Pre-Surgery Care

Optimize Your Nutrition

Eating a healthy, balanced diet with lots of fruits and vegetables will prepare your body for optimal healing after top surgery. Your body needs certain nutrients to use as building blocks in the healing process, so it is important you are not in the middle of any fad diets at the time of surgery or actively losing weight at the time of surgery. You would ideally be at your optimal weight well ahead of surgery day and focusing on providing your body with adequate nutrition months in advance.

Wait for Breast Growth Stabilization

Before undergoing breast augmentation, it is important to allow your breast development from hormone therapy to stabilize. Hormones continue to reshape the chest over time, and the amount of natural breast tissue you develop can significantly influence both implant selection and your final surgical result.

Waiting until your breast size has remained relatively stable helps ensure that your implants are appropriately sized. If implants are placed before breast growth is complete, continued hormone-related growth afterward may result in a larger overall breast size than you originally intended.

Natural breast tissue also plays an important role in achieving an attractive, natural-looking result. It helps camouflage the edges of the implant, creates a smoother transition between the implant and the chest, and provides additional soft tissue coverage. In addition, allowing your own breast tissue and skin to develop naturally often improves the skin's ability to accommodate an implant, reducing tension and supporting a more aesthetically pleasing outcome.

Work On Your Therapy Letter

If you are going through insurance for top surgery, you are almost guaranteed to be required to supply a letter of support from a licensed therapist, which means the therapist needs to have a master’s degree (ex. LPC, LCSW). The letter may also come from a psychiatrist. You will also need a short letter from your hormone provider documenting how long you have been on hormone therapy. Here are some options to obtain a therapy appointment with a gender specialist: Matthew Phillips*** https://www.matthewkphillips.com/

Growth Therapy*** https://growththerapyllc.com/

Rachel Doyle*** www.aspenpsychologicalcenter.com

4-6 weeks prior to surgery:

These are things your surgeon may want from you around this time:

• Primary care doctor clearance–may or may not be required by your doctor
• Blood work – may or may not be required by your doctor (ex. CBC, BMP, PT/PTT)-EKG and/or Chest XR in patients with a history of cardiovascular disease or over a certain age (usually age 50).
• Mammogram if you have been on hormone therapy for 5 years or longer – this will generally be required to get a baseline and to make sure you don’t have any areas that may need to be biopsied prior to top surgery
• See our list of Medications to Avoid which generally should be stopped 2-4 weeks prior to surgery depending on the medication. Always double check with your surgeon before you start or stop any medications or vitamins/herbal supplements prior to surgery. Pay attention to avoiding ibuprofen/NSAIDS/aspirin products and products with added Vitamin E (ex. some almond milks) which can increase risk of bleeding after surgery.
• Stop Smoking.
• It is important not to consume NICOTINE PRODUCTS OF ANY KIND INCLUDING SECOND HAND SMOKE. Nicotine increases risk of infection and wound healing complications by over 50% and should be AVOIDED FOR AMINIMUM OF 4 WEEKS PRIOR TO SURGERY AND 4 WEEKS AFTER. Your surgeon may require a longer time period than 4 weeks, so it is important to check with your surgeon about their specific guidelines. It is important to also avoid Marjuana, which can interfere with anesthesia medications and increase risk of complications from anesthesia.
• Avoid alcohol at least one week prior to surgery.
• This can increase risk of bleeding and interfere with anesthesia.
• Avoid other recreational drug use which can interfere with administration of anesthesia.

Set up your physical and emotional support system:

• After general anesthesia, you will need someone around to drive you home from surgery and stay with you for 24 hours.
• You may want someone around to help you for a few days, if not for the entire 7 days after surgery. You will not necessarily need their constant assistance, but company can be helpful during the initial recovery period.

In general, you want your body both physically and emotionally to be completely optimized so that you are physically and emotionally healthy and prepared to undergo top surgery!

Things you may need from the pharmacy

1. Bacitracin Ointment and/or Aquaphor for incision and/or nipple graft care
2. Tylenol
3. Chapstick (for dry lips)
4. Throat lozenges (for sore throat after anesthesia)
5. Tums or Maalox (for a sensitive stomach)
6. Colace and Senna (for constipation)
7. Silicone scar tape or gel (cannot be used until ~4 weeks after surgery, but ok to get it ready ahead of time) this will help prevent thickened scars and can be purchased from the pharmacy or on Amazon.

Days before surgery:

• Schedule a postop visit with your surgeon, usually about 1 week ahead of surgery.
• If you have Diabetes: Do not take medication for Diabetes on the day of your surgery. This is because you are not eating, and your blood sugar could drop too low if you take your medication. If you take metformin, it is usually recommended that you do not take metformin about 48 hours prior to surgery. Check with your surgeon or primary care doctor if you have Diabetes to confirm their specific instructions regarding your individual medication regimen.
• Stay hydrated the day before surgery, since your body may be devoid of fluids for a time prior to surgery depending on whether your surgery is in the morning or afternoon.

On The Morning Of Surgery

• NO SOLID FOOD OR DRINK for 8 hours prior to your surgery.
• You may have small sips of water with medications only.
• If you take blood pressure medication, make sure you TAKE THIS MEDICATION on the morning of surgery unless otherwise instructed by your doctor.
• Shower as usual, but do not use any creams, lotions, oils, deodorants, or products with fragrances such as cologne.
• Brush your teeth but avoid swallowing much water.
• TAKE OUT ANY METAL JEWELRY. If you have metal piercings you will probably be allowed to replace them with plastic, as long as there is no metal at all. This is because of the electrocautery that is used during surgery and the risk for thermal injury from conduction of the metal piercing.
• Take out contact lenses. You may bring glasses on surgery day and there will likely be a place where a small number of personal belongings will be stored.
• Leave all valuables at home
• Bring a photo ID, insurance card and a contact number for the friend or family member who will be around on your surgery day.
• Usually you need to arrive about 1.5-2 hours prior to your surgery time.
• Someone will need to drive you home from the facility after your surgery and stay with you for 24 hours (no taxis or ubers).