Bilateral mastopexy, capsulotomy on right side, liposuction of flanks 1,000 mL, excision of abdominal skin

PREOPERATIVE DIAGNOSIS:  Breast ptosis, abdominal lipodystrophy.

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.