Prof. Jian Farhadi is a plastic surgeon who specialises in reconstructive and aesthetic breast surgery and in surgery after major weight loss. In this interview, published in March 2022, he explains why the time before an operation matters as much as the operation itself, describes the preoperative heat treatment his team used, talks about swelling and recovery after surgery, and shares his own daily routine. His answers are printed in his own words.
Key takeaways from the interview
- Prof. Farhadi compares surgery to competition: like an athlete, a patient benefits from preparing both physically and mentally.
- He is clear that the immune system cannot simply be “strengthened”; the aim is to reduce the factors that harm it, including stress, which good preoperative support and education can reduce.
- His team used a preoperative heat treatment of the surgical site the day before surgery: 30 minutes at 43 degrees, 30 minutes of cooling, repeated three times.
- Before and after surgery, the goal is to limit the inflammatory response, swelling and oedema, and to support functional recovery.
- His own routine is simple and strict: early start, water, a short back workout, no work in the evenings.
- Practical rule for every patient: follow your own surgeon’s instructions, and take nothing new before surgery without asking your surgeon.
Who is Prof. Jian Farhadi?
Professor Jian Farhadi is a plastic surgeon specialising in reconstructive and aesthetic breast surgery, as well as post-weight-loss surgery. At the time of the interview he was chair of the London Breast Meeting and co-director of the Masters in Breast Surgery programme. As founder of the BRA Foundation, he raises awareness of breast reconstruction options for women facing mastectomy. He is the fifth generation in his family to practise surgery. His practice, the Plastic Surgery Group (now Affidea Plastic Surgery Group), is based in Zurich, with a further location in Ticino.
We sat down with him to talk about the phases before and after an operation, and about health and wellbeing in his own life. Here are the highlights.
Why is the time before surgery so challenging?
Q: Why is pre-operation such a challenging phase for both doctors and patients?
Every athlete prepares for competition at different levels, both physically and mentally. I believe that proper preparation yields faster and better healing. Pre- and post-surgery, I recommend taking Sanbera to make these stages easier.
This is Prof. Farhadi’s recommendation from his own practice. Whether any supplement suits you around an operation is a question for your own surgeon: take nothing new before surgery without asking your surgeon. In practice, preparation means the things your surgical team asks of you: attending the pre-assessment, sharing a full list of your medication and supplements, arranging help at home for the first days, and following the fasting and medication instructions you are given.
Can you prepare your immune system for surgery?
Q: How do you make sure that the patient's immune system will be able to handle surgery?
Although we cannot strengthen the immune system, we can influence all the damaging factors. With Sanbera supplements, as an example, we can improve a diet low in vitamins and minerals, which can also provide benefits for another problematic factor that is stress, which we can minimize by providing adequate preoperative support and education.
Damaging factors that patients can influence include smoking, poorly controlled blood sugar, a diet that is short of protein, vitamins and minerals, and stress. Your surgeon or anaesthetist will tell you which of these matter for your procedure. If you want to understand which nutrients have an established role in the immune system, our guide to vitamins and minerals for a healthy immune system explains the authorised facts.
What is preoperative heat treatment?
Q: How can patients optimize their healing and recovery process so they can be back to their best as quickly as possible?
Besides supplementing with Sanbera, which contains highly bioavailable ingredients, we also use preoperative heat treatment. The surgical site is heated to 43 degrees for 30 minutes one day before surgery, then cooled down for 30 minutes. The procedure repeats three times. And it leads to the increase of specific proteins, which protects the tissue from damage and leads to increased blood flow.
This is a clinical procedure carried out by a surgical team, not something to try at home. Whether it is used for your operation is a question for your own surgeon.
Swelling and inflammation after surgery
Q: Are there ways to reduce inflammation after surgery?
The goal during the preoperative period is to reduce the inflammatory response and the development of edema. Antioxidant agents protect against free radicals, promote blood circulation, and increase the production of collagen, which is essential for proper healing. I recommended my patients take Sanbera Reload Time To Time with a premium-quality vitamin C and all B vitamins to optimize tissue remodelling and collagen and elastin production.
After surgery, we continue to support the healing process and ensure functional recovery. Vitamins and minerals play a key role in supporting normal cell proliferation (essential in the recovery phase). As well as promoting wound healing and lymphatic drainage after surgery, it is critical to reducing swelling and edema to sustain and consolidate the results.
Some swelling is a normal part of recovery. How you manage it, for example with a support bra, rest, positioning and lymphatic drainage, depends on your procedure and your surgeon’s protocol. Our article on breast surgery recovery and self-care covers the first weeks at home in more detail.
What should you eat before surgery?
The interview does not give diet rules, so here is the general picture from the guidelines. Your hospital’s own instructions always come first.
The last hours: follow the fasting rules
You are asked not to eat before an anaesthetic so that the stomach is empty, which lowers the risk of stomach contents entering the lungs. For healthy adults having planned surgery, the European Society of Anaesthesiology guideline generally allows solid food up to six hours and clear fluids, such as water, up to two hours before anaesthesia. Your hospital may set different times for your procedure.
