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Circumferential Abdominoplasty Mastopexy MT Sample

DATE OF OPERATION:  MM/DD/YYYY

PREOPERATIVE DIAGNOSIS:  Dermatochalasis of the abdomen and hips and ptosis of the breast.

POSTOPERATIVE DIAGNOSIS:  Dermatochalasis of the abdomen and hips and ptosis of the breast.

OPERATIONS PERFORMED:
1.  Circumferential abdominoplasty.
2.  Bilateral breast mastopexy.

SURGEON:  John Doe, MD

ANESTHESIA:  General.

DESCRIPTION OF OPERATION:  With the patient positioned in the sitting and the standing position preoperatively, preoperative markings were performed. The patient was taken to the operating room where general endotracheal anesthesia was obtained. Thromboguards were placed on the lower extremities, and the patient was then turned to the prone position on the operating room table. The patient's arms were padded at the anatomic position on arm boards, and she was placed on chest rolls. The patient's knees were protected with gel pads and attention was turned to prepping the lower back and buttocks region with Betadine gel and draping in a sterile manner.

Attention was then turned to the previously marked areas of lower back, where the skin was incised with a 10 blade and carried to the subcutaneous tissue to the lumbar fascia and gluteal fascia. Once this was completed, for approximately 8 cm, the gluteal skin was undermined for advancement to the previously marked areas where cross-hatching had been done. Once this was completed, the complete strip of the lower back and upper buttocks was removed and hemostasis was obtained. The wound was irrigated with Ancef solution, and attention was turned to advancement and closure of the skin flaps using 0 Nurolon in the deep Scarpa's fascia and lumbar fascial region, 2-0 Vicryl in the deep dermis, 3-0 Vicryl in the intermediate dermis, and subcuticular running 4-0 Monocryl. After these areas were completed, all areas were cleansed. Xeroform gauze was applied. A Coverlet dressing was applied, and the patient was then undraped, cleansed, returned to her bed in supine position and then repositioned on the operating room table in the supine position.

The patient's arms were secured to the arm boards with padded blankets and Ace wraps. Thromboguards were re-placed on the lower extremities. Foley catheter was placed in the bladder. Perineum was prepared by shaving. Attention was then turned to prepping the chest and abdomen with Betadine gel and draping in a sterile manner. Attention was first turned to the lower abdominal region, where the skin was incised with 10 blade and carried down to the level of the rectus fascia. Superior dissection was carried to the level of the umbilicus. The umbilicus was freed from the overlying skin and then further dissection was carried to the level of the xiphoid. A high-tension abdominoplasty was performed by undermining the flanks with a sponge stick and hemostasis was obtained. Wound was then irrigated with Ancef solution. Two Blake drains were then placed through either side of the mons pubis and secured with 3-0 Vicryl suture. One leg was laid into the area of the anterior iliac crest. The other was laid superiorly along the paramedian portion of the abdomen. Diastasis of the abdomen was extremely minimal, so no muscle repair was required.

Attention was now turned to placing the patient in the general jackknife position. Excessive skin was marked for resection and completely removed, removing a total of 29 cm of skin from the lower abdomen. Once this was completed, hemostasis was obtained. Attention was turned to closure using 0 Vicryl in the deep tissue, 3-0 Vicryl in the deep dermis, and subcuticular running 4-0 Monocryl. Umbilicus had been marked and brought through a transverse stab wound in the abdomen and was then secured with 3-0 Vicryl and 5-0 nylon. The patient tolerated that portion of the procedure extremely well. All areas were cleansed. Xeroform gauze 2 x 2 and full length Steri-Strips were applied to the umbilical region, and attention was then turned to covering the abdomen with a sterile sheet.

Attention was then turned to the area of the breast. The breast area was marked, and attention was turned to injecting the incision lines with dilute solution of adrenaline and Ringer's lactate. After this was completed and hemostasis was obtained as evidenced by blanching of the skin, attention was turned to de-epithelializing the entire inferior quadrant of the breast skin, and the small triangle in the lateral and medial aspects of the breast were resected for adequate closure. After this was completed, the medial and lateral breast flaps were elevated at the level of the pectoral fascia. Hemostasis was obtained.

The wounds were irrigated with Ancef solution. The inferior pedicle of the breast was then advanced superiorly and the medial and lateral breast flaps were closed over the top of the inferior pedicle. Attention was then turned to formal closure using 3-0 Vicryl in the deep tissue and subcuticular running 4-0 Monocryl after bringing the nipple areolar complex through at 5 cm above the inframammary crease. The patient tolerated the procedure well. Nipple circulation looked excellent at the end of the procedure. All areas were cleansed. Half-inch Steri-Strip and Xeroform gauze were applied to the incision lines. The patient was then undraped, completely cleansed, dried, and sterile dressings were applied. The patient was then placed in a compression garment and a postoperative bra. She tolerated the procedure well. Estimated blood loss was 150 to 200 mL. The patient received 2000 mL of crystalloids. Urinary output was excellent. The patient returned to the recovery room in good condition where she will be admitted for 23-hour observation.

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