ASSISTANT :
ANESTHESIOLOGIST:
DATE OF BIRTH: July 8, 1979.
AGE: 28.
OPERATION: Bilateral breast reduction with shortscar periareolar inferior pedicle reduction (SPAIR) approach or technique.
PREOPERATIVE DIAGNOSIS: Bilateral macromastia.
POSTOPERATIVE DIAGNOSIS: Bilateral macromastia.
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Less than 150 mL.
INDICATION FOR PROCEDURE: The patient is with the above diagnosis for many years in that it has been causing her back, neck, and shoulder pain. The risks of the surgery were explained to the patient in detail including bleeding, infection, scarring, needing more surgery, limits, etc. These are including but not limited to an ultimate risk would be death. The patient understood the risks and wished to proceed with the surgery. The patient was provided comprehensive consent from the
American Society of Plastic Surgeons; she understood and wished to proceed.
OPERATIVE FINDINGS: After verbal and written consent was obtained, the patient had TED hose inserted in the preoperative area as well as IV inserted with IV antibiotics. She was taken to the operating room and placed on the operating room table in the supine position. She was centered as well as slipped up to the head of the table.
Following induction and intubation by the anesthesiologist, the patient had a Foley inserted

sterilely as well as sequential compression device on bilateral lower extremities. Her arms were placed on an arm board and secured. The patient's entire chest area from the chin to the umbilicus, laterally to the posterior axillary line, as well as her shoulders and her upper arms were sterilely prepped and draped in sterile fashion.
We first proceeded with the patient's right breast.
Using a lap, squeezing the base of the patient's right breast, using a cookie-cutter and a marker to center the patient's nipple as well as marking of the areolar tissue, SPAIR of 5.2 cm in diameter was done. One-half percent lidocaine with epinephrine was then used to infiltrate the entire periareolar tissue excess that was to be de-epithelized as well as along the incision line of the horseshoe shape of breast tissue to be removed.
Using a #15 scalpel a periareolar incision was made and the epithelialization of the superior part of the inferior pedicle was performed and passed on to the inner table as specimen. We then proceeded with a scalpel to incise along the horseshoe shaped breast tissue to be removed through the dermis.
Then using a Bovie dissection was performed to completely remove the horseshoe shape of breast tissue making sure that the inferior pedicle has adequate base to provide blood supply to the pedicle. The horseshoe shape of tissue was then passed off to the inner table as specimen.
Undermining the superior breast pole flap was done up to the second intercostal space and using #3-0
PDS suture this deep edge of the flap was rotated internally and superiorly and secured into the pectoralis major fascia. A second suture was used to contour the superior medial surface of the superior pole of the breast. Further trimming of the excess breast tissue to remove was also

performed using a Bovie. Hemostasis was controlled with electrocauterization. Irrigation with antibiotic solution was also performed.
The corner of the apex of the horseshoe shape of breast tissue removed was plicated together using staples with the patient positioned about 60 degrees was performed which allowed marking of the excess skin to be removed and the shape of the breast to be contoured was performed. Again adequate marking was performed and the skin on the inferior pedicle that was excess to be removed was done with the de-epithelialization following infiltration of 0.5% lidocaine with epinephrine was performed.
A #2-0 Prolene suture was used to pursestring the periareolar skin to the periareolar itself with the knot buried. Using #3-0 Monocryl sutures the entire lollypop wound of the patient's right breast was reapproximated in interrupted fashion in two layers. A second subcuticular layer was performed using #4-0 Monocryl sutures in a running __________ fashion.
Please notice that at 12, 3, 6, and 9 o'clock of the periareolar was also approximated with #3-0
Monocryl suture in interrupted fashion with the knot buried.
The patient's right breast was then cleaned.
We repeated the same procedure on that of the left breast including the shaping and contouring suture as well as the stapling to see the shape of the patient's left breast.
Following completion of the patient's left breast, the total of the right breast amount of breast

tissue removed was 495 gm and the left breast was
497 gm.
All the wounds were then cleaned, dried, Mastisol applied with Steri-Strips and then Tegaderm. The patient was gently sat up and Ace wrap applied.
The patient tolerated the procedure well and remained stable throughout the procedure as well as on transferring out to the recovery room.