Blepharoplasty
Breast Reduction
Also known as reduction mammoplasty, a breast reduction is a surgical procedure to reduce size of large breasts.
01 - Patient Setup
Pre-op Meds: Ancef, Clindamycin if PCN allergy
Anesthesia: General
Patient position: Supine; arms out and wrapped with webril
Bed position: No turn
DVT ppx: Compression boots on - working BEFORE induction of anesthesia
Side Table: N/A
Lights: Overhead only
Power: 2 Bovie Machines
Bovie Settings: 40/40
Preinjection: Tumescent
Prep: Chloraprep
Drapes: Split drapes x2
Instrument sets: Plastics major set
02 - Case Details
Special Instruments: Tumescent (NEEDS to be ready at the start of the case – 1L LR, 2 amps epi, 30 cc lidocaine), many 10 blades, 60cc syringe x2, 18G spinal needles x2, dermabond x4, Marcaine
Devices/Implants: N/A
Hypodermic needles: N/A
Syringes: 21 guage on 20mL syringe
Drains: Drains rarely placed
Suture: 3-0 monocryl, 4-0 Monocryl
Anesthesia on field: Tumescent
Dressing: Prineo, surgical bra
03 - Post-Op Information
Admission status: Same Day Surgery
Estimated time: 3 hrs
Coding: 19318-50, 611.1, 724.2, 724.4
Post-op wound care: Shower in 48h; no drains
Post-op activity restrictions: No heavy activity for 6 wks
Follow up: 1 wk
Post-Op Instructions obtain from MedConnect
Tips for Setup
1. Draping Tips
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Prep as wide as possible
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When toweling off the surgical field and apply drapes, maintain the wide field and not make it smaller with each additional layer
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Dr. Tom does not use any instrument to clamp movie and section (just staple drapes together) to avoid count being off
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Do not let the place the movie holder in the way of the surgeon (e.g. not on R side next to patient)
2. Place a bra on the table before the patient arrives, covered with 2 folded Chux pads.
3. After anesthesia, wrap the arms in Webril (not Kerlix) in case the patient sits up.
4. Inject 180 cc of tumescent along the lateral wall and another 180 cc along the IMF/chest wall.
5. Apply breast tourniquets and mark the NAC with a 38 or 42 mm cookie cutter.
6. De-epithelialize the pedicle and remove the tourniquet.
7. Create a 2 cm thick lateral wall flap.
8. Develop the medial flap, deskin the medial breast, and resect the remaining breast tissue.