of these:
- Blood tests for anaemia and clotting
- Electrocardiogram (ECG) to check for heart conditions
- Chest x-ray to check for lung problems
- Mammography to check for early tumours
- CT scanning to check previous health problems or for preoperative mapping of the blood supply to tissue
A plan will be made for any post-operative support garments that may be required such as bras or abdominal supports.
In the weeks before your surgery it is a good idea to prepare a bag, packed with all of the things you may need, including a sports bra as recommended by your surgeon. You will need to stop taking blood-thinning medicines like aspirin a week in advance and it is a good idea to reduce your intake of vitamin E and garlic. In some cases you may be advised to take a mild laxative or fibre supplement to minimise the risk of constipation, which can be a troublesome side-effect of many of the pain medicines used around the time of surgery.
At home it is wise to prepare for your return from surgery by having good supplies of easy-to-prepare meals or home help. Also ensure that you have enough of your normal prescription medication to last for 2 weeks following the procedure.
The night before surgery you must not eat or drink after midnight and definitely avoid alcohol.
Admission for Surgery
For large operations you may be asked to come in the night before, but for most procedures, arriving on the day of surgery is sufficient. Because your surgeon wants to ensure that all of the patients are properly prepared before starting to operate, he/she will usually ask everyone to arrive first thing in the morning. Those who are scheduled for surgery later in the day will need to have something to do, such as a good book but also a good deal of patience!
Your surgeon will visit you and answer any last minute questions before often taking photographs for your medical records. He/she will then make some pen drawings to plan the surgery with you in an upright position, as the shape of things changes when you lie down. This planning can still be rechecked during surgery using a tilting operating table.