Plastics

Pre/Post Procedure Diagnosis: Gender dysphoria
  Procedure: Bilateral mastectomy with free nipple/areolar grafts and liposuction flanks and IMF

Patient was marked in the preanesthesia area and brought to the operative theater. After adequate GETA was undertaken, the patient was prepped and draped in sterile fashion. Appropriate DVT prevention interventions undertaken and perioperative antibiotics were provided.

We infiltrated tumescence fluid into bilateral breasts, flanks and along the IMF. While that was setting up, we harvested the areolar grafts as full thickness grafts using the 25 mm marker. These were defatted and set into saline guaze for later use. We had marked the patient preoperatively for excision mastectomy and these marks were confirmed. We used VASER liposuction and then suction assisted liposuction to the lateral breasts on the flanks and across the IMF to obliterate this distinct mark as feminizing. We then made the inferior incisions and used bovie to excise the breast tissue bilaterally, leaving a flap consistent with superior chest and lower abdominal thickness to match contour. This resulted in leaving some breast tissue on the flaps as well. These were then excised from the pre pec fascia and sent as specimen. Adjustments were made with face lift scissors and bovie to desired symmetric contour. Copious irrigation undertaken and hemostasis achieved. We placed drains bilaterally and brought out through stab incisions laterally. These were sutured into place. We then placed progressive tension sutures to obliterate dead space with 2-0 vicryl in 3-4 locations on each side and sprayed thrombin into the cavities. We stapled closed and then closed in layers with 2-0 for SFS and then 3-0 monocryl for deep dermals and 4-0 monocryl for running subcuticular sutures. We then sat the patient up and measured and marked the NAC at lower border of lateral pecs. This area was marked and deepithelialized for reception of the grafts. These were inset with chromic and silk bolsters were sewn atop xeroform. Dermabond and op site dressings applied. An abdominal binder was placed.

Drain: No
Sutures: 2-0 SFS, 3-0 vicryl for deep dermal sutures and then 4-0 monocryl for running subcuticular suture Dressing: Dermabond and op site dressings applied. Abdominal binder for compression.

Starts with tumescence.
Dr. French uses liposuction to obliterate IMF and to thin out the tail of Spence.
Hemostasis is critical and she will progressive tension sutures, thrombin, and compression.

Pre/Post Procedure Diagnosis: Gender dysphoria

Procedure: Bilateral mastectomy with free nipple/areolar grafts and liposuction flanks and IMF

Surgeon: Brooke French, MD

Assistant: Jonathan Freedman, MD resident

Anesthesia: GETA

EBL: 100 cc

IVF: See op note

Specimen: Right and left breast tissue

DOS: 11/7/19

Complications: None

Condition: Patient is extubated and transferred to PACU in stable condition

I have discussed the risks, benefits, alternatives and the procedure itself, including, but not limited to, pain, infection, bleeding, injury to surrounding structures, need for reoperation, recurrence, scarring, persistence of symptoms and asymmetry. The patient understands the typical perioperative course with the need/potential for dissatisfaction with results. All questions have been answered to the best of my ability.

Patient was marked in the preanesthesia area and brought to the operative theater. After adequate GETA was undertaken, the patient was prepped and draped in sterile fashion. Appropriate DVT prevention interventions undertaken and perioperative antibiotics were provided.

We infiltrated tumescence fluid into bilateral breasts, flanks and along the IMF. While that was setting up, we harvested the areolar grafts as full thickness grafts using the 25 mm marker. These were defatted and set into saline guaze for later use. We had marked Blaire preoperatively for excision mastectomy and these marks were confirmed. We used VASER liposuction and then SAL to the lateral breasts on the flanks and across the IMF to obliterate this distinct mark as feminizing. We then made the inferior incisions and used bovie to excise the breast tissue bilaterally, leaving a flap consistent with superior chest and lower abdominal thickness to match contour. This resulted in leaving some breast tissue on the flaps as well. These were then excised from the pre pec fascia and sent as specimen. Adjustments were made with face lift scissors and bovie to desired symmetric contour. Copious irrigation undertaken and hemostasis achieved. We placed drains bilaterally and brought out through stab incisions laterally. These were sutured into place. We then placed progressive tension sutures to obliterate dead space with 2-0 vicryl in 3-4 locations on each side and sprayed thrombin into the cavities. We stapled closed and then closed in layers with 2-0 for SFS and then 3-0 monocryl for deep dermals and 4-0 monocryl for running subcuticular sutures. We then sat the patient up and measured and marked the NAC at lower border of lateral pecs. This area was marked and deepithelialized for reception of the grafts. These were inset with chromic and silk bolsters were sewn atop xeroform. Dressings applied.

