Achieving a predictable 24-hour return to normal activities after breast augmentation: Part II. Patient preparation, refined surgical techniques, and instrumentation.

摘要: The goal of this study was to develop practices that would allow patients undergoing subpectoral augmentation predictably return full normal activities within 24 hours after the operation, free postoperative adjuncts. Part I used motion and time principles reduce operative times, medication dosages, perioperative morbidity, recovery times in mammaplasty. II focuses on details patient education, preoperative planning, instrumentation, surgical technique modifications were identified, modified, implemented achieve results reported part I. Two groups 16 each (groups 1 2) studied retrospectively for comparison a third group 627 (group 3) prospectively. Patients had axillary partial retropectoral breast augmentations 1982-1983, using dissociative anesthesia, blunt instrument implant pocket dissection, Dow Corning, double-lumen implants containing 20 mg methylprednisolone cc saline outer lumen implants. 2 (1990) inframammary, retromammary by combination electrocautery Surgitek Replicon polyurethane-covered, silicone gel-filled implants, general endotracheal anesthesia. 3 (1998 2001, n = 627) inframammary retropectoral, retromammary, under Refined techniques from studies applied 3. Videotapes procedures analyzed with macromotion micromotion principles, tables events formulated move during operation all personnel operating room. Extensive examined reexamined 13 different stages described maximize efficiency without any change quality. Unnecessary or unproductive motions progressively eliminated, essential, productive streamlined eliminate wasted motion. Instrumentation evaluated detail modified minimize bleeding tissue trauma. Detailed data presented document shorter discharge home, activities. This changes basis findings study. More extensive information integrated staged informed consent resulted more formed confident patient. Applying analysis refinement instrumentation substantial reduction morbidity simpler, 24-hour activity 96 percent compared 2. than able activities, lift their arms above heads, normal-weight objects, drive car augmentation. Patient based video analyses reduced trauma bleeding, allowed predictable full, less. Specific factors contributed these included (1) prospective hemostasis zero tolerance even smallest amount (2) strict "no-touch" periosteum perichondrium, (3) eliminating (4) performing dissection direct vision, (5) simplified (6) optimal use muscle relaxants dissection.