POSTOPERATIVE DIAGNOSIS: Micromastia.
Breast ptosis. Lipodystrophy.
OPERATION PERFORMED: Bilateral augmentation mammoplasty and
mastopexy with Mentor Moderate Profile Plus gel-filled implants, size 400
ml. The right implant is serial
#5797405-068, left implant is serial #5797405-115. Liposuction of abdomen, flanks, and hips of
approximately 1700 ml.
ANESTHESIA: General.
PROCEDURE IN DETAIL: The patient was brought to the operating room
and placed supine on the operating table.
General anesthesia was administered and the patient was prepped and
draped.
Next,
a 38-mm cookie cutter was used to incise the nipple-areolar complex. A lower areolar incision was made. Bovie cautery was then used to divide the
subcutaneous tissue. A subpectoral
pocket was then created with Bovie cautery. The sizers were then placed and
filled to approximately 420 ml. The
same procedure was performed on the contralateral side.
At
this point, a 400 ml implant was chosen.
The sizers were deflated and the pockets were irrigated. Meticulous hemostasis was obtained. Irrigation was performed until the pockets
were completely clean. Next, the
implants were placed. The patient was
then sat up. At this point, it appeared
that a periareolar mastopexy would adequately lift the nipple into place. The periareolar skin was incised and
de-epithelialized.
Next,
multiple layer closure was performed with 3-0 Monocryl, 5-0 Monocryl, and 5-0
fast-absorbing plain gut. Dermabond was
then applied.
Next,
multiple stab incisions were made and the areas were infiltrated. Infiltrating fluid consisted of 1 liter of
lactated Ringer mixed with 30 ml of 1% lidocaine and 1 amp of epinephrine. In total, 2 liters was infiltrated.
Next,
ultrasonic liposuction was performed with the small and large cannula for
approximately 7 minutes on the abdomen and flanks and 5 minutes on the
hips. Next, conventional liposuction was
performed with 3 and 4-mm cannulas.
Approximately 1 liter was liposuctioned from the abdomen and
flanks. The rest of the 700 ml was
liposuctioned from the hips and upper thighs.
The incisions were then closed with 5-0 fast-absorbing plain
gut. The _____ were released with a V
dissector. These were also closed with
5-0 fast-absorbing plain gut. Dressings
were applied. The patient was then
awakened and taken to recovery in stable condition.
The
patient was awakened and taken to the recovery room in stable condition.
PROCEDURE IN DETAIL: The patient was brought
to the operating room and positioned supine on the operating room table. General anesthesia was administered and the
patient was prepped and draped.
Next,
1% lidocaine with epinephrine was injected into both breasts, approximately 15
mL. Next, a small inframammary incision
was made. Bovie cautery was then used to
divide the subcutaneous tissue as well as the pectoralis muscle. Bovie cautery was then used to dissect the
subpectoral pocket. A sizer was placed
and then filled to 450 mL. The same
procedure was performed on the contralateral side.
After
this, the sizers were deflated.
Hemostasis was obtained. The
pockets were then irrigated. The
implants were placed after checking for leaks.
These were then filled with 450 mL.
The subcutaneous tissue was then released which appeared to be fibrotic
and holding a portion of the breast tissue down.
Next,
hemostasis was obtained. Multiple-layer
closure was then performed with 4-0 and 5-0 Monocryl. Mastisol and Steri-Strips and dressings were
applied.
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