DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Bilateral breast hypoplasia with tuberous deformity.
POSTOPERATIVE DIAGNOSIS:
Bilateral breast hypoplasia with tuberous deformity.
OPERATION PERFORMED:
Bilateral submuscular augmentation mammoplasty.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
SPECIMENS: None.
IMPLANTS: Mentor smooth, round, moderate profile saline implants, base 325 mL, filled to 375 mL on the left and 390 mL on the right.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old female who presents today with bilateral breast hypoplasia and tuberous breasts with slightly constricted inframammary fold and lower pole with prominent areola. The left breast is fuller than the right by approximately 15 mL. She presents for augmentation.
DESCRIPTION OF OPERATION: The patient was seen in the preoperative area where the breast skin was wiped with alcohol and marked with a marking pen for surgery. We planned on the inferior periareolar incision with release of the inframammary fold and lowering of it to round it out. The patient was then brought into the operating room, placed supine on the operating room table, administered general anesthesia successfully. A total of 15 mL of a 50:50 mixture of 1% lidocaine with epinephrine and 0.25% Marcaine with epinephrine was infiltrated into the breast skin. The chest was prepped and draped in the usual sterile fashion.
Bilateral inferior periareolar incisions were performed with a very thin crescent-type excision of lower areolar skin, which was redundant and then carried down just through the depth of dermis to the subcutaneous plane with a knife. Hemostasis was obtained with cautery. A skin flap was then raised inferiorly to just shy of the inframammary fold and then straight down to the chest wall. Inferior dissection then proceeded deep to the soft tissue plane on top of the fascia to lower the inframammary fold by approximately 1 to 1.5 cm. The outer border of the pectoralis major muscle was identified. Submuscular flap was then created with Bovie cautery in the chest wall with minimal dissection down lateral to the outer edge of the muscle. Pockets were compared and felt to be symmetrical and irrigated with antibiotic solution. Hemostasis was obtained with cautery. Then, 2.5 mL of local anesthetic mixture was injected into each pocket. Implants were brought onto the field. Mentor smooth, round, moderate profile saline-filled implants were filled with 50 mL of sterile saline. Solution was aspirated free. They were rinsed in antibiotic solution. They were placed in submuscular pockets, positioned appropriately, and then both filled. The final fill volume was 375 mL on left, 390 mL on the right. Sides were compared and felt to be symmetrical.
Tubes were removed. Caps noted to be in place. The 3-0 Vicryl sutures had previously been placed to reapproximate the base breast gland, and these were then tied to reapproximate this and close it off from the breast implant. Subcutaneous pocket was irrigated with antibiotic solution. Some of the lower pole parenchymal tissue was then radially scored to loosen it up some because of its tightness. Skin closure was then completed with buried 4-0 PDS suture and in the subcutaneous and deep dermis 4-0 PDS in the dermal subcuticular repair. Wounds were cleaned with saline solution, dry dressing, benzoin and Steri-Strips. Light gauze dressing, staples and surgical bra were applied. The patient tolerated the procedure well. No apparent complications. The patient was then extubated in the operating room and transferred to the recovery room in satisfactory condition.
