Robert Whitfield MD explains his protocol to minimize pain after breast implant removal. He starts anti-nausea meds and Celebrex the night before, uses regional nerve blocks during surgery, and applies ice immediately after to reduce inflammation. The goal is to avoid heavy narcotics so patients wake up clear-headed.
I think this has really been shaped by experiences in the past that patients have had. And I will tell you it stems from how I was trained. I was not trained to take preemptive action so that the wake up or recovery from surgery is as smooth as possible. And then full disclosure, I was told basically to go to the recovery room for patients many, many times and just write a prescription for narcotic and leave. That's how I was taught. And so that's entirely different from what we want. We want you to feel as comfortable as possible when you wake up. And so that all starts the night before with our specific protocol. That's different. So we want you to not have nausea. So we use an anti nausea medicine that you start taking the night before surgery. We want to decrease inflammation which helps with your wake up process. So we have you take Celebrex the night before surgery. We don't want you to have what can be a little shocky type electrical signal coming from the nerves that sometimes we will irritate when we operate. I have patients taking neuromodulator the night before surgery. It also decreases anxiety. So the wake up process is already being manipulated by me. Before you ever go to surgery, then during surgery, as we've alluded to in other shows, we do a block. The block is for multiple areas and tissues. Obviously we want to block nerves that could stimulate you. We want to block the intercostal musculature because as I elevate tissues off the rib surfaces, those will be sensitive. We want to block the incisional points we use, whether we're doing something through the fold around the areola complex or a lift that's down the front of the breast. So all of those things are addressed in the operating room. Now I have one more little trick that I'll let you in on. The number one anti inflammatory in the world is, is ice. And so many times what I do is I gently wrap folks with an ace wrap, but we'll get some ice packs and actually put it gently over the ears where we operated. And so that will wrap that. And when you're waking up, it's a little bit before you're completely awake. You're breathing on your own, everything's fine. But once again you're going to be really comfortable when you wake up because if you don't wake up in discomfort, if you don't wake up with sharp, say incisional pain or nerve pain or something else, you're probably not going to need much in the way of narcotic which is, we're all trying to avoid this for you. Because narcotics make you groggy. It's difficult to just be interactive with your family and friends, hard for us to communicate with you if you're too sedated. And basically, the number one reason I want you to take narcotics any more than you have to is constipation. I trained as a general surgeon where I took care of all sorts of GI tract issues. And one of the main things we want to avoid is that problem for you as well. I want you to wake up comfortable as we get you gently from the operating room table over to the recovery bed and take you into the recovery room. That is a different type of process.
