108 BREAST AUGMENTATION with SALINE or GEL IMPLANTS

NOTE differences if using saline or gel

updated June 14, 2013

 

OPERATIVE TIME: 2 hours

ASSISTANT: Yes

ICD9 CODE:

V50.1 ELECTIVE COSMETIC, 757.6 BREAST

CPT CODE(S):

19325 BREAST AUGMENTATION WITH PROSTHESIS

 

ANESTHESIA NOTES

GA, ETT or LMA, Kefzol 1gm IV

PATIENT POSITION | SETUP

Dr. C will mark in holding area.

Supine, 2 chux under each side, 1 chux under each shoulder. Arms on boards, covered with towels, 2" silk tape.

Sometimes arms are folded (ask). Dr. C to tattoo.

Tattoo kit: 22g needle (BD SafetyGlide), 18g needle, Kelly clamp, 3cc syringe, 4x4 sponges, gloves.

Hang 1-2L sterile IV saline on IV pole to fill implants.

TABLE POSITION

Normal, pillow under knees, Dr. C will position table. Sometimes sits patient upright during surgery.

ROOM SETUP

Pre-warm table with Baer hugger

Hang 1-2L Saline bag at head of table

 

EQUIPMENT

Baer hugger, bag decanter. Headlight and [2] light sources, wrapping boards

IMPLANTS

Implant sizers - NOTE: as of 2013, sterile, non-reusable implant sizers will be provided by the OR.

Implants - open only when requested, verify with Dr.C before opening. DO NOT REMOVE ANY STICKERS. KEEP ALL LABELS AND PACKING IN BOX. MARK BOX WITH R or L SIDE AND RECORD VOLUMES. INCLUDE 6 PT ID STICKERS FOR DR.C TO USE.

PREP

CHG prep set, down to blue chux

DRAPING

Plastic drape pack. Laparoscopic chole drape (89233), mag pad, [2] half sheets, [1] quarter sheet, [1] mayo stand covers, [4-6] sticky paper drapes, basic pack, [1] size 7½ gloves for Dr.C,

7½ Biogel and 7½ blue for Gwen

CAUTERY

Bovie 30/30 pure; [2] bovie tips: silver tip and ValleyLab coated silver extended

SUCTION

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

[2] sterile suction tubing

 

SOLUTIONS | IRRIGATION

● Normal saline irrigation [3] liters

● [2] Asepto syringes

● Kefzol irrigation for implants w/ blue bulb

OPEN ONLY IF USING SALINE:

    ● Hang 1-2L sterile IV saline bags to fill implants

    ● Cysto tubing, single

    ● 3- way stop-cock # MY43411l

NEEDLES | SYRINGES

[8-10] 60cc syringes for filling implants

[2] 20cc syringes for solution “C”

[2] long Quincke 22g spinal needles

LOCAL ANESTHETIC

Solution “C” 200cc - Mix 2% lidocaine w/epi 50cc +

                     0.5%Marcaine w/epi 50cc + NS 100cc

MEDICATIONS

methylene blue

Kefzol 1 gm for irrigation

 

108 BREAST AUGMENTATION with SALINE or GEL IMPLANTS

page 2

 

SETS TO OPEN

Dr. C Plastic set, basin for Solution C, Double Basin Set, metal kidney basin

INSTRUMENTS USED (ON MAYO STAND)

     FORCEPS

01-03-05-08 Adson, long Adson-Brown, Debakey

     SCISSORS

5 ½” cvd Metzenbaum, str Metz, cvd Mayo, str Mayo

     NEEDLE HOLDERS

[2] serr Crile-Wood, [2] smooth Crile-Wood, [1] Mayo-Hagar

     RETRACTORS

Breast, long Breast, Army Navy, [2] Senn, small Freeman facelift

     KNIFE | BLADES

[1] knife handle, [1] No. 15 blade

     OTHER

Hagar dilator/uterine sound

 

STERILE SUPPLIES

[2] surgical marking pens w/ruler, mag pad

SYRINGES and CONNECTORS

● [2] Asepto syringes

● [1] Blue bulb syringe for antibiotic irrigation

OPEN ONLY IF USING SALINE:

    ● [8-10] 60cc syringes for filling sizers and implants

    ● [1] Twist-n-Ject stop cock

    ● [2] blue one-way valve connectors

    ● [1-2] Cysto tubing, single

    ● 3- way stop-cock # MY43411l

SPONGES

[3] packs lap sponges

NON-STERILE SUPPLIES

Wrapping board, large or medium, baby powder

 

 

No

Type

SN

status

SUTURES 

[ 3 ]

2-0 Vicryl CT1

J259

open

 

[ 2]

3-0 Monocryl SH

Y416

open

 

[ 2 ]

4-0 Monocryl PS-2

Y426

open

 

[ 2 ]

5-0 Monocryl P3

Y426

open

 

[ 2 ]

5-0 Fast gut

1915G

open

 

[ 2 ]

Tegaderm 23/8"x 23/4"

6 x 7cm, cut in half

1624W

open

 

 

DRAINS

NONE

DRESSINGS

[2] Tegaderm 23/8” x 23/4 ” (6 x 7cm) cat 1624W - cut in half

[2] Kerlix, [2] ABD pads, [2] 6" Ace, [2] 4x4

Wrapping board, large or medium, baby powder

 

POSTOPERATIVE

Lift with wrapping board, 3 people

NOTES

Cosmetic Self-pay, Record room enter and room exit time on green sheet.

 

DATES MODIFIED

September 2006, March 2008, January 2009, May 2009, Jan 2013, Mar 2013,

Jun 2013