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Surgery for Breast Cancer

Breast cancer is life-threatening and one of the leading causes of cancer deaths in women worldwide. Changes in the size and shape of the breast, skin dimpling, nipple inversion, blood-stained single-duct discharge and presence of an axillary lump are some of the signs and symptoms noticed in patients with breast cancer. Abnormalities are initially detected on a mammogram along with clinical evaluation. Subsequent Ultrasonography and MRI assist in clinical examination of all suspicious lesions. PET scans accompanied by CT will localize and identify internal mammary or supraclavicular lymph node metastasis to stage the cancer.

Percutaneous vacuum-assisted large-gauge core needle biopsy acronymed VACNB provides image guidance for freshly detected tumours. Scarring is minimized and accurate pathologic diagnosis is obtained for appropriate management.

Techniques

Surgery is the only available treatment for breast cancer. Negative margins along with the complete resection of tumour are accomplished to reduce the risk of recurrences.

Lumpectomy – A wide 1 cm margin around the lesion is resected along with the primary tumour. This surgery is carried out for patients with stage I and stage II carcinomas. A quandrantectomy will remove the entire breast quadrant and is cosmetically less preferred than the lumpectomy. Palpation guidance and image guidance are used in performing the technique.

  • The lump is marked with an indelible marker before making the skin incision

  • A periareolar incision or a curvilinear incision is made depending on the location of the lump

  • One side of the skin incision is lifted up with the help of cat’s paws retractors or Littlewood forceps

  • Diathermy will lift the flaps all around the dimensions of the lesion

  • The lump is excised down up to the pectoral muscle taking a significant margin along with it

  • The surrounding breast tissue is mobilized for good cosmesis

Total mastectomy – Also known as the modified radical mastectomy, the procedure involves removal of the entire breast which includes skin, nipple, areola and a major portion of the axillary lymph nodes.

  • The skin is incised along the markings

  • Approximately 5 mm thick skin flaps are made viable to leave subcutaneous tissue and superficial vasculature

  • The avascular plane is identified after adequate countertraction and careful retraction

  • Tumescent solution is infused into the avascular plane to aid dissection and minimize blood loss

  • Superior and medial division of the pectoralis fascia is done with the dissection proceeding to the lateral edge of the pectoralis

  • The breast is then completely removed

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