109 BREAST IMPLANT REMOVAL and REPLACEMENT

       with SALINE or GEL IMPLANTS

Note: may include capsulotomy, capsulectomy or capsulorhaphy

updated March 25, 2013 page 1

 

OPERATIVE TIME 2-3 hours

FREQUENCY 10 / yr ASSISTANT Gwen or Cheryl

ICD9 CODE:

V50.1 ELECTIVE COSMETIC, 757.6 BREAST,

996.54 COMPLICATION PROSTHESIS

CPT CODES:

19325 BREAST AUGMENTATION WITH PROSTHESIS

19330 REMOVAL RUPTURED IMPLANT

19328 REMOVAL INTACT IMPLANT

 

ANESTHESIA NOTES

GA, ETT or LMA, Kefzol 1gm IV

PATIENT POSITION | SETUP

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

Sometimes arms are folded (ask).

Tattoo kit: 22g, 18g, 3cc syringe, Kelly, 4x4's, vinyl gloves.

Hang 1-2 L IV saline bags at head of table to fill implants.

TABLE POSITION

Normal w/ pillow under knees.

ROOM SETUP

Pre-warm table with Baer hugger

Hang 1-2 L IV saline bags at head of table to fill implants.

 

EQUIPMENT

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

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

PDSC: Custom Plastic Pack with one additional mayo stand cover.

ASC: Plastic drape pack. Laparoscopic chole drape (89233), mag pad, [1] quarter sheet, [1] mayo stand covers, [4-6] sticky paper drapes, basic pack, [1] gown, [2] size 8 gloves for Dr. C, 7 ½ Biogel and 7 ½ 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 2L sterile IV saline to fill implants

    ● Cysto tubing, single

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

109 BREAST IMPLANT REMOVAL and REPLACEMENT

       with SALINE or GEL IMPLANTS

 Page 2

 

SETS TO OPEN

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

INSTRUMENTS USED (ON MAYO STAND)

     FORCEPS

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

     SCISSORS

cvd Metzenbaum, str Metz, cvd Mayo, str Mayo, str Stevens

     NEEDLE HOLDERS

[2] Crile-Wood, [2] Webster, [1] Mayo-Hagar

     RETRACTORS

Short Breast, long Breast, Army Navy, [2] Senn, [2] large facelift, gold double ended Breast, regular and extra large Richardsons,

     KNIFE | BLADES

[2] knife handle, [2] No. 15 blades [2] No. 10 blades

     OTHER

Sponge stick

 

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:

    ● extra fill tubes

    ● [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

SPONGES

[3] packs lap sponges

NON-STERILE SUPPLIES

Wrapping board, large or small, baby powder

 

 

No

Type

SN

status

SUTURES 

[ 2 ]

2-0 Vicryl CT1

J259

open

 

[ 4 ]

3-0 Monocryl SH

Y416

open

 

[ 2 ]

3-0 Nylon PS-1

1663

 

hold

[ 2 ]

4-0 Monocryl PS-2

Y 426

open

 

[ 2 ]

5-0 Monocryl P3

Y426

 

hold

[ 2 ]

5-0 Fast gut

1915G

 

hold

 

DRAINS

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

DRESSINGS

[2]Tegaderm small or medium, 2 x 23/4" or 4 x 43/4- [HOLD]

[3] kerlix, [2] ABD pads, [2] 6" Ace, [2] 4x4

Wrapping board, large or small, baby powder

 

POSTOPERATIVE

Lift with wrapping board, 3 people

NOTES

Cosmetic Self-pay, Record room enter and room exit time

May involve intact or ruptured silicone gel or saline implants.

Usually includes capsulectomy or capsulotomy.

Set up is essentially the same as

108 BREAST AUGMENTATION WITH SALINE IMPLANTS

107 MASTOPEXY WITH SALINE IMPLANTS.

 

DATE MODIFIED

January 2009, December 2011, March 2013