DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Hypovolemic breasts.
2. Redundant abdomen.
3. Lipodystrophy, hips and knees.
POSTOPERATIVE DIAGNOSES:
1. Hypovolemic breasts.
2. Redundant abdomen.
3. Lipodystrophy, hips and knees.
OPERATIONS PERFORMED:
1. Bilateral augmentation mammoplasty, 450 mL saline prosthesis, submuscular.
2. A mini abdominoplasty.
3. Suction lipectomy, hips and medial knees.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
DESCRIPTION OF OPERATION: The patient was marked for three separate procedures. She was given a general anesthetic. We first began by infiltrating the iliac crest area and the medial knees with tumescent solution, and suction lipectomy was performed in each of the four areas through two ports using a 4 mm cannula. This resulted in pleasing contours. All wounds were closed with buried interrupted 4-0 Vicryl sutures. Steri-Strips and dressings were applied.
We then began by making bilateral inframammary crease incisions 4 cm in length. Dissection was carried down through subcutaneous tissue to the chest wall. Subpectoral pockets were created of adequate size and of equal size. They were checked for adequate hemostasis. Because of the redundancy of her skin envelope, the breast tissue above the pectoralis inferomedially was dissected off the pectoralis, and the pectoralis was then released toward the sternum. Adequate hemostasis was checked again. Multiple sizes were placed, and 450 mL seemed perfect.
The wounds were copiously irrigated one more time and checked for hemostasis. Four 4-0 Vicryls were placed in the subcutaneous tissue. The implants were placed and inflated to 450 mL . The Vicryls were tied down and another layer of interrupted 4-0 Vicryls were placed and a running 5-0 nylon.
Then, attention was turned to her lower abdomen where a suprapubic, semicircular incision was then made and dissection carried down through subcutaneous tissue and fascia to the abdominal wall. This skin fat flap was then elevated to the umbilicus. Adequate hemostasis was checked x2. The midline fascia was imbricated with buried interrupted figure-of-eight #2 Tevdek sutures. Adequate hemostasis was checked again. A single Jackson-Pratt drain was placed through a suprapubic stab wound. The redundant tissue was then excised, excising about 10 cm of skin in the midline.
Adequate hemostasis was obtained. The wound was closed with two layers of buried interrupted 3-0 Vicryl and then running subcuticular 4-0 Monocryl. Steri-Strips were applied as well as compressive dressing. The patient tolerated the procedure well and was transferred to the recovery room in satisfactory condition.
