DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES: Symptomatic macromastia with history of neck pain, back pain, shoulder pain, chronic hyperhidrosis, and intertrigo of the breast.
POSTOPERATIVE DIAGNOSES: Symptomatic macromastia with history of neck pain, back pain, shoulder pain, chronic hyperhidrosis, and intertrigo of the breast.
OPERATION PERFORMED: Bilateral breast reduction.
SURGEON: John Doe, MD
ANESTHESIA: General.
BLOOD LOSS: Less than 150 mL.
SPECIMENS: Right breast tissue weighing 560 grams and left breast tissue weighing 550 grams.
FLUIDS GIVEN: 2200 mL of crystalloid.
DRAINS: JP drain to bulb x2.
COMPLICATIONS: None.
INDICATIONS FOR SURGERY: The patient presents for symptomatic macromastia requesting breast reduction surgery. The risks and benefits of the procedure were explained to the patient, including but not limited to potential complications of bleeding, infection, healing problems, scar, breast asymmetry, loss of sensation, loss of skin, loss of nipple complex, dissatisfaction with the result, among other things. The patient expressed understanding of these risks and wished to proceed with the procedure.
DESCRIPTION OF OPERATION: On the day prior to surgery, the patient presented to the office for a preoperative visit. The patient was marked in the presence of the nurse. We made markings for standard Wise pattern incision with an inferior pedicle technique with a pedicle width of 9 cm, vertical inferior nipple to crease distance at 8 cm.
The patient presented on the day of surgery to the emergency department. The patient was taken to the operating suite and placed on the operating table in the supine position. After induction of general anesthesia, antibiotic prophylaxis was given, and sequential compressive stockings were placed for DVT prophylaxis. The chest was prepped and draped in the usual sterile fashion using Betadine paint. The surgery was begun using a 42 mm diameter cookie cutter to mark out the nipple-areolar complex. We de-epithelialized the inferior pedicles using electrocautery and a 10 blade scalpel. We made an incision in the breast tissue with a 10 blade scalpel and removed breast tissue from the outer quadrant, upper quadrant, lower quadrant of each breast. The breast tissue removed weighed approximately 560 grams on the right and 550 grams on the left. Removing the clips, we irrigated the wounds with saline containing bacitracin. Attention was paid to hemostasis with electrocautery. We injected pectoral muscle with 1/8 strength of Marcaine with epinephrine for postoperative analgesia. A #10 flat JP drain was inserted in the depth of the pectoralis muscle. The dissection was completed up to the level of left clavipectoral fascia.
The incisions were closed in layers using 0 Vicryl sutures in the subdermal tissue in buried fashion and 4-0 PDS along the subcuticular layer. The nipples inset in layers using 0 Vicryl sutures, the subcutaneous tissue in running fashion with 5-0 PDS along the subcuticular layer. The drains were brought out through the lateral extent of the crease incision and secured to the skin with 2-0 nylon suture and placed to bulb suction. All skin, including nipples, remained viable. The patient had a nice cosmetic result. Mastisol, Steri-Strips, and sterile dressings were applied. She was placed in a surgical bra, extubated, and taken to recovery in stable condition with no complications.
