breast reduction
DESCRIPTION
Breast Reduction . Emily Beacham. What and Why. Back, neck, and shoulder pain Skeletal deformities Skin irritations Decrease in respiratory problems. Removal of excess tissue from the breast to reduce the size of the breasts. - PowerPoint PPT PresentationTRANSCRIPT
Breast Reduction Emily Beacham
Removal of excess tissue from the breast to reduce the size of the breasts.
Relieves legitimate medical problems due to the weight of the breasts.
Back, neck, and shoulder pain
Skeletal deformities
Skin irritations Decrease in
respiratory problems
What and Why
Starting to cover breast reduction surgery because it’s easier for them to pay for a reduction that have to pay for back, neck, and shoulder surgeries later.
Insurance
Nipple Areola Adipose tissue of
the breast
Anatomy
Padded footrest for modified sitting position Suction Fiber-optic headlight and light-source ESU with needle tip and extension tip Autotransfusion system (available)
Equipment
Basic pack Basin set Gloves/Gown Several #15 blades Suture, drains,
dressings: surgeon’s preference
Drapes Banked blood
Local anesthetic (if used)
Marker Medical scale
(weighing tissue) Lap sponges Areolar template
(cookie cutter) Liposuction (if
requested)
Supplies
Plastic instrument set
Basic or minor procedure tray
Instrumentation
Incision lines and landmarks are marked with the marker in Fowler’s position prior to anesthesia, may be before patient’s in the operating room.
Patient may require blood transfusion and may be asked to donate blood before surgery for possible reinfusion.
A pre operative mammogram may be requested.
Special Considerations
Position◦ Supine with each arm at 90 degrees on armboard
Prep◦ Chest and breast from chin to the hips and entire width
of patient including axillae Draping
◦ Folded towels and transverse sheet or folded towels and chest drape
◦ Applied to expose entire chest and secured with staples
Anesthesia◦ general
Pre-Op
TIME OUT Initial incision with #15
blade around areola Ensure a perfectly round
incision for resizing with a nipple pattern marker.
Second incision is vertical, beginning at the bottom center or areola and continue to inframammary fold and lateral to each side with #15 blade.
Procedure
Deepithelization is the process of separating the skin from underlying tissue
Dissection begins at the inverted “T” in the existing incision at the inframammary fold and extends laterally until the circumference of the breast is exposed, this is done with a #15 blade and forceps or electrosurgically.
Continued
A pedicle is created that includes the nipple and areola, preserving blood supply and innervation this done with a #15 blade◦ Pedicle remains in situ and a new opening in the
skin is created to accommodate existing tissue Breast tissue is debulked, involving the
removal of wedges of tissue radially with ESU
Continued
Some surgeons may want the removed tissue to be weighed on the scale.◦ Make sure scale is zeroed
before the procedure starts◦ Keep tissue specimens
separate (right from left) After all wanted tissue is
removed the new “keyhole” incision is made with a new #10 or #15 blade.
Continued
Wound is temporarily closed with staples, excess skin is removed (#1 suture).
Process is repeated on the other breast◦ Due to difference in breast size, the exact same
amount (weight) of tissue may not be removed bilaterally.
Once both sides are temporally closed the patient may be placed in Fowler’s to assess size and symmetry.
Continued
It is common for the surgeon to reopen one or both wounds to make adjustments◦ Repositioning repeatedly may be necessary
Placement of nipple and areolar begins the permanent closure (2-0 maxon).
If drain place laterally◦ Have drain available but open upon request
Remaining wound edges are approximated with 2-0 or smaller suture◦ Liposuction may be performed at this time
Continued
Fluff-type dressing is applied, followed by a postsurgical bra.
Expected to remain 1-3 days in the hospital
Narcotics may be indicated for the first 24 hours.
Patient should be educated in wound care and management of drains before leaving hospital
Post-Op
Patient will have large permanent scars
Expected to have full recovery, return to normal activities in about 2 weeks
Refrain from vigorous exercise for 6-8 weeks
Repeat mammogram may be requested for comparison to pre-op study in 6 months
Prognosis
Hemorrhage Infection Scar tissue Patient dissatisfaction with appearance,
requiring further intervention.
Complications
Before and After