PREOPERATIVE DIAGNOSIS: Mammary hypertrophy.
POSTOPERATIVE DIAGNOSIS: Mammary hypertrophy.
PROCEDURE(S) PERFORMED: Bilateral reduction mammoplasty.
SURGEON: Andrew Jackson, M.D.
ANESTHESIA GIVEN: General endotracheal anesthesia, Abe Lincoln, M.D.
INDICATIONS FOR PROCEDURE: The patient is a healthy middle-aged woman with markedly enlarged and heavy breasts, who has decided that their size, weight, and symptoms are no longer acceptable and she would like to have them reduced. The various options for reduction mammoplasty were discussed with the patient preoperatively and she is aware of the nature of her situation, the planned surgical procedure, the expected outcome and probable course as well as the risks involved. She is also aware of other alternative forms of treatment and the inability to determine the exact size of the breasts.
DESCRIPTION OF THE PROCEDURE: The operative markings were made in the sitting position in preop. The patient was taken to the operating area and placed supine with arms padded at 90 degrees and placed under adequate general endotracheal anesthesia. Operative markings were completed and lateral intercostal and field blocks of 0.5% Marcaine with epinephrine were carried out for both breasts. After a full Betadine scrub, prep, and sterile draping, starting with the right side, an inferior glandular pedicle technique was utilized with vertical takeout of skin. The areola was of reasonably normal diameter and therefore, it was circumscribed and the area within the V-wedge and marked area around the areola was de-epithelialized. The incision was carried through the dermis along the lateral edges of the V-wedge and subcutaneous dissection was carried out over the lower pole of the breast. The incision was then continued through the dermis above the areola creating an inferior glandular pedicle which was dissected out to the appropriate shape and volume, using cautery control. The inferior aspect was carefully denuded to allow for creation of the inframammary crease. The excess breast tissue was then resected from the medial, superior, and lateral aspects above this pedicle. After initial hemostasis, the sides of the pedicle were tacked up with 2-0 Maxon sutures. The V-wedge measured at 10-cm was tacked closed with 2-0 Maxon. The dermal collar surrounding the pedicle was trimmed and cut in wedges and sutured in such a way as to reduce its diameter at the dermal level. The dermis beneath the edges of the areola was then brought out and sutured in quadrants with 2-0 Maxon allowing for a closure around the areola without a pursestring and without significant tension. This was eventually completed with 4-0 PDS and 5-0 Prolene and skin staples. The left side was completed and the patient was sat up to check for size and symmetry before completing the closure. The tissue removed was sent to pathology with weights in the range of 500 grams. After final closure of both sides, the Jackson-Pratt drains which had been placed inferiorly before the closure and brought out through separate stab wounds were secured with nylon sutures. Dressing consisted of antibiotic ointment, Xeroform gauze, 4 x 4 gauze, and a bias-cut stocking at wrap. The patient was awakened and returned to the recovery area in good condition, having tolerated the procedure well.
Estimated blood loss was 300 cc.
The lips are divided into three main sections which include: cutaneous, vermilion, and mucosal. (Vermilion section is where we apply our lipstick!)
Other terms you will hear include:
pink vermilion on the lip
white vermilion on the lip
white roll on the lip
philtral dimple
philtral skin
philtral crest or philtral tubercle
wet and dry vermilion
nasal sill
nasolabial groove
columella
buccal branch of facial nerve
trigeminal nerve
infraorbital nerve
M-plasty
Z-plasty
The primary muscle of the lip is the circumferential orbicularis oris muscle.
Other muscles include:
levator labii superioris alaeque nasi
levator labii superioris
zygomaticus major
zygomaticus minor
levator anguli oris
depressor anguli oris
depressor labii inferioris
platysma muscles
mentalis
perioral muscles
The arterial supply of the lips comes from the inferior and superior labial arteries, which branch from the facial artery at the oral commissures. They are found between the orbicularis oris and the submucosa, deep to the vermilion-mucosal transition zone. The surgeon must be sure to locate and identify the labial artery to provide adequate hemostasis during surgery.
Please feel free to print and distribute any of the reports from this web site. My only requirement is that you give credit to this web site by placing the referral note below back to this site:"Patients and Medical Transcription" at http://www.mt-stuff.com
If you do use these sample reports for students or classes, please let me know. My goal for this web site is to mentor future MTs to carry on our professional craft and legacy; I would like to know I helped in some small way to achieve that goal.
Thank you and May God Bless You,
Rosemarie
