Surgery E.O.R. -- Breast Surgery

Patient History

family history of breast cancer, previous breast biopsies, other breast-related conditions,

Risk Factors for Breast Surgery

smoking, obesity, diabetes, and poor nutritional status (increase risk for wound healing and infections)

hormone replacement therapy (HRT) or oral contraceptives (increase thromboembolic risk)

lymphedema risk (prior axillary lymph node dissection = increase risk for lymphedema post surgery)

Preoperative Imagining

mammography, ultrasound, MRI to look for extent of disease and guide surgical planning

Multidisciplinary Approach

oncology, radiology, plastics

Common Post-Operative Breast Surgery Complications -- Wound Infection

higher risk in patients with DM or obesity

redness, warmth, pain, and drainage at incision site

prophylactic antibiotics

Common Post-Operative Breast Surgery Complications -- Hematoma/Seroma

accumulation of blood or fluid in surgical area is common

managed with aspiration or drain placement to prevent infection or wound dehiscence

Common Post-Operative Breast Surgery Complications -- Lymphedema

swelling of the arm occur following axillary lymph node dissection or radiation therapy

educated patients about lymphedema precautions

Common Post-Operative Breast Surgery Complications -- Nerve Damage

injury to intercostobrachial nerve during axillary dissection

Common Post-Operative Breast Surgery Complications -- Flap Necrosis

due to inadequate blood supply with reconstruction

risk factors include smoking and DM

Common Post-Operative Breast Surgery Complications -- Capsular Contracture

in reconstruction

scar tissue forms around the implant, causing pain or distortion

management = capsulotomy or capsulectomy

Management and Prevention

-- preoperative counseling

-- antibiotic prophylaxis (implant-based reconstruction)

-- drain care

-- lymphedmea prevention

Breast Biopsy -- Indications

when breast lesion is identified via clinical exam, mammogram, ultrasound, or MRI

palpable masses, suspicious imaging findings, or nipple discharge

Breast Biopsy -- Types: Fine-Needle Aspiration

thin needle to extract fluid or cells from breast lump

useful for distinguishing between cysts and solid masses

Breast Biopsy -- Types: Core Needle Biopsy

larger needle to obtain core of tissue providing information about tumor architecture and allow for receptor analysis

guided by ultrasound, stereotactic mammography, or MRI

Breast Biopsy -- Types: Excisional Biopsy

entire lump or suspicious area removed, used when core biopsy is inconclusive or if larger

may be done under local anesthesia or general anesthesia

Breast Biopsy -- Types: Stereotactic Biopsy

specialized type of core biopsy performed with mammographic guidance, used for microcalcifications or other