Wounds need a lot of energy to heal well. Since energy can only come from food, it is vital that patients eat as healthily as possible especially before and after surgery. Crucial nutrients for wound healing include protein, zinc and the vitamins A and C.
So what are the best things to eat? Meats, nuts, beans and dairy products are great sources of protein. Carrots, tomatoes, sweet potatoes, spinach and apricots are great sources of vitamin A. Citrus fruits and green leafy vegetables are great sources of Vitamin C. Yogurt, green peas, beef, oysters, black beans and crab are great sources of zinc.
Patients must also stay well hydrated before and after surgery by drinking enough water. Dehydration causes the skin and soft tissues to lose moisture and become dry. Dry wounds do not heal well. A good goal is to drink eight (8 oz) glasses of water a day. Caffeinated products should also be avoided because caffeine can cause dehydration.
The importance of healthy nutrition is really emphasized by the link between obesity (Body Mass Index [BMI] over 30) and complication rates after surgery. Obese patients have much higher rates of infection, wound healing problems (breakdown of wounds), hematomas (blood collections), and seromas (fluid collections) compared to non-obese patients.
Obese patients also have a thicker subcutaneous adipose layer with a poorer blood supply. Blood flow to the healing tissues is therefore less robust and the amount of vital nutrients and oxygen reaching these tissues are far less than in non-obese patients. This poor blood flow compounds the negative effects of poor nutrition. If possible, losing weight before surgery will only decrease the risk of complications.
Smoking can also really impact healing. The nicotine in cigarette smoke causes blood vessels to shrink, so again tissues do not receive enough of the nutrients and oxygen required for healing. At best, this can cause the wound healing process to take much longer. At worst, smoking can cause wounds to breakdown. Unfortunately, many smoking-cessation products will also increase the risk of healing problems because of the nicotine they contain!
Cigarette smoke also contains carbon monoxide. This combines with your blood cells preventing them from carrying oxygen and effectively lowering the level of oxygen in the blood. Since oxygen is vital for healing, it is crucial to quit smoking before and after surgery to decrease the risk of healing complications.
Another good thing to do?... Exercise. Regular aerobic exercise improves healing after surgery and boosts the immune system. Start with walking and progressively build up to more of a sweat once given the "all-clear" by your surgeon.
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Dr Chrysopoulo is a board certified plastic surgeon specializing in breast cancer reconstruction. On Facebook?.... Connect with Dr C and breast cancer patients in our FB Breast Cancer Reconstruction Community. You can also follow Dr C on Twitter!
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Showing posts with label obesity. Show all posts
Showing posts with label obesity. Show all posts
Monday, November 1, 2010
Thursday, January 7, 2010
Triangle
Cancer Bitch is slightly traumatized (if that's not an oxymoron). She admits she did gain 30 pounds in her 40s, but she thought she was still sort of in the normal range. But today she went to the Y to meet for the very first time with a personal trainer and the trainer gave her that thing to hold in front of herself that looks like white binoculars except there's plastic where the lenses would be. It feels a little like a dousing tool but it supposedly sends out fat-seeking beams that report back to the device with a number. And that number corresponds to designations and according to the number, Cancer Bitch was designated as obese. How could this be?
[Bathsheba by Rembrandt]
Her friend G once said that women retain the image of themselves as they were at 30. Cancer Bitch wonders if this statement is accurate, first of all, and second of all, for the rest of someone's life. If you're 80, do you still think of yourself as you were at 30? When she was 30 Cancer Bitch had a very little bit of cellulite. When she was 28 she did aerobics and felt that she looked OK. But it has been a long time since she was 28. Does she think of herself as she was at 30? No. And she has a couple of items of clothing from yesteryear that she keeps around because she hopes one day to be able to wear them again. She will.
[Renoir]
CB has not had sugar (well, not had foods that have a lot of sugar, like candy, cookies, cake, muffins) since December 28 and she has been rowing indoors with her rowing team (which welcomes new members, with or without rowing experience). Shouldn't that count for something? CB also thinks that a person should get credit for the foods she's exposed to and does not eat. That, too, doesn't seem like too much to ask, but the problem is there is no one to ask because, in her lights, there is no god or divine Mind running things, things just are. So buck up, Cancer Bitch. This is not the best of all possible worlds.