Needle, sponge and instrument counts were correct at the conclusion of the case. I was present and scrubbed throughout, performing or directing all key aspects of the case. There were no complications apparent. Patient was extubated and transferred to PACU in stable condition.

Tourniquet: No
Drain: placed bilaterally and brought out through stab incisions laterally
Sutures: placed progressive tension sutures to obliterate dead space with 2-0 vicryl in 3-4 locations on each side and sprayed thrombin into the cavities. We stapled closed and then closed in layers with 2-0 for SFS and then 3-0 monocryl for deep dermals and 4-0 monocryl for running subcuticular sutures.
Dressing: Yes

Patient was marked in the preanesthesia area and brought to the operative theater. After adequate GETA was undertaken, the patient was prepped and draped in sterile fashion. Appropriate DVT prevention interventions undertaken and perioperative antibiotics were provided.

She was positioned prone and appropriately padded. We injected local into her scar and knife and bovie were used to incise the scar. We hoped to excise some of the scar but were unable at the end due to tension. I bluntly dissected above the periosteum with bovie, malleable, and uterine dilators to accommodate the 8 x 18 cm implant. We then irrigated copiously with antibiotics and saline and then assured hemostasis. We soaked the implant in the same solution and then sucked out the air through the internal port. We placed 10 cc of methylene blue and injectable saline in the implant and then placed the implant without folds. We then accessed it through the skin and injected another 10 cc for a total of 20 cc. We then closed the skin in layers with 3-0 vicryl for deep sutures and 4-0 prolene in the skin. Scalp was cleansed and dried and bacitracin was applied.

Tourniquet: No
Drain: No
Sutures: 3-0 vicryl for deep sutures and 4-0 prolene Dressing:No

Pre/Post Procedure Diagnosis: Gender dysphoria

Procedure: 1. Forehead reduction/set back and contouring 2. Bilateral brow lift 3. Division corrugators 4. Anterior hairline advancement flap 20 x 4 cm 5. Bilateral mandibular angle and ramus reduction/contouring 6. 8 mm genioplasty setback

Surgeon: Brooke French, MD

Assistant: Jonathan Freedman, MD resident

Anesthesia: GETA

EBL: 100 cc

IVF: See op note

Specimen: None

DOS: 10/31/19

Complications: None

Condition: Patient is extubated and transferred to PACU in stable condition

I have discussed the risks, benefits, alternatives and the procedure itself, including, but not limited to, pain, infection, bleeding, injury to surrounding structures, need for reoperation, recurrence, scarring, persistence of symptoms and asymmetry. The patient understands the typical perioperative course with the need/potential for dissatisfaction with results. All questions have been answered to the best of my ability.

Patient was marked in the preanesthesia area and brought to the operative theater. After adequate GETA was undertaken, the patient was prepped and draped in sterile fashion. Appropriate DVT prevention interventions undertaken and perioperative antibiotics were provided.

VSP had been performed to increase operative safety, efficiency and speed. First performed a bicoronal incision, diving into the hairline past the temporal recession bilaterally. Scalp flaps were reflected above the periosteum, taking care to stay deep below the temporal branch of the facial nerve. 7 JP drain placed posteriorly. Anteriorly based pericranial flap elevated and ultimately lain atop the forehead reconstruction and sutured to native scalp periosteum posteriorly for vascularized support of frontal bone graft. Cutting guides used to mark out the proposed cuts and then sonopet used to remove and horizontally split the anterior table inside the pneumatized sinus. This was placed in modling and plating guide and secured with plates and screws in the inner table. 4 plates and screws used along the outer table to secure into new recessed position. Burr used to then take down the lower forehead to appropriate level by drill guides that were marked and stained with pen. We secured the brow into position and then made adjustments with the burr. Corrugators accessed through galea and divided, protecting branches of supratrochlear nerves. We then advanced the brow superiorly to elevate the brow, while advancing the hairline inferiorly, particularly at the temporal recession regions. Part of non-hair-bearing forehead was excised in this region bilaterally and the flaps were brought forward and stapled. We placed the drain, irrigated and assured hemostasis. Closed in layers. Local injected into chin and mandibular region bilaterally. Teeth had been brushed with peridex and throat pack placed. First the mandibular reduction undertaken with sonopet to 3 -4 mm bilaterally. Washout and closure undertaken. Then genioplasty performed with gingivobuccal sulcus incision and protection of bilateral mental nerves. Calipers used for measurement and sonopet and oscillating saw used to taper the cut. Freed and set back 8 mm with stair step Stryker plate and 8 mm screws. Interferences or step offs burred with sonopet. Closed in layers and OG used after throat pack out. Headwrap and jaw braw applied.

