DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Lipodystrophy of breast, flanks, abdomen, and neck.
POSTOPERATIVE DIAGNOSIS: Lipodystrophy of breast, flanks, abdomen, and neck.
OPERATION PERFORMED: Suction-assisted lipectomy of breasts, flanks, abdomen, and neck.
SURGEON: John Doe, MD
ANESTHESIA: General.
BLOOD LOSS: Minimal.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: The patient was seen in the preoperative area, where in the standing position, all areas were wiped with alcohol and marked with a marking pen for surgery as well as liposuction and access site of incisions. In a few areas, we will use new incisions, trying to avoid dense scarring as well as to get better access. The patient was then brought in to the operating room and placed supine on the operating room table and administered general anesthesia successfully. A total of 8 mL of a 50:50 mixture of 1% lidocaine with epinephrine and 0.25% Marcaine with epinephrine was infiltrated into the liposuction access site incisions of the high lateral groin, upper umbilicus, low lateral flank, lateral inframammary fold, submental crease, and mastoid area.
The abdomen, flanks, chest, and neck were prepped and draped in the usual sterile fashion. Stab incisions were performed with a #15 blade, dilated with a hemostat. Tumescent solution with standard mixture of 20 mL of lidocaine, 1 mL of adrenaline/liter, warm lactated Ringer’s was infiltrated throughout the subcutaneous plane for a total of 2500 mL. We obviously encountered fairly dense subcutaneous tissue in the entire anterior abdomen, particularly in the periumbilical area, as well as the lateral and posterolateral flank. This was allowed to sit 10 minutes plus.
Suction was then performed throughout the mons pubis and suprapubic area as well as central abdomen and upper abdomen with standard cross-suctioning being done. We were very careful to stay level with the skin just deep to the skin surface in the deeper subcutaneous plane, particularly in order not to perforate the abdomen because the patient had a previous vertical midline scar. We used, additionally, the incisions at the base of the breast to cross-suction the upper abdomen for better access and to avoid areas of scarring. The additional suction was performed to the lateral and posterior and lateral flanks on both sides, suctioning the prominent roll. Total amount of output from the abdomen and flanks was 1600 mL, which appeared to be about 80% fat by volume.
Attention was then turned to the breast where suctioning was then performed through the lateral inframammary crease incision of the entire breast, as well as lateral chest, to just over the latissimus muscle edge. We were very careful, particularly in the axilla, to stay superficial and not to penetrate towards the upper axillary fold. Total output from each breast approximately 500 mL.
Finally, chin suctioning was done with a 1 mL single-hole cannula, primarily through the submental incision and then with cross-suctioning done through the lateral mastoid incisions across the midline, always staying just deep to the skin surface and above the platysmal plane and not trying to penetrate it all. No obvious bleeding or swelling was noted in any area. There was no obvious bruising or bleeding through the incisions. The incisions were all closed with 5-0 Prolene interrupted sutures x2. Broad Band-Aid dressings were then applied followed by a liposuction chest, abdominal vest, and then binder as well as the neck garment. The patient tolerated the procedures well. Total chin output was 100 mL. The patient was extubated in the operating room and transferred to the recovery room in satisfactory condition.