Alas, during CB's travels in November (Omaha, Houston, Atlanta, South Florida) she carried suitcases up and down stairs, which put pressure on her knees so now she can't jog or even do the elliptical without her knees hurting some. But her new personal trainer says she will give her exercises that will strengthen surrounding leg parts and help her knees. CB also picked up her suitcase and stored it in the overhead bin a few too many times and has some muscle pain in her back. She hopes it is muscle pain and not metastasis in her ribs. Yet there is this terrible terrible part of her that wants what they call "mets." How could this be? Metastasis is one more step toward death. Is it the dark drama of it she wants? She knows that only this thanatos-loving part of her wants...thanatos, death. She heard on the radio that teens under 15 don't understand the finality of death. Maybe CB is so immature that she is like a 15-year-old. Yet she has thought about death all her life. She is tired of writing about how she has always thought of death. But she does not want that warm oblivion. Or cool. She imagines it dark like a deep deep purple, a forever-sleep.
Cancer Bitch knows that she is a Holocaust Girl, a person obsessed with the Holocaust. She coined the term and wrote the book. But she also wants to live and be strong (Hello, Lance Armstrong) and turn that fat into muscle or into nothingness. She wants the fat to disappear. How odd that parts of your body can disappear. She likes the flier that promises: Lose 150 pounds of ugly fat instantly. It's a flier advertising martial arts for women. (See, you push the guy away.)
For many years Cancer Bitch was tall and gangly. Her mother said she could be a model. Once where she was in her early teens she met with a modeling agent who looked at her and then ran her hands along her sides and said that she had the shape of a coke bottle. This was not a good thing in a model. CB was too short to be a model, too, but the agent didn't even bother with that. Over the years CB has become more triangle-shaped. A pyramid. A delta. This is not a good shape to be, even if we didn't live in a fat-obsessed society that oppresses women who do not conform to the unhealthily thin Hollywood ideal. Cancer Bitch will work on her muscles and cardio and she hopes one day to be a coke bottle again, but one with some umph to her. She will challenge you to an arm-wrestle, even.
[Bathsheba by Rembrandt]
Her friend G once said that women retain the image of themselves as they were at 30. Cancer Bitch wonders if this statement is accurate, first of all, and second of all, for the rest of someone's life. If you're 80, do you still think of yourself as you were at 30? When she was 30 Cancer Bitch had a very little bit of cellulite. When she was 28 she did aerobics and felt that she looked OK. But it has been a long time since she was 28. Does she think of herself as she was at 30? No. And she has a couple of items of clothing from yesteryear that she keeps around because she hopes one day to be able to wear them again. She will.
[Renoir]
CB has not had sugar (well, not had foods that have a lot of sugar, like candy, cookies, cake, muffins) since December 28 and she has been rowing indoors with her rowing team (which welcomes new members, with or without rowing experience). Shouldn't that count for something? CB also thinks that a person should get credit for the foods she's exposed to and does not eat. That, too, doesn't seem like too much to ask, but the problem is there is no one to ask because, in her lights, there is no god or divine Mind running things, things just are. So buck up, Cancer Bitch. This is not the best of all possible worlds.
Alas, during CB's travels in November (Omaha, Houston, Atlanta, South Florida) she carried suitcases up and down stairs, which put pressure on her knees so now she can't jog or even do the elliptical without her knees hurting some. But her new personal trainer says she will give her exercises that will strengthen surrounding leg parts and help her knees. CB also picked up her suitcase and stored it in the overhead bin a few too many times and has some muscle pain in her back. She hopes it is muscle pain and not metastasis in her ribs. Yet there is this terrible terrible part of her that wants what they call "mets." How could this be? Metastasis is one more step toward death. Is it the dark drama of it she wants? She knows that only this thanatos-loving part of her wants...thanatos, death. She heard on the radio that teens under 15 don't understand the finality of death. Maybe CB is so immature that she is like a 15-year-old. Yet she has thought about death all her life. She is tired of writing about how she has always thought of death. But she does not want that warm oblivion. Or cool. She imagines it dark like a deep deep purple, a forever-sleep.
Cancer Bitch knows that she is a Holocaust Girl, a person obsessed with the Holocaust. She coined the term and wrote the book. But she also wants to live and be strong (Hello, Lance Armstrong) and turn that fat into muscle or into nothingness. She wants the fat to disappear. How odd that parts of your body can disappear. She likes the flier that promises: Lose 150 pounds of ugly fat instantly. It's a flier advertising martial arts for women. (See, you push the guy away.)
