DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Acquired absence of left and right breast, status post mastectomy for breast cancer.
2. Ruptured gel subpectoral implants.
POSTOPERATIVE DIAGNOSES:
1. Acquired absence of left and right breast, status post mastectomy for breast cancer.
2. Ruptured gel subpectoral implants.
OPERATION PERFORMED:
1. Left and right total capsulectomy with en bloc implant removal of ruptured gel implants.
2. Left and right subpectoral expander reconstruction.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, PA-C
ANESTHESIA: General.
BLOOD LOSS: Less than 100 mL.
COMPLICATIONS: None.
SPECIMEN: None.
EXPANDERS PLACED: Mentor Siltex Tall Height Contour Profile expanders.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and under general anesthesia had undergone bilateral mastectomy and sentinel node biopsy. The inferior lateral edge of the capsule was identified and dissection then proceeded deep to the pectoralis muscle, creating a submuscular flap, elevating muscle tissue up off the entire anterior capsular surface. The outer edge of the capsule was then elevated up off the chest wall, removing the entire capsule with gel implant inside of it intact on both sides. There were multiple small areas of bleb-type extensions outside of the capsular wall, where it had thinned out and gel was probably about to leak through. These were removed completely. Both fields were then irrigated with bacitracin antibiotic solution. Hemostasis was obtained with cautery, both along the skin flaps as well as the muscle surface.
The pectoralis minor muscle was then elevated in medial and lateral direction just lateral to the anterior axillary line. The muscle was additionally released just off the parasternal margin and partially thinning its attachment. The expanders were brought into the field with clean gloves. They were prepared. The Mentor Siltex Tall Height Contour Profile expanders; they were both filled with 150 mL of sterile saline solution. All air was aspirated free. They were marked with marking pen for orientation; rinsed in antibiotic solution, placed in the submuscular pockets and positioned appropriately.
The tab of the expander was then sutured to the inframammary fold on each side with 3-0 Vicryl interrupted suture. The muscles were covered over the expander on each side. The pectoralis minor muscle was then brought across the lateral edge and then medial edge of the pectoralis minor was sutured to the lateral edge of the pectoralis major muscle with 3-0 Vicryl interrupted sutures. Just a small area of expander was exposed inferolaterally on each side. Through a lateral chest wall stab incision, a 10 mm Jackson-Pratt drain was brought through on each side, cut to appropriate length, sutured in place with 2-0 silk drain stitch.
Skin closure was then completed with buried 3-0 Vicryl suture in the subcu and deep dermis with running 4-0 PDS mid dermal subcuticular repair. A small core biopsy was then performed of the biopsy site of the right superior breast in a vertical direction. This was sent to pathology. Site was closed with buried PDS suture. Drains were aspirated dry and then 10 mL of 0.25% Marcaine with epinephrine was injected on each side through the drain tubing. Bulb was placed on but not yet suctioned. Benzoin and Steri-Strips were applied to the incision. Gauze dressing, tapes, and surgical bra were applied.
The patient tolerated the procedure well with no apparent complications. The patient was extubated in the operating room and transferred to recovery in satisfactory condition postoperatively.
