POSTOPERATIVE DIAGNOSIS: Breast ptosis, abdominal lipodystrophy.
OPERATION PERFORMED: Bilateral
mastopexy, capsulotomy on right side, liposuction of flanks 1,000 mL, excision
of abdominal skin.
ANESTHESIA: General.
NARRATIVE: The patient was
brought to the operating room and placed supine on the operating table. General anesthesia was
administered, and the patient was then prepped and draped. Next, multiple stab
incisions were made in the abdomen, flanks and breasts. Tumescent fluid was
then infiltrated bilaterally. Approximately 1.5 liters was infiltrated.
Tumescent fluid consisted of 1 liters of Lactated Ringer's mixed with 30 mL of
1% lidocaine and 1 amp of epinephrine. Tumescent liposuction was then performed at a setting
of 5 for approximately 2 minutes at each flank, 1 minute on the abdomen and 1
minute on each breast. Conventional liposuction was then performed. A total of
1 liters was liposuctioned from the flanks, abdomen and lateral breasts.
Next, the abdominal skin was
excised. The skin was incised. Undermining was then performed, and the excess
was excised. Multiple layered closure was performed after hemostasis with 3-0
PDS and 4-0 running Monocryl. Dermabond was then applied. The liposuction holes
in the flanks were then closed with 5-0 nylon.
Attention was then drawn to
the breasts where first the right side was incised. The capsule was opened. The
implant was removed and the capsulotomy was performed. After the capsulotomy
was performed, hemostasis was obtained. The pocket was irrigated and the
implant was replaced. A drain was placed in the site and suture placed with 2-0
silk suture. Next, the redundant skin was excised in the inverted-T fashion as
well as around the areola. A 38-mm cookie-cutter was used to incise the nipple
areolar complex. Once the excess skin was excised, a multiple layered closure
was performed around the areola with 3-0 PDS and a running 5-0 Monocryl. The
rest of the incisions were closed with 3-0 PDS and 4-0 running Monocryl. This
procedure was performed on the contralateral side, except on the left side the
implant pocket was not opened. Once again, excess skin was excised. A lift was
performed. The patient was sat up, and a good symmetry was noted. Once again,
Dermabond was applied.
The patient was then awakened and taken to the recovery room
in stable condition.
The recollection of events noted here seems like the procedure was really easy. I actually fear in the sight of needles, much more in the sight of huge and long tubes with sharp points.
ReplyDelete