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

PREOPERATIVE DIAGNOSIS:  Micromastia.  Breast ptosis.  Lipodystrophy.

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.

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.

The patient was awakened and taken to the recovery room in stable condition.