Indications for Surgery: 13 weeks status post replacement of bilateral breast implants with revision to prepectoral pocket. She developed a right breast incision dehiscence with cellulitis postoperatively. Her cellulitis was easily controlled, and she has been maintained on oral antibiotics prophylactically. She presents now for implant removal, washout, implant replacement and scar revision. She is aware that she will run increased risk of future infection. *Risks will also include hematoma, seroma, further wound healing issues, scarring, asymmetry, implant loss and need for further surgery.*and I reviewed the*nature, purpose, benefits, usual and most frequent risks of, and alternatives to, the operation or procedure. **The patient had an opportunity to ask questions, and those questions were*answered. Informed consent was then obtained.
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Operative Procedure: I began by injecting 30 cc of 0.25% marcaine with Epinephrine into the planned area of incision. On the right I excised a 7 cm long ellipse to completely remove the skin around the dehisced incision. This allowed me to come back to healthy bleeding skin edges. The patient’s intact saline implant was then ruptured and removed. The pocket was inspected and there was no purulent material identified. In fact there was no fluid seen within the pocket at all. The pocket was then copiously irrigated with 3 L of normal saline using a Pulsavac. Antibiotic irrigation was used with 500 cc NS and 1 gram ancef, 80 milligrams gentamycin, and 50,000 units of bacitracin. Following this my gloves were changed. A Mentor smooth round moderate plus profile saline implant style 2000 was then placed. It was expanded to 1100 cc using sterile saline. The implant capsule was then closed using 3-0 Vicryl suture. The skin was closed in layers using 3-0 Vicryl in the dermis and 4-0 Monocryl running subcuticular suture. Dermabond prineo was placed. A surgical bra was placed. The patient was awoken from anesthesia without complication and transferred to the recovery room in stable condition. At the end of the case all the needle, sponge and instrument counts were correct x 2 and I was present for the entire case.
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thank you