Liposuction
Preoperative
diagnoses:
1.
Deformity, right breast reconstruction.
2. Excess soft tissue, anterior
abdomen and flank.
3.
Lipodystrophy of the abdomen.
Postoperative
diagnoses:
1.
Deformity, right breast reconstruction.
2. Excess soft tissue, anterior
abdomen and flank.
3.
Lipodystrophy of the abdomen.
Procedures Performed:
1. Revision, right breast reconstruction.
2. Excision, soft tissue fullness of the lateral abdomen and flank.
3. Liposuction of the supraumbilical abdomen.
Anesthesia: General.
Indications: The patient is a 41-year-old white female who
previously has undergone latissimus dorsi flap and implant, breast
reconstruction. The patient now had
lateralization of the implant with loss of medial fullness for correction. It was felt that mobilization of the implant
medially would provide the patient significant improvement and this was
discussed with the patient at length. The
patient also had a small dog ear in the flank area on the right from the
latissimus flap harvest, which was to be corrected. She had also had liposuction of the
periumbilical and infraumbilical abdomen with desire to have great improvement
superiorly, was felt to be a candidate for such. The above-noted procedure was discussed with
the patient in detail. The risks,
benefits and potential complications were discussed. The patient was marked in the upright position
and then taken to the operating room for the above-noted procedure.
Procedure in Detail: The patient was taken to the operating room
and placed in the supine position. Following adequate induction of general LMA
anesthesia, the chest and abdomen was prepped and draped in the usual sterile
fashion. The supraumbilical abdomen was
then injected with a solution of 5% lidocaine with epinephrine, as was the dog
ear. At this time, the superior central
scar was then excised, dissection continued through the subcutaneous tissue,
the underlying latissimus muscle until the capsule of the implant was reached. This was then opened. The implant was removed and placed on the back
table in antibiotic solution. Using
Bovie cautery, the medial capsule was released and undermining was then
performed with release of the muscle to the level of the proposed medial
projection of the breast. The
inframammary fold medially was secured with 2-0 PDS suture to create greater
takeoff point at this level which in the upright position and using a sizer
produced a good form. The lateral pocket
was diminished by series of 2-0 PDS suture to provide medialization of the
implant. The implant was then placed
back into the submuscular pocket with much improved positioning and medial
fullness. With this completed, the
implant was again removed, antibiotic irrigation was performed. A drain was placed and brought out through a
separate inferior stab wound incision and hemostasis was confirmed. The implant was then replaced and the wound
was then closed in layers using 2-0 PDS running suture on the muscle and 3-0
Monocryl Dermabond subcuticular sutures. The 2.5 cm dog ear was then excised into and
including the subcutaneous tissue, even contouring was achieved and this was
closed with two layers using 3-0 Monocryl suture. Using a #3 cannula, a superior umbilical
incision, liposuction was carried out into the supraumbilical abdomen, removing
approximately 40 to 50 mL of fat with improved supraumbilical contours. This was closed with 6-0 Prolene suture. The patient was placed in a compressive
garment after treating the incision with Dermabond, Steri-Strips and antibiotic
ointment around the drain site and umbilicus. A Kerlix dressing and a surgical bra was
placed to the chest area. A compressive
garment was placed. The patient was then
aroused from anesthesia, extubated, and taken to the recovery room in stable
condition. Sponge, needle, lap,
instrument counts were all correct. The
patient tolerated the procedure well. There were no complications. The estimated blood loss was approximately 25
mL.
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