PREOP DIAGNOSIS: Right breast mass, status post vacuum-assisted biopsy with intraductal papilloma, persistent palpable m
Posted: Mon Dec 20, 2021 9:01 am
PREOP DIAGNOSIS: Right breast mass, status post vacuum-assisted
biopsy with intraductal papilloma, persistent palpable mass
POSTOP DIAGNOSIS: Same as above
PROCEDURE: Right lactiferous duct excision and partial
mastectomy
FINDINGS: Patient had what appeared to be a papilloma located under
the areola at the 12 o'clock position. Lactiferous duct was excised
along with this as well as underlying breast tissue which was
marked for orientation for pathology.
EBL: Less than 10 cc
SPECIMENS: Lactiferous ducts and partial mastectomy specimen
COMPLICATIONS: 0
DRAINS: 0
OPERATIVE REPORT: Preoperative timeout was carried out for patient,
surgeon, and procedure definition. Patient was placed under
adequate general anesthesia. Incisional timeout was carried out.
Surgical site was prepped and draped in a sterile manner. Incision
was made over the palpable mass at the areola at the 12 o'clock
position. This appeared to be a intraductal papilloma, dissection
was carried out along the lactiferous ducts coming up to the under
side of the nipple. Lactiferous ducts were separated from the
underlying nipple. Dissection was then carried down superiorly
medially laterally and deep. This area was excised, and then marked
and oriented for pathology. Normal gross margins were obtained.
Hemostasis was achieved using electrocautery unit. This was
provided traction countertraction and visualization for the
procedure, and then closed the wound utilizing a 3-0 Vicryl deep,
and a 4-0 subcuticular Monocryl on the skin with Steri-Strips.
19301 partial mastectomy
19120 Excision of cyst, fibroadenoma, or other benign or
malignant, aberrant breast tissue, duct lesion nipple, areola
lesion, open, 1 or more lesions
Both a and b
19303-50 Mastectomy, simple, complete - Bilateral
biopsy with intraductal papilloma, persistent palpable mass
POSTOP DIAGNOSIS: Same as above
PROCEDURE: Right lactiferous duct excision and partial
mastectomy
FINDINGS: Patient had what appeared to be a papilloma located under
the areola at the 12 o'clock position. Lactiferous duct was excised
along with this as well as underlying breast tissue which was
marked for orientation for pathology.
EBL: Less than 10 cc
SPECIMENS: Lactiferous ducts and partial mastectomy specimen
COMPLICATIONS: 0
DRAINS: 0
OPERATIVE REPORT: Preoperative timeout was carried out for patient,
surgeon, and procedure definition. Patient was placed under
adequate general anesthesia. Incisional timeout was carried out.
Surgical site was prepped and draped in a sterile manner. Incision
was made over the palpable mass at the areola at the 12 o'clock
position. This appeared to be a intraductal papilloma, dissection
was carried out along the lactiferous ducts coming up to the under
side of the nipple. Lactiferous ducts were separated from the
underlying nipple. Dissection was then carried down superiorly
medially laterally and deep. This area was excised, and then marked
and oriented for pathology. Normal gross margins were obtained.
Hemostasis was achieved using electrocautery unit. This was
provided traction countertraction and visualization for the
procedure, and then closed the wound utilizing a 3-0 Vicryl deep,
and a 4-0 subcuticular Monocryl on the skin with Steri-Strips.
19301 partial mastectomy
19120 Excision of cyst, fibroadenoma, or other benign or
malignant, aberrant breast tissue, duct lesion nipple, areola
lesion, open, 1 or more lesions
Both a and b
19303-50 Mastectomy, simple, complete - Bilateral