Can someone please advise. Thanks
Melissa Bedford,CCS,CPC
SURGEON:
ASSISTANT:
PREOPERATIVE DIAGNOSIS:
left breast ptosis.
Right deformity s/p tumor removal
Deformity and disproportion of reconstructed breasts.
POSTOPERATIVE DIAGNOSIS:
same.
PROCEDURE:
Right oncoplastic reconstruction
Left mastopexy for symmetry.
ANESTHESIA:
General LMA.
ANTIBIOTICS:
Vancomycin 1 gm IV with in 1 hour of incision time.
ESTIMATED BLOOD LOSS:
25mL.
FLUID:
1500 mL.
SPECIMENS:
Right breast tissue, left breast tissue
DRAINS:
None.
DISPOSITION:
Stable.
SUMMARY:
The patient was transported to the operating room and placed in supine position. After time-out procedure was performed, general LMA anesthesia was induced. The patient was then prepped and draped. A formal time-out procedure was performed then verifying patient, procedure, position and dosing of preoperative antibiotics and DVT prophylaxis. After confirming, the right breast was addressed first. Using the preoperatively placed marks, the infracentral pedicle was deepithelialized. TH elarge lateral based defect was identified. The medial and lateral breast flaps were raised at the skin level only. The infracentral pedicle was freed from its superior breast attachments, minimally to preserve blood supply to the nipple. The lateral flap was advanced into the defect completely filling it. The skin flaps were then tailored to the appropriate size. The wound was irrigated with dilute betadine and the normal saline and meticulous hemostasis was achieved. The wounds were then closed using interrupted 3-0 deep dermal sutures.
The left breast was then addressed. Again, using the preoperatively placed marks, the infracentral pedicle was deepithelialized. The medial and lateral skin flaps were elevated. The infracentral pedicle was freed from its superior breast attachments. The superior breast flap was then freed from the chest wall to the level of the clavicle. The medial and lateral skin flaps were then tailored to appropriate size. The wounds were then irrigated with antibiotic-containing solution and meticulous hemostasis was achieved. The wounds were then closed using interrupted deep dermal 3-0 Biosyn.
The patient was placed into a sitting position where nipple position was marked noting 5.5 cm from inframammary crease and 10.5 cm from the marked midline. After noting symmetry of the breast size, shape and volume as well as nipple position, the patient was placed back into a supine position. The incision was made sharply full thickness. The skin was then deepithelialized. The nipples were then delivered through the incisions then inset using interrupted 3-0 Biosyn. All incisions were then closed with a running 4-0 Biosyn subcuticular stitch. Dermabond was applied to the incisions. The patient was placed into a dressing consisting of dressing sponges followed by circumferentially placed Kerlix and Ace wraps.
The patient was allowed to awaken from anesthesia, the LMA device was removed and she was transferred to the postanesthetic care unit in stable condition. The patient tolerated the procedure well without complications. Counts were correct x2.
Melissa Bedford,CCS,CPC
SURGEON:
ASSISTANT:
PREOPERATIVE DIAGNOSIS:
left breast ptosis.
Right deformity s/p tumor removal
Deformity and disproportion of reconstructed breasts.
POSTOPERATIVE DIAGNOSIS:
same.
PROCEDURE:
Right oncoplastic reconstruction
Left mastopexy for symmetry.
ANESTHESIA:
General LMA.
ANTIBIOTICS:
Vancomycin 1 gm IV with in 1 hour of incision time.
ESTIMATED BLOOD LOSS:
25mL.
FLUID:
1500 mL.
SPECIMENS:
Right breast tissue, left breast tissue
DRAINS:
None.
DISPOSITION:
Stable.
SUMMARY:
The patient was transported to the operating room and placed in supine position. After time-out procedure was performed, general LMA anesthesia was induced. The patient was then prepped and draped. A formal time-out procedure was performed then verifying patient, procedure, position and dosing of preoperative antibiotics and DVT prophylaxis. After confirming, the right breast was addressed first. Using the preoperatively placed marks, the infracentral pedicle was deepithelialized. TH elarge lateral based defect was identified. The medial and lateral breast flaps were raised at the skin level only. The infracentral pedicle was freed from its superior breast attachments, minimally to preserve blood supply to the nipple. The lateral flap was advanced into the defect completely filling it. The skin flaps were then tailored to the appropriate size. The wound was irrigated with dilute betadine and the normal saline and meticulous hemostasis was achieved. The wounds were then closed using interrupted 3-0 deep dermal sutures.
The left breast was then addressed. Again, using the preoperatively placed marks, the infracentral pedicle was deepithelialized. The medial and lateral skin flaps were elevated. The infracentral pedicle was freed from its superior breast attachments. The superior breast flap was then freed from the chest wall to the level of the clavicle. The medial and lateral skin flaps were then tailored to appropriate size. The wounds were then irrigated with antibiotic-containing solution and meticulous hemostasis was achieved. The wounds were then closed using interrupted deep dermal 3-0 Biosyn.
The patient was placed into a sitting position where nipple position was marked noting 5.5 cm from inframammary crease and 10.5 cm from the marked midline. After noting symmetry of the breast size, shape and volume as well as nipple position, the patient was placed back into a supine position. The incision was made sharply full thickness. The skin was then deepithelialized. The nipples were then delivered through the incisions then inset using interrupted 3-0 Biosyn. All incisions were then closed with a running 4-0 Biosyn subcuticular stitch. Dermabond was applied to the incisions. The patient was placed into a dressing consisting of dressing sponges followed by circumferentially placed Kerlix and Ace wraps.
The patient was allowed to awaken from anesthesia, the LMA device was removed and she was transferred to the postanesthetic care unit in stable condition. The patient tolerated the procedure well without complications. Counts were correct x2.