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PREOPERATIVE DIAGNOSES: 1.	Bilateral breast hypoplasia. 2.	Breast asymmetry. 3.	Left breast ptosis.

POSTOPERATIVE DIAGNOSES: 1.	Bilateral breast hypoplasia. 2.	Breast asymmetry. 3.	Left breast ptosis.

OPERATIONS PERFORMED: 1.	Bilateral breast augmentation with Inamed style 68 MP saline-filled smooth round implants, right implant is 360 cc implant, reference #68-360, serial #13553905 filled to 360 cc, left implant is a 300 cc implant filled to 330 cc, reference #68-300, serial #13692602. 2.	Left periareolar mastopexy.

ANESTHESIA: General endotracheal anesthesia.

ESTIMATED BLOOD LOSS: 50 cc.

DRAINS: None.

COMPLICATIONS: None.

INDICATIONS FOR PROCEDURE: This is a 36-year-old female with bilateral congenital breast asymmetry. She has an A cup on the right and a B cup on the left with grade II ptosis. She is seeking a more defined breast shape and volume and better symmetry.

DESCRIPTION OF PROCEDURE: The patient was marked in the standing position in the holding area. She was brought to the operating suite. She was placed supine on the table. She underwent general endotracheal anesthesia. Her chest wall was prepped and draped in a sterile manner. Beginning on the left side, a 3.5-cm inframammary incision was made and the subpectoral pocket was dissected. The muscle was released inferiorly and the breast tissue was released off the pectoralis muscle to the level of the nipple. The breast tissue was scoured in the lower pole. The chest wall was measured, and the 360 cc implant was chosen. The pocket was irrigated with antibiotic solution. On the back table, the implant was opened and placed in the antibiotic solution and evacuated of air. Using a closed system, 120 cc of saline was added. The air bubbles were removed and the implant was placed in the chest wall pocket and inflated to 360 cc.

Attention was turned to the left side. Through an inframammary incision, a subpectoral pocket was dissected. Again, the muscle was released inferiorly to the area of the nipple. The breast tissue again was released over the pectoralis fascia and scoured inferiorly. The 300 cc implant was chosen. It was opened on the back table and placed in antibiotic solution. The air was evacuated, and 120 cc of saline was added and the air bubbles were removed. The pocket was irrigated with antibiotic solution. On both sides, the skin was reprepped with Betadine prior to placement of the implant. The implant was placed and inflated to 300 cc. The patient was placed in the upright position and additional 30 cc was added to the left side. The mastopexy with tailor tacking the staples and a periareolar mastopexy design was used. The patient was returned to the recumbent position. The area on the left of the mastopexy was de-epithelialized and the incision was stapled into place. The patient was then placed in the upright position again. There was additional slight release on the right side. Both the sides were examined for hemostasis. The mastopexy incision was closed after the patient was returned to the recumbent position with interrupted 3-0 Monocryl sutures and a running 2-0 Monocryl suture. The filling ports were removed. The incision was closed with interrupted 3-0 Monocryl sutures and a running 3-0 Monocryl suture. Steri-Strips were placed. A Kerlix was folded across the chest wall. The patient was placed in the postsurgical bra.

The patient tolerated the procedure well. The counts were correct. The patient was extubated in the operating room and brought to the recovery room in stable condition