Operative Procedure: A 3.5 cm diameter circle at her mastectomy scar, and a 2.5 cm diameter circle superiorly where her tissue expander port site was previously located. Her implant is grossly visible at both of these locations. There is a thin intervening skin bridge connecting these 2 locations. With her consent a photo was taken in preoperative holding area and scanned into media prior to surgery. The skin bridge is clearly not viable and it is incised. The implant is removed and sent to pathology for gross examination. The implant pocket is then copiously irrigated with 3 L of pulse lavage saline. There is an inflammatory rind evident in the pocket. However there is no gross purulence. At the level of the prepectoral plane under direct visualization using cautery the skin flaps are elevated circumferentially. Using a 15 blade the skin edges were then debrided to remove the circular skin defects which leads to a vertical defect measuring 11 cm her left chest wall. The skin edges do bleed with this tissue removed. The mastectomy skin is sent to pathology for examination. 30 cc of quarter percent Marcaine with 1:100,000 epinephrine is injected for local anesthetic and hemostasis. With the wide undermining I am able to close the skin flaps with only minimal tension. Hemostasis is achieved using cautery. Saline was used for additional irrigation. A 10 French round JP drain is placed within the pocket. 3-0 Vicryl sutures were used to reapproximate the dermis. 4-0 Monocryl horizontal mattress sutures were used to loosely reapproximate the skin edges. A 13 cm Prevena incisional wound VAC is placed over the incision. A drain sponges placed around the drain site. 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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