In the world of plastic surgery, the focus is often on the procedure itself and the recovery that follows. However, what if there was a way to prepare patients before surgery to optimize their outcomes and enhance their overall experience? This concept, known as prehabilitation, is gaining traction among plastic surgeons, particularly in the realm of breast reconstruction and other complex procedures. In a recent episode of the *Resident Review* podcast, Dr. Rebecca Knackstedt, a board-certified plastic surgeon and assistant professor at Duke University, shared her insights on the importance of prehabilitation and how it can transform patient care.

What is Prehabilitation?

Prehabilitation refers to interventions taken before a surgical procedure to improve a patient’s physical and mental readiness for surgery. While rehabilitation focuses on recovery after an injury or surgery, prehabilitation takes a proactive approach by addressing factors such as nutrition, exercise, sleep, stress management, and social support *before* the procedure. The goal is to enhance the body’s resilience, reduce the risk of complications, and promote faster, smoother recovery.

Dr. Knackstedt explains that prehabilitation is particularly important for patients undergoing major surgeries, such as breast reconstruction, where the physical and emotional demands are significant. By preparing the body and mind in advance, patients can enter surgery in the best possible condition, which can lead to better outcomes and an improved overall experience.

The Holistic Approach to Prehabilitation

Prehabilitation is not just about physical preparation; it’s a holistic approach that encompasses multiple aspects of a patient’s health:

1. Nutrition: Proper nutrition is critical for wound healing and recovery. Dr. Knackstedt emphasizes the importance of increasing protein intake and ensuring adequate levels of key nutrients like vitamin C, arginine, and glutamine. She also recommends high-quality supplements, as many patients may not get enough of these nutrients from their diet alone.

2. Exercise: Targeted exercise can help build lean muscle mass, which is essential for recovery, especially after surgeries that require prolonged bed rest. Dr. Knackstedt advises patients to focus on strengthening areas that will be relied upon post-surgery, such as the legs for patients undergoing abdominal flap procedures.

3. Sleep: Quality sleep is often overlooked but is crucial for recovery. Dr. Knackstedt recommends improving sleep hygiene before surgery and suggests bringing comfort items like pillows, blankets, and aromatherapy diffusers to the hospital to create a more restful environment.

4. Stress and Anxiety Management: Surgery can be a significant source of stress and anxiety. Dr. Knackstedt encourages patients to use tools like guided meditation, yoga, or counseling to manage their stress before surgery. She also notes that providing patients with more information and tasks to focus on can help them feel more in control and less anxious.

5. Social Support: Having a strong support system in place is essential for recovery. Dr. Knackstedt advises patients to identify who will help care for them after surgery and to communicate their needs to their support network.

The Evidence Behind Prehabilitation

The benefits of prehabilitation are supported by a growing body of evidence. Dr. Knackstedt highlights a recent review of 186 studies involving over 15,000 patients, which found that all forms of prehabilitation—whether focused on nutrition, exercise, or a combination of interventions—improved physical recovery after surgery. Interestingly, much of this research comes from fields outside of plastic surgery, such as anesthesiology and ENT, underscoring the importance of looking beyond our own specialty for insights.

Challenges and Future Directions

Despite the clear benefits, prehabilitation is not yet widely adopted in plastic surgery. One of the challenges is the lack of standardized protocols and the difficulty of measuring outcomes. Dr. Knackstedt suggests that future research should focus on developing better ways to assess the impact of prehabilitation, such as using wearable technology to track patient activity and recovery.

Another barrier is the cost of prehabilitation interventions, which are often not covered by insurance. Dr. Knackstedt points out that investing in prehabilitation could ultimately save money by reducing complications, hospital stays, and readmissions. She hopes that more studies will demonstrate the cost-effectiveness of prehabilitation, making it easier to advocate for insurance coverage.

Practical Tips for Patients and Providers

For patients preparing for surgery, Dr. Knackstedt offers the following high-yield recommendations:

• Increase protein intake: Aim for 1.2 to 2 grams of protein per kilogram of body weight per day.
• Consider supplements: Look for high-quality, third-party validated supplements that provide key nutrients like arginine, glutamine, and probiotics.
• Strengthen your body: Focus on building lean muscle mass, particularly in areas that will be relied upon after surgery.
• Improve sleep hygiene: Create a restful environment and consider bringing comfort items to the hospital.
• Manage stress: Use tools like meditation, yoga, or counseling to reduce anxiety before surgery.

For providers, Dr. Knackstedt encourages looking beyond traditional plastic surgery literature for insights on prehabilitation. She also emphasizes the importance of educating patients about the benefits of prehabilitation and providing them with resources to prepare for surgery.

Conclusion

Prehabilitation represents a paradigm shift in plastic surgery, moving from a reactive approach to a proactive one. By preparing patients physically and mentally before surgery, we can optimize their outcomes, enhance their recovery, and improve their overall experience. As Dr. Knackstedt’s insights demonstrate, prehabilitation is not just a good idea—it’s a critical component of patient care that has the potential to transform the field of plastic surgery.