DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Submental lipodystrophy.
2. Postpartum atrophy of the breasts with asymmetry, left breast being smaller than the right.
3. Abdominal lipodystrophy.
POSTOPERATIVE DIAGNOSES:
1. Submental lipodystrophy.
2. Postpartum atrophy of the breasts with asymmetry, left breast being smaller than the right.
3. Abdominal lipodystrophy.
OPERATIONS PERFORMED:
1. Submental liposculpturing.
2. Bilateral breast augmentation using subpectoral saline implants.
3. Abdominoplasty.
SURGEON: John Doe, MD
ANESTHESIA: General.
DESCRIPTION OF OPERATION: With the patient positioned in the sitting and the standing position preoperatively, preoperative markings were performed for submental liposculpturing, bilateral breast augmentation and abdominoplasty.
The patient was then taken to the operating room where the patient was laid in the supine position on the operating room table, and a satisfactory level of general endotracheal anesthesia was obtained. Foley catheter was placed in the bladder. Thromboguards were placed on the lower extremities. and her arms were secured to the arm boards with padded blankets and Ace wraps.
The chest and abdomen were prepped with Betadine gel and draped in a sterile manner.
Attention was first turned to the right breast where a submammary incision was made and carried through the subcutaneous tissue to the lateral border of the pectoralis major muscle. A subpectoral pocket was created by means of blunt and cautery dissection, and hemostasis was obtained with cautery. Several sizers were attempted.
A 350 mL implant was placed, filled to 380 mL of saline. The contour looked excellent. Attention was then turned to placing sizers on the left side, and it was felt that a postoperative adjustable implant on the left side would be needed. A 325-390 range postoperative adjustable Spectrum saline implant was prepared and placed in the subpectoral pocket. The valve was positioned appropriately in the left anterior axillary line just below the inframammary crease.
After this was completed, attention was turned to irrigating the pockets with bacitracin solution, suctioning all bacitracin from the wound and checking one additional time for hemostasis and closing the wounds with 3-0 Vicryl in the deep tissue, 3-0 Vicryl in the deep dermis, and subcuticular running 4-0 Monocryl. Half-inch Steri-Strips, Xeroform gauze, 4 x 4, and Tegaderms were applied.
Attention was now turned to the abdomen where incision was made on the previously marked incisions of the abdomen and carried down through the subcutaneous tissue to the level of the anterior rectus sheath. Dissection was carried up to the level of the xiphoid. The umbilicus was released from the overlying skin. High-tension abdominoplasty was performed by undermining with sponge stick in the lateral flanks.
Hemostasis was obtained with cautery and bacitracin solution was used to irrigate the wound. A Hemaduct drain was placed through the mons pubis and secured with 3-0 Vicryl suture. Attention was turned then to repair of the diastasis in the midline of the abdomen with continuous running double-stranded nylon superiorly from the xiphoid to the umbilicus and horizontal mattress of 0 Ethibond in the lower diastasis.
Once this was completed, attention was turned to bring the patient into general jackknife position. Excessive skin was marked and resected, and hemostasis was obtained. Closure of the abdominal incision was now performed with 0 Vicryl in the deep tissue, 3-0 Vicryl in the deep dermis and subcuticular running 4-0 Monocryl. Attention was then turned to make a transverse elliptical incision in the midline of the abdomen. The umbilicus was delivered and was secured with 3-0 Vicryl and half mattresses of 5-0 nylon.
After this was completed, attention was turned to application of sterile dressings to the abdomen. The patient was placed in a compression garment and a bra was applied. The patient was undraped, and the patient was repositioned. The submental area was injected with 0.5% lidocaine with adrenaline. After hemostasis was obtained as evidenced by blanching of skin, attention was turned to prepping the neck with Betadine gel and draped in a sterile manner. Cross-tunneling liposculpturing was performed using decreasing caliber Klein cannulas until adequate contour had been obtained. The areas expressed excessive fluid.
Closure with 5-0 nylon was performed and attention was then turned to the application of the compression head garment. The patient tolerated the submental liposculpturing, bilateral breast augmentation and abdominoplasty very well.
Estimated blood loss was approximately 150-200 mL. The patient received approximately 2000 mL of crystalloids, had good urinary output, and was transferred to the recovery room in jackknife position in good condition. The patient will be admitted for 23-hour observation.
