Quiz Q 4

Op Note Signed Procedure: BILATERAL EXCHANGE OF TISSUE EXPANDERS FOR SILICONE GEL IMPLANTS

Case Time: 1/25/2021 3:52 PM

Date of Service: 1/25/2021 3:52 PM

Surgeon:

Plastic Surgery -- Operative Note

Patient Name: Surgical Date: 1/25/2021 MRN: Pre-op diagnosis: Acquired surgical absence of bilateral breast; history of right breast cancer Post-op diagnosis: Same Procedure: 1. Bilateral exchange of tissue expander for silicone gel implant 2. Bilateral partial capsulotomy 3. Left lateral capsulorrhaphy Surgeon: Assistant: Scrub Person: Surgical Assistant: Anesthesia: General Indications for surgery: This is a 62-year-old woman with a history of right-sided breast cancer. She underwent adjuvant radiation therapy. She presents today for bilateral exchange of tissue expander for silicone gel implant. Risks and benefits have been discussed with the patient and are detailed in our office notes. Day of surgery there are no additional questions Procedure Details: In the preoperative holding area patient was marked in the standing position. She was then brought back to the operating room and positioned supine. All pressure points were padded, SCDs were placed, and general anesthesia was induced. Incisions were injected with 1 % lidocaine with epinephrine and she was prepped and draped in the usual sterile manner.

Attention was turned to the left breast. The old mastectomy incision was partially opened and stairstep entry to the capsule was performed. Tissue expander was then

deflated and removed. Laterally, capsular plication was performed with interrupted PDS sutures. Temporary sizer was then placed and pocket was assessed. Medial colotomy was performed and pocket was reinspected. At this point, we had good control of the pocket with the desired sizer. On the right side, pocket was again expected and here we did not need to do any lateral release. In fact, the site was a little bit tight because of her history of radiation. We performed a medial capsulotomy and again with the sizer placed, good control was noted.

Both sizers were then removed. Pockets were irrigated with Betadine containing antibiotic solution and chest wall blocks were performed. Using a Keller funnel, the implants were positioned into the pocket with appropriate orientation confirmed.

Capsules were then closed with Vicryl and then the skin with Monocryl in multiple layers. Dermabond Prineo was applied. Patient was placed in dressings and tolerated the procedure well without any complication EBL: Minimal Findings: The above Implants: Left breast was reconstructed with an Allergan SCF 520 implant. Serial number: 2473083 Right breast was reconstructed with an Allergan SCF 520 implant. Serial number: 24780366 Complications: None