The weeks before: eat well, not differently
The ESPEN guideline on clinical nutrition in surgery recommends checking patients for malnutrition before major surgery, avoiding unnecessarily long fasting and returning to normal eating as early as possible afterwards. For most people that means regular, balanced meals with enough protein, vegetables, fruit and whole grains, and enough fluid. There is no good evidence that particular foods, such as pineapple, reduce swelling or bruising.
Supplements before surgery
Take nothing new before surgery without asking your surgeon. Some supplements and herbal products can affect bleeding or interact with anaesthesia and medication, so list everything you take, including vitamins, at your pre-operative appointment. A supplement does not replace your surgeon’s instructions.
Prof. Farhadi’s daily ritual
Q: Do you have a daily ritual?
Every day, I wake up at 5:30. To start, I take one espresso, half a liter of water, and, of course, Sanbera Essential Men. Then 30 minutes of workout for my back. I then have another espresso and do all my emails before leaving the house at 6:45. In the evenings, I do not work or check emails. It is to spend time with my family.
For context: Daily Essential Men is a morning formula of three tablets with 12 vitamins and 6 minerals, for example vitamin C 51.8 mg (65 % NRV), zinc 4 mg (40 % NRV) and vitamin B12 1.88 µg (75 % NRV). It is a food supplement for everyday use and does not replace a varied, balanced diet. Before an operation, ask your surgeon before taking it or any other supplement.
Self-care for men of any age
Q: What is your recommendation for men of any age to include self-care rituals in their daily lives?
For me, every day is very intense and full of variety. Mental preparation for the day and all the events is one of the most effective methods of self-preservation. It reduces stress in everyday life. Instead, it allows me to cope with even the most complex situations with ease. Of course, mental and physical self-care go hand in hand. And exercise, for example, is a physical aspect of self-care. But for me, posture and nutrition are just as important.
His point that nutrition matters as much as exercise matches what nutrition authorities say: food first, and supplements only where the diet or life stage leaves a gap. Our guide which dietary supplements are most useful, and for whom walks through who actually benefits.
What was next for Prof. Farhadi?
Q: What's on the horizon for you you'd like to share with our lovely readers?
We are evaluating the use of hyperbaric oxygenation and infusion therapy in the preoperative phase of fat cell retention. In more detail, the patient would need to be in a hyperbaric chamber three to five times before they have autologous fat transferred. The first experiences are very positive, so we hope to have better results.
This answer describes work that was being evaluated at the time of the interview in March 2022; it is not an established treatment recommendation.
Read more conversations with surgeons: spine surgeon Dr. med. Sina Havakeshian on precision and recovery, and the science behind Sanbera on how the formulas are put together.
Frequently asked questions
Who is Prof. Jian Farhadi?
Prof. Jian Farhadi is a plastic surgeon specialising in reconstructive and aesthetic breast surgery and surgery after major weight loss. At the time of this interview (March 2022) he chaired the London Breast Meeting and co-directed the Masters in Breast Surgery programme. He founded the BRA Foundation, which raises awareness of breast reconstruction options, and is the fifth generation of surgeons in his family. He practises with the Plastic Surgery Group in Zurich.
What does Prof. Farhadi say about preparing for surgery?
He compares a patient to an athlete before a competition: preparing physically and mentally pays off, and in his view proper preparation leads to faster and better healing. He adds that the immune system cannot simply be strengthened, but the factors that damage it, such as stress, can be influenced through good preoperative support and education.
What is preoperative heat treatment?
In the interview, Prof. Farhadi describes heating the surgical site to 43 degrees for 30 minutes the day before surgery, then cooling it for 30 minutes, three times in a row. He says this increases specific proteins that protect the tissue and increases blood flow. It is a clinical procedure, so ask your own surgeon whether it applies to you.
What should I eat before surgery?
Follow your hospital’s fasting instructions exactly. For healthy adults having planned surgery, European anaesthesia guidance generally allows solid food up to six hours and clear fluids up to two hours before anaesthesia. In the weeks before, eat regular balanced meals with enough protein and fluid; there is no special pre-surgery diet that replaces your team’s advice.
Should I take supplements before surgery?
Take nothing new before surgery without asking your surgeon. Some supplements and herbal products can affect bleeding or interact with anaesthesia and medicines, so tell your team about everything you take, including vitamins. If your surgeon agrees that a supplement makes sense for you, it supports a balanced diet; it never replaces the surgeon’s instructions.
Sources
- Smith I. et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol, 2011.
- Weimann A. et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr, 2021.
- Plastic Surgery Group (Prof. Jian Farhadi)
- BRA Foundation
This article is for general information and does not replace advice from a doctor or pharmacist. Food supplements are not a substitute for a varied, balanced diet and a healthy lifestyle.