For many years Cancer Bitch was tall and gangly. Her mother said she could be a model. Once where she was in her early teens she met with a modeling agent who looked at her and then ran her hands along her sides and said that she had the shape of a coke bottle. This was not a good thing in a model. CB was too short to be a model, too, but the agent didn't even bother with that. Over the years CB has become more triangle-shaped. A pyramid. A delta. This is not a good shape to be, even if we didn't live in a fat-obsessed society that oppresses women who do not conform to the unhealthily thin Hollywood ideal. Cancer Bitch will work on her muscles and cardio and she hopes one day to be a coke bottle again, but one with some umph to her. She will challenge you to an arm-wrestle, even.
Saturday, November 18, 2006
Breast Reconstruction Not as Safe For Obese Patients
Significantly obese women may wish to consider delaying breast reconstruction following mastectomy until they achieve a healthier body weight. According to findings presented today at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2006 conference in San Francisco, women who are significantly obese are at higher risk for complications and have a lower satisfaction rate than do normal and overweight patients.
“Just because someone is overweight doesn’t mean they should not be entitled to undergo breast reconstruction after mastectomy,” said Elisabeth Beahm, MD, ASPS Member Surgeon, author of the study, and associate professor at M. D. Anderson Cancer Center. “Feeling ‘whole’ can be an integral part of recovery from cancer, yet significant concerns have been
raised about the wisdom of doing breast reconstruction in very obese patients due to a high complication rate.”
The current retrospective study found that patients with a BMI greater than 35 demonstrated significantly increased complication rates for all types of breast reconstruction, from implants to flaps. The complication rate approached 100 percent for morbidly obese patients with a BMI over 40.
“We investigated whether plastic surgeons can safely perform breast reconstruction for these patients or if we would be depriving them reconstruction simply because of empiric concerns for their weight,” said Dr. Beahm. “We found that significantly obese patients, those having a BMI of 35 or higher, had a higher risk for complications. Our experience suggests that in many cases it may be more prudent to delay breast reconstruction until the patient has lost weight.”
The most frequent complications for obese patients were fluid collections and infection at both the reconstructive site and the flap donor site. When the flap was harvested from the abdominal area, weakness and deformity of the abdominal wall such as hernia and bulge was much more common than in normal weight patients.
“While it’s very difficult to tell a patient she needs to wait for breast reconstruction, patient safety is our primary concern,” said Dr. Beahm. “We must not compromise the oncologic imperative in breast cancer. Each case must be individualized. Morbidly obese patients need to work with their plastic surgeons and carefully assess risk factors. Patients may be best served by deferring breast reconstruction until they have achieved and maintained a lower BMI through exercise and nutrition.”
For referrals to ASPS Member Surgeons certified by the American Board of Plastic Surgery, call 888-4-PLASTIC (475-2784) or visit www.plasticsurgery.org where you can also learn more about cosmetic and reconstructive plastic surgery.
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
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“Just because someone is overweight doesn’t mean they should not be entitled to undergo breast reconstruction after mastectomy,” said Elisabeth Beahm, MD, ASPS Member Surgeon, author of the study, and associate professor at M. D. Anderson Cancer Center. “Feeling ‘whole’ can be an integral part of recovery from cancer, yet significant concerns have been
raised about the wisdom of doing breast reconstruction in very obese patients due to a high complication rate.”
The current retrospective study found that patients with a BMI greater than 35 demonstrated significantly increased complication rates for all types of breast reconstruction, from implants to flaps. The complication rate approached 100 percent for morbidly obese patients with a BMI over 40.
“We investigated whether plastic surgeons can safely perform breast reconstruction for these patients or if we would be depriving them reconstruction simply because of empiric concerns for their weight,” said Dr. Beahm. “We found that significantly obese patients, those having a BMI of 35 or higher, had a higher risk for complications. Our experience suggests that in many cases it may be more prudent to delay breast reconstruction until the patient has lost weight.”
The most frequent complications for obese patients were fluid collections and infection at both the reconstructive site and the flap donor site. When the flap was harvested from the abdominal area, weakness and deformity of the abdominal wall such as hernia and bulge was much more common than in normal weight patients.
“While it’s very difficult to tell a patient she needs to wait for breast reconstruction, patient safety is our primary concern,” said Dr. Beahm. “We must not compromise the oncologic imperative in breast cancer. Each case must be individualized. Morbidly obese patients need to work with their plastic surgeons and carefully assess risk factors. Patients may be best served by deferring breast reconstruction until they have achieved and maintained a lower BMI through exercise and nutrition.”
For referrals to ASPS Member Surgeons certified by the American Board of Plastic Surgery, call 888-4-PLASTIC (475-2784) or visit www.plasticsurgery.org where you can also learn more about cosmetic and reconstructive plastic surgery.
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
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