PREOPERATIVE DIAGNOSIS(ES):
1. Ultra Sound documented Seroma left breast
2. Probable Seroma Right breast
POSTOPERATIVE DIAGNOSIS(ES):
1. Ultra Sound documented Seroma left breast
2. Seroma Right breast
PROCEDURE PERFORMED:
1. Left Incision, evacuation of Seroma, removal of Tissue Expander
2. Right Incision, evacuation of seroma, removal of Tissue Expander
3. Placement of bilateral silicone implants
IMPLANTS:
Mentor smooth round MemoryGel silicone implants, High profile.
Right implant: reference number 350-5004 BC, serial number 6735758-034
Left implant: reference number 350-5504 BC, serial number 6723399-066
SURGEON:
ASSISTANT SURGEON(S):
None.
ANESTHESIA:
GET
ANESTHESIOLOGIST:
OR FLUIDS:
Intravenous fluids were administered, lactated Ringer's 800 ml's
ESTIMATED BLOOD LOSS:
Minimal.
COMPLICATIONS:
Seroma bilateral breasts.
Left 50cc, right 25cc
DRAINS:
JP 15-French x 2, one each breast.
LOCAL:
6 mL 1% lidocaine with 1:200,000 epinephrine.
SPECIMENS:
Cultures of left and right seroma fluid.
ANTIBIOTICS:
Vancomycin 1 gm IVPB and Clindamycin 900mg IVPB prior to incision
DVT PROPHYLAXIS:
TEDs and SCDs to bilateral extremities, engaged prior to anesthesia.
INDICATIONS:
The patient is 2.5 weeks s/p bilateral second stage of a delayed bilateral breast reconstruction. Her drains were removed POD 8. She returned at one week stating she had "over done it" the weekend previously and was sore. She demonstrated a larger full left breast (upper lateral quadrant). US discerned seroma more likely than hematoma. The pt was given 48 hours of compression to see if resolution was possible, but returned feeling tighter In the left breast and with a smaller but likley seroma in the right breast as well. Decision was made for operative intervention.
SUMMARY:
The patient was first seen in the preoperative area, where the planned surgical sites were marked and the procedure reviewed with the patient.
She was taken to the OR and placed in supine position on the operating
table. Following induction of general endotracheal anesthesia, the
patient's bilateral mastectomy incisions were infiltrated with 6 mL of
1% lidocaine with 1:200,000 epinephrine per side. She was prepped and
draped in usual sterile manner.
I began on the left side by incising through the skin to the subcutaneous
tissue in the planned incision. The dissection was carried
through breast tissue until the breast
implant capsule was identified and entered. Straw colored clear fluid that was not malodorous was seen and cultured. The implant was removed and was intact. Roughly 50-60cc of the fluid was evacuated from the pocket. The pocket was copiously irrigated with triple antibiotic solution. And a antibiotic soaked lap sponge was place over the incision.
I turned my attention to the right breast and incised through the skin to the subcutaneous
tissue in the mastectomy incision. The dissection was carried
through breast tissue until the breast implant capsule was identified and entered. No obvious fluid came from the incision. After removing the implant, straw colored clear fluid that was not malodorous was identified and cultured. Roughly 25cc of seroma fluid was suctioned from this pocket. The pocket was copiously irrigated with triple antibiotic solution. And a antibiotic soaked lap sponge was place over the incision.
Implants were selected to replace those removed. The same 500 CC HP for the right breast and a 550cc HP for the left breast at the patient's request as she felt this breats was slightly smaller post op. A high profile 500 and 550 cc Implants were brought to the table and placed to soak in antibiotic irrigation for a minimum of ten minutes prior to placement.
JP 15-French drains were placed from the lateral aspect of the
breasts into the inframammary fold and secured with a 3-0 nylon suture. Both pockets were once again irrigated and checked for hemostasis. Deep buried 3-0 Polysorb pop-off sutures were placed in an interrupted fashion at Scarpa's level, they were not tied down, but placed to hemostats.
My gloves were changed and washed in triple antibiotic solution. I was the only team member to handle the implant. First, the right implant was brought to the table, a new Deavor was dipped in Triple antibiotic solution and placed in the right implant pocket. The size of the implant and right designation was verified and the implant was placed atraumatically into the implant pocket. My hands were again washed in triple
antibiotic solution. The Deaver was again dipped in
triple antibiotic solution and placed atraumatically in the left implant pocket. The
deep buried 3-0 Polysorb sutures in Scarpa's were tied down bilaterally. Another layer of 3-0 Polysorb sutures were placed in an interrupted fashion in the deep dermis in the IMF incisions bilaterally. Finally, a running 4-0 subcuticular
Caprosyn suture was placed to close the skin in both incisions.
All surgical marks were removed with rubbing alcohol. Dermbond was placed over the incisions, followed by Telfa.
All needle and sponge counts were reported equal at the end of the case.
The patient tolerated the procedure without any difficulty. She was
transferred from the OR to the PACU, awake, extubated, and in stable
condition.
1. Ultra Sound documented Seroma left breast
2. Probable Seroma Right breast
POSTOPERATIVE DIAGNOSIS(ES):
1. Ultra Sound documented Seroma left breast
2. Seroma Right breast
PROCEDURE PERFORMED:
1. Left Incision, evacuation of Seroma, removal of Tissue Expander
2. Right Incision, evacuation of seroma, removal of Tissue Expander
3. Placement of bilateral silicone implants
IMPLANTS:
Mentor smooth round MemoryGel silicone implants, High profile.
Right implant: reference number 350-5004 BC, serial number 6735758-034
Left implant: reference number 350-5504 BC, serial number 6723399-066
SURGEON:
ASSISTANT SURGEON(S):
None.
ANESTHESIA:
GET
ANESTHESIOLOGIST:
OR FLUIDS:
Intravenous fluids were administered, lactated Ringer's 800 ml's
ESTIMATED BLOOD LOSS:
Minimal.
COMPLICATIONS:
Seroma bilateral breasts.
Left 50cc, right 25cc
DRAINS:
JP 15-French x 2, one each breast.
LOCAL:
6 mL 1% lidocaine with 1:200,000 epinephrine.
SPECIMENS:
Cultures of left and right seroma fluid.
ANTIBIOTICS:
Vancomycin 1 gm IVPB and Clindamycin 900mg IVPB prior to incision
DVT PROPHYLAXIS:
TEDs and SCDs to bilateral extremities, engaged prior to anesthesia.
INDICATIONS:
The patient is 2.5 weeks s/p bilateral second stage of a delayed bilateral breast reconstruction. Her drains were removed POD 8. She returned at one week stating she had "over done it" the weekend previously and was sore. She demonstrated a larger full left breast (upper lateral quadrant). US discerned seroma more likely than hematoma. The pt was given 48 hours of compression to see if resolution was possible, but returned feeling tighter In the left breast and with a smaller but likley seroma in the right breast as well. Decision was made for operative intervention.
SUMMARY:
The patient was first seen in the preoperative area, where the planned surgical sites were marked and the procedure reviewed with the patient.
She was taken to the OR and placed in supine position on the operating
table. Following induction of general endotracheal anesthesia, the
patient's bilateral mastectomy incisions were infiltrated with 6 mL of
1% lidocaine with 1:200,000 epinephrine per side. She was prepped and
draped in usual sterile manner.
I began on the left side by incising through the skin to the subcutaneous
tissue in the planned incision. The dissection was carried
through breast tissue until the breast
implant capsule was identified and entered. Straw colored clear fluid that was not malodorous was seen and cultured. The implant was removed and was intact. Roughly 50-60cc of the fluid was evacuated from the pocket. The pocket was copiously irrigated with triple antibiotic solution. And a antibiotic soaked lap sponge was place over the incision.
I turned my attention to the right breast and incised through the skin to the subcutaneous
tissue in the mastectomy incision. The dissection was carried
through breast tissue until the breast implant capsule was identified and entered. No obvious fluid came from the incision. After removing the implant, straw colored clear fluid that was not malodorous was identified and cultured. Roughly 25cc of seroma fluid was suctioned from this pocket. The pocket was copiously irrigated with triple antibiotic solution. And a antibiotic soaked lap sponge was place over the incision.
Implants were selected to replace those removed. The same 500 CC HP for the right breast and a 550cc HP for the left breast at the patient's request as she felt this breats was slightly smaller post op. A high profile 500 and 550 cc Implants were brought to the table and placed to soak in antibiotic irrigation for a minimum of ten minutes prior to placement.
JP 15-French drains were placed from the lateral aspect of the
breasts into the inframammary fold and secured with a 3-0 nylon suture. Both pockets were once again irrigated and checked for hemostasis. Deep buried 3-0 Polysorb pop-off sutures were placed in an interrupted fashion at Scarpa's level, they were not tied down, but placed to hemostats.
My gloves were changed and washed in triple antibiotic solution. I was the only team member to handle the implant. First, the right implant was brought to the table, a new Deavor was dipped in Triple antibiotic solution and placed in the right implant pocket. The size of the implant and right designation was verified and the implant was placed atraumatically into the implant pocket. My hands were again washed in triple
antibiotic solution. The Deaver was again dipped in
triple antibiotic solution and placed atraumatically in the left implant pocket. The
deep buried 3-0 Polysorb sutures in Scarpa's were tied down bilaterally. Another layer of 3-0 Polysorb sutures were placed in an interrupted fashion in the deep dermis in the IMF incisions bilaterally. Finally, a running 4-0 subcuticular
Caprosyn suture was placed to close the skin in both incisions.
All surgical marks were removed with rubbing alcohol. Dermbond was placed over the incisions, followed by Telfa.
All needle and sponge counts were reported equal at the end of the case.
The patient tolerated the procedure without any difficulty. She was
transferred from the OR to the PACU, awake, extubated, and in stable
condition.