DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Macromastia.
POSTOPERATIVE DIAGNOSIS:
Macromastia.
OPERATION PERFORMED:
Reduction mammoplasty, bilateral.
SURGEON: John Doe, MD
ANESTHESIA: General.
DESCRIPTION OF OPERATION: In the preoperative holding area, the patient was marked for a new nipple location at 23 cm from the sternal notch using modified wire and keyhole pattern. The patient was then taken back to the operating room, prepped and draped in the sterile fashion. IV Ancef 1 g was given prior to surgery. Next, the breast meridian was marked and measured from the midline, which was 12 cm from the midline on the right and left side. A 10 cm wide pedicle was divided with the center of it over the breast meridian on the right and left side. Next, attention was addressed to the patient’s right side. The 52 mm areolar marker was used to outline around the nipple-areolar complex, and this was scored with a #15 blade. Next, the pedicle was de-epithelialized with a #10 blade. The pedicle was developed medially down to the chest wall and then laterally down to the chest wall.
Conservative skin and tissue excision was performed medially with superficial excision and then deeper as we moved more laterally towards the pedicle. Lateral wedge resection was then accomplished down to the chest wall. The pedicle was then superiorly dissected down to the chest wall, and the keyhole center portion was also removed. The area was checked for hemostasis, and hemostasis was achieved with Bovie cautery. The flaps were checked and were smoothed as needed. Total amount of tissue removed from the patient’s right side was 495 grams. The breast was closed using a 2-0 Vicryl to approximate the keyhole. Additional 2-0 Vicryl was used to approximate along the inframammary fold. Lateral dog ear was excised and a #10 Jackson-Pratt drain was placed due to the overall wetness of the breast. A 4-0 Vicryl was used approximate the areola to the opening of the new nipple-areolar complex as well as vertical portion of the T incision. A running subcuticular 4-0 Monocryl was placed from the inframammary fold incision as well as a vertical portion of the incision. It should be noted that the inframammary fold incision would need 1 cm above the previously marked inframammary fold removed.
Attention was then addressed to the patient’s left side where a similar procedure was performed. Breast also had a pedicle designed at 10 cm in width along the breast meridian. The pedicle was de-epithelialized bilaterally. The pedicle was developed down to the chest wall and then wedge excision of the lateral breast tissue was performed. The medial breast pedicle was developed down to the chest wall and medial excision of the tissue was performed leaving some more deeper tissue of the hole more medially then laterally on the medial portion. The superior edge of the pedicle was dissected free from the superior skin flap.
The keyhole tissue was removed and the superior and lateral flaps were elevated along the prepectoral fascia to allow an adequate pocket. This had also been done on the patient’s right side as well. Of course, prior to the de-epithelization of the pedicle, a 52 mm nipple-areolar complex had been used to score the nipple-areola complex on the left side as had been done on the right side. The other side was then closed in the manner similar to the right side with 2-0 Vicryl to complete the key stitch on the keyhole as well as the horizontal and vertical portion, interrupted 4-0 Vicryl to approximate the areolar complex, and then a running subcuticular 4-0 Monocryl along the inframammary fold and vertical portion. A #10 Jackson-Pratt drain was also placed on the left side. Each drain was secured with a nylon suture.
All wounds were irrigated prior to closure and checked for hemostasis. Mastisol and Steri-Strips completed the wound closures bilaterally. Fluffs, ABDs, and surgical bra completed the dressing. The patient had a total 625 grams removed from the left. Estimated blood loss was 350 mL, and the patient was awakened and transferred to the recovery room in stable condition.