Needle, sponge and instrument counts were correct at the conclusion of the case. I was present and scrubbed throughout, performing or directing all key aspects of the case. There were no complications apparent. Patient was extubated and transferred to PACU in stable condition.

Tourniquet: No
Drain: 7 JP
Sutures: No
Dressing:No

Pre/Post Procedure Diagnosis: Breast ptosis and excess skin abdomen with severe rectus diastasis

Procedure: 1. Bilateral breast augmentation silicone 325 cc submuscular dual plane 2. Abdominoplasty with rectus plication

Surgeon: Brooke French, MD

Assistant: Jonathan Freedman, MD resident

Anesthesia: GETA

EBL: 150 cc

IVF: See op report

Specimen: None

DOS: November 07, 2019

Complications: None

Condition: Patient is extubated and transferred to PACU in stable condition

I have discussed the risks, benefits, alternatives and the procedure itself, including, but not limited to, pain, infection, bleeding, injury to surrounding structures, need for reoperation, recurrence, scarring, persistence of symptoms and asymmetry. The patient understands the typical perioperative course with the need/potential for capsular contracture, mastopexy or need to repair hernia. All questions have been answered to the best of my ability.

Patient was marked in the preanesthesia area and brought to the operative theater. After adequate GETA was undertaken, the patient was prepped and draped in sterile fashion. Appropriate DVT prevention interventions undertaken and perioperative antibiotics were provided.

We initiated with the breast augmentation with 5 cm incisions after 4 cc of 1% lidocaine with epi injected here. Scalpel and bovie used to elevate the pec major bilaterally and create pockets for implants. Copious irrigation undertaken and hemostasis achieved. On the right, I elevated a portion of the pec minor for 2 cm which I then sutured back down with 2-0 vicryl. Released portion of the sternal head of pec major bilaterally and performed dual plane to the level of the inferior border of the areola bilaterally with the sizers in place to facilitate. We first placed the 300 cc sizers on the right and then assessed the 325 on the left. The 325 cc sizers better approximated her preop photo desires and so we removed the sizers and then irrigated again. We changed gloves and used a no touch technique with the funnel to place the implants. Sitting up, the breasts appeared symmetric and thereafter we closed in layers with 3-0 PDS for deep sutures and then 3-0 monocryl for SFS and deep dermals. 4-0 monocryl for skin and then dermabond and telfa with tegaderm.

We then addressed the abdominoplasty with incision 7.5 cm above labial majora and extending towards the hips. We dissected down to anterior rectus sheath. The patient is very slender and great care undertaken to protect the vascularity of the abdominal flap. She had significant rectus diastasis with the umbilicus nearly entirely attenuated down to the fasia. There was effectively no umbilical stalk. We carried the dissection up the costal margins and xiphoid. Copious irrigation undertaken and then hemostasis achieved. We undertook rectus plication with 0 neurolon in figure of eight sutures above and below the umbilicus. We then sat her up and made small adjustments of tightening with the same suture. We estimated the amount of skin to excise and did so. We then placed a 10 blake drain out the right side of the incision and secured with 3-0 nylon. Marked umbilical location and excised an oval. We placed progressive tension sutures with 2-0 viryl and then inset the umbilicus with 4-0 monocryl from deep dermals down to fascia to approximate the appearance of an “innie.” We then closed the skin over 10 cc of spray thrombin using 3-0 vicryl for SFS and then 3-0 monocryl for deep dermal sutures and 4-0 monocryl for running subcuticular sutures. Dressing applied and patient maintained in flexed position for transfer. Abdominal binder and bra placed.

Needle, sponge and instrument counts were correct at the conclusion of the case. I was present and scrubbed throughout, performing or directing all key aspects of the case. There were no complications apparent. Patient was extubated and transferred to PACU in stable condition.

Tourniquet: No
Drain: 10 blake secured with 3-0 nylon
Sutures: 2-0 vicryl, 3-0 PDS for deep sutures and then 3-0 monocryl for SFS and deep demals. 4.0 monocryl for skin and then derabond and telfa with tegaderm. Progressive tension sutures with 2-0 viryl and then inset the umbilicus with 4-0 monocryl from deep dermals down to fascia to approximate the appearance of an “innie.” We then closed the skin over 10 cc of spray thrombin using 3-0 vicryl for SFS and then 3-0 monocryl for deep dermal sutures and 4-0 monocryl for running subcuticular sutures.
Dressing:Yes