Bilateral Mastectomy and DIEP Flap Reconstruction

You are in the preadmission clinic reviewing a 38-year-old woman with breast cancer whom you will anaesthetise for bilateral mastectomy and immediate deep inferior epigastric perforator (DIEP) flap reconstruction in two weeks' time. Medical History: Type 2 diabetes mellitus – diagnosed two years ago Antiphospholipid syndrome – diagnosed three months ago after first episode of lower limb deep vein thrombosis with pulmonary embolism Medications: Rivaroxaban 20 mg daily Metformin 500 mg twice daily Empagliflozin 10 mg daily Semaglutide 2 mg weekly (subcutaneously) Examination Weight 80 kg Height 160 cm BMI 31 kg/m2 Examination is otherwise unremarkable Investigations Full blood examination – normal, with haemoglobin 125 g/dL (120 – 160 g/dL) Electrolytes, urea and creatinine – normal Coagulation studies – normal HbA1c - 5.8% (normal value < 6%) - 40 (normal value < 42 mmol/mol) ECG – sinus rhythm