codedog
True Blue
booking was 19325-50 with 19330? I think this is wrong . Looking at 19330 with 19340 , but then why not 19330 with 19380?
here is operative report if anyone has any suggestions
PREOPERATIVE DIAGNOSIS: Suspected ruptured implants, bilaterally.
POSTOPERATIVE DIAGNOSES: Suspected ruptured implants bilaterally with collapse of the capsule bilaterally and mass associated with the right anterior capsule.
PROCEDURE PERFORMED:
OPERATIVE FINDINGS: The patient had very aged implants and had had an MRI, which suggested that the implants were not intact.
She was told that with the age of her implants and the MRI results, she would likely have ruptured implants and that they should be removed or replaced.
The patient was otherwise asymptomatic.
OPERATIVE PROCEDURE: The patient was taken to the operating room and placed under adequate general endotracheal anesthesia. The chest and abdomen were prepped with Hibiclens and then the patient was draped in customary fashion. The patient had had a mastopexy performed sometime in the past and lateral aspect of the mastopexy incision was used for access. The incision was made down through the skin and subcutaneous tissue and then through the soft tissue above the capsule. When the capsule was entered, there was yellowish thick material, which was somewhat different than the usual findings. It was not as viscous as the normal findings and normal silicone gel, and that the majority of it simply poured out of the incision. The implants, which were removed, there were no serial numbers or size as seen on the implant. It was an old double-lumen implant.
Because of the unusual color and viscosity, a Gram stain was done of the material; however, there were no organism seen on the Gram stain. Once everything had been removed and the capsule was cleansed, the silicone with multiple passes of dry sterile sponges, the capsule and breasts were bimanually palpated. There was an area in the inferior portion of the capsule, which was very thick and had verrucous looking growth on it. Because of this abnormal appearance and induration, this was excised and sent to the lab frozen sections, but was found to be benign.
The patient then required a capsulotomy because of the total collapse of the previous implants in order to put the new implants in. She had had a plaster moulage made at the breast before surgery, which indicated the breast size of approximately 500+ cc. The implants, which were removed were obviously not intact, but appeared to be about 14-cm in diameter. A 375 cc implant, which had a diameter of 14 cm, was then selected and after capsulotomy and hemostasis, the implant was placed within the breast. The right breast had a good bit of oozing from the capsulotomies and therefore a suction drain was left in that breast.
The implant appeared to be in good position with no visible wrinkling and the wound was closed in layers with 3-0 Vicryl and the deep tissue (pre-placed) and a 3-0 Vicryl in the dermis and running 3-0 Monocryl. The patient tolerated the procedure well and was send back to the recovery room in good condition.
here is operative report if anyone has any suggestions
PREOPERATIVE DIAGNOSIS: Suspected ruptured implants, bilaterally.
POSTOPERATIVE DIAGNOSES: Suspected ruptured implants bilaterally with collapse of the capsule bilaterally and mass associated with the right anterior capsule.
PROCEDURE PERFORMED:
OPERATIVE FINDINGS: The patient had very aged implants and had had an MRI, which suggested that the implants were not intact.
She was told that with the age of her implants and the MRI results, she would likely have ruptured implants and that they should be removed or replaced.
The patient was otherwise asymptomatic.
OPERATIVE PROCEDURE: The patient was taken to the operating room and placed under adequate general endotracheal anesthesia. The chest and abdomen were prepped with Hibiclens and then the patient was draped in customary fashion. The patient had had a mastopexy performed sometime in the past and lateral aspect of the mastopexy incision was used for access. The incision was made down through the skin and subcutaneous tissue and then through the soft tissue above the capsule. When the capsule was entered, there was yellowish thick material, which was somewhat different than the usual findings. It was not as viscous as the normal findings and normal silicone gel, and that the majority of it simply poured out of the incision. The implants, which were removed, there were no serial numbers or size as seen on the implant. It was an old double-lumen implant.
Because of the unusual color and viscosity, a Gram stain was done of the material; however, there were no organism seen on the Gram stain. Once everything had been removed and the capsule was cleansed, the silicone with multiple passes of dry sterile sponges, the capsule and breasts were bimanually palpated. There was an area in the inferior portion of the capsule, which was very thick and had verrucous looking growth on it. Because of this abnormal appearance and induration, this was excised and sent to the lab frozen sections, but was found to be benign.
The patient then required a capsulotomy because of the total collapse of the previous implants in order to put the new implants in. She had had a plaster moulage made at the breast before surgery, which indicated the breast size of approximately 500+ cc. The implants, which were removed were obviously not intact, but appeared to be about 14-cm in diameter. A 375 cc implant, which had a diameter of 14 cm, was then selected and after capsulotomy and hemostasis, the implant was placed within the breast. The right breast had a good bit of oozing from the capsulotomies and therefore a suction drain was left in that breast.
The implant appeared to be in good position with no visible wrinkling and the wound was closed in layers with 3-0 Vicryl and the deep tissue (pre-placed) and a 3-0 Vicryl in the dermis and running 3-0 Monocryl. The patient tolerated the procedure well and was send back to the recovery room in good condition.