PREOPERATIVE DIAGNOSIS: Bilateral mammary hypertrophy.
POSTOPERATIVE DIAGNOSIS: Bilateral mammary hypertrophy.
PROCEDURE PERFORMED: Bilateral reduction mammoplasty by inferior pedicle Wise pattern technique.
SURGEON: John Doe, MD
ANESTHESIA: General anesthesia.
ESTIMATED BLOOD LOSS: 200 mL.
SPECIMENS: 890 grams of right breast tissue and 960 grams of left breast tissue.
COMPLICATIONS: None.
SPONGE/INSTRUMENT/NEEDLE COUNTS: Reportedly correct.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old female who presented to the office with complaints of back pain, neck pain and shoulder pain secondary to mammary hypertrophy. She sought relief of her symptoms via reduction mammoplasty.
The patient was counseled preoperatively regarding the risks associated with the inferior pedicle Wise pattern technique reduction mammoplasty and agreed to proceed.
The patient was marked preoperatively in the erect sitting position for bilateral reduction mammoplasty, placing the nipple-areolar complex at 22 cm from the sternal notch bilaterally. The markings were completed, and she was brought to the operating room for bilateral reduction mammoplasty.
DESCRIPTION OF PROCEDURE: The patient was placed on the table in the supine position for bilateral reduction mammoplasty. After induction of general anesthesia, her arms were padded with blankets, wrapped in blankets, and secured on arm boards out at her sides. Her chest was prepped and draped in the usual sterile fashion.
The incision lines on the right breast were infiltrated with lactated Ringer’s with epinephrine tumescent solution via a closed fill system. The nipple-areolar complex was then marked with a 45 mm cookie cutter and lightly incised.
The pedicle was then incised with a scalpel and de-epithelialized with curved Stille scissors. The upper breast flap was then incised with a scalpel and elevated at a centimeter-and-a-half thickness throughout down to the underlying chest wall with scalpel and cautery dissection. Hemostasis was achieved throughout with cautery.
The flap was undermined off the chest wall with cautery. Medial, lateral and central superior resection of breast tissue was then accomplished with scalpel and cautery dissection, isolating the inferiorly based pedicle on the chest wall. Initial weight of resection was 810 grams, and resection was stopped at this point. Hemostasis was achieved in the wound with cautery, and the wound was irrigated with bacitracin antibiotic solution. The wound was temporarily tacked closed with surgical skin staples and the patient brought to the erect sitting position where she was noted to have excellent volume reduction and shape in the right breast mound.
She was returned to the supine position where the nipple-areolar complex was marked with a 45 mm cookie cutter at 5 cm along the vertical limb. Tissue was incised and excised, bringing the total weight of resection on the right to 890 grams. The nipple was delivered on this pedicle through the keyhole opening and secured with 3-0 Vicryl dermal-to-dermal sutures.
Left reduction mammoplasty was then performed in an identical fashion with a total weight of resection of 960 grams, giving excellent volume, shape, and symmetry match between the left and right sides. All incisions were closed with 3-0 Vicryl dermal-to-dermal sutures. The skin edges were approximated with 4-0 Monocryl intracuticular stitches. The T-incisions were covered with Steri-Strips. Xeroform dressings were used to dress the circumareolar scars. Dry dressing and micropore tape used to dress the wounds.
The patient was placed in a postoperative sports bra and taken to the recovery room in satisfactory condition at the end of the bilateral reduction mammoplasty.
