104 VERTICAL BREAST REDUCTION

This is essentially the same as conventional reduction, main difference is in sutures.

Note slightly different setup in Main and Day

updated May 12, 2009


 

OPERATIVE TIME: 3 HOURS

USUAL LOCATION(S): Pres Main and Day

FREQUENCY: 2-4 per year

ASSISTANT: Yes, Cheryl or Gwen

ICD9 CODE: 611.1

CPT CODE(S): 19318 Breast Reduction

 

ANESTHESIA NOTES

GA, ETT or LMA

Antibiotic: Kefzol 1gm IV

PATIENT POSITION | SETUP

supine, 6 chux, arms out on boards, covered with green towels and taped, 2" silk. Sequential teds (Main) or plexipulses (Day),

tattoo kit: 22g needle, kelly clamp, 3cc syringe 18g needle, 4x4, gloves

TABLE POSITION

pillow under knees, table in semi-recumbent position

ROOM SETUP

Pre-warm room and table

 

EQUIPMENT

Baer hugger, metric digital scale, small suction canisters for weighing tissue, bag decanter for solution C.

Day surgery need headlight

SPECIALS

Main OR need fluid warmer for Gwen

PREP

CHG prep set, down to blue chux

DRAPING

Day Surgery Plastic Drape Pack, [2] size 8 gloves for Dr. C, 7 ½ Biogel and 7 ½ blue for Gwen

Main OR Plastic Drape Pack, mag pad, [3] quarter sheets, [2] mayo stand covers, [4-6] sticky paper drapes, basic pack, 3 gowns, [2] size 8 gloves

CAUTERY

Bovie 50/50 pure, Valley lab silver tip with Saf-T-Vac

SUCTION

[2] suction: regular with plastic Yankauer and Saf-T-Vac

[2] suction tubing

 

SOLUTIONS | IRRIGATION

Normal saline [3] liters

NEEDLES | SYRINGES

[4] 20cc syringes, [4] long Quincke 22g spinal needles

LOCAL ANESTHETIC

Solution “C” 200cc - Pharmacy will make up

MEDICATIONS

□Bacitracin ointment 2 oz

□methylene blue

104 VERTICAL BREAST REDUCTION

page 2

 

SETS TO OPEN

Dr. C Plastic set, basin for Solution C

 

INSTRUMENTS USED (ON MAYO STAND)

     FORCEPS

Martin 7x8 tissue, 01 Adson, 03 Adson, regular adson with teeth

     SCISSORS

curved Mayo serrated, str Mayo, str Metz,

     NEEDLE HOLDERS

[3] Crile wood, [3] Mayo Hagar, [1] Webster

     RETRACTORS

[2] large facelift, Gold breast retractor

     KNIFE | BLADES

[2] knife handles, [4] No. 10 blades

     OTHER

[2] Hemostats for drains

 

STERILE SUPPLIES

[4] marking pens

[2] Asepto syringes,

[2] non-disposable light handles (Main)

SPONGES

[6] Lap sponges

NON-STERILE SUPPLIES

Wrapping board, large or small, baby powder

[3] Small suction canisters for weighing

 

 

No

Type

SN

status

SUTURES  

[ 2 ]

3-0 Ethilon PS-1

1663

open

 

[ 4 ]

2-0 Vicryl CT-1

J945

 

hold

[ 4 ]

3-0 Vicryl SH

J416

 

hold

[ 4 ]

4-0 Vicryl PS-2

J496

open

 

[ 2 ]

3-0 Monocryl PS-2

Y427

 

hold

[ 4 ]

3-0 Monocryl SH

Y416

open

 

[ 4 ]

4-0 Monocryl PS-2

Y426

open

 

[ 2 ]

5-0 Monocryl P-3

Y493

open

 

[ 1 ]

5-0 Plain gut P3

1915

 

hold

 

DRAINS

[2] 15 Fr. Round Blake drains with connectors and reservoir bulbs - 2188.

DRESSINGS

[2] tongue blades

[2] 3x18 Vaseline gauze

[2] 4x4

[2] cut drain sponges

[2] ABD

[2] 6" Ace

[2] kerlix

[2] safety pins

 

POSTOPERATIVE

Call for bed from 7D

Lift with wrapping board, 3 people

Safety pin reservoirs to ace, mark 1 & 2 with Sharpie

NOTES

weigh specimen on digital scale in small suction canister after zeroing. Record weight on board, chart operative report and card for Dr. C.

 

COMMENTS: The main difference with Vertical technique is the use of 3-0 monocryl, everything else is the same. The difference is the absence of a long horizontal scar. Markings are done the day before surgery in the office.

SEE ALSO, SAME AS

See 103 Breast Reduction for Master setup

DATE MODIFIED

May 2006, Jan 2008, April 2008, May 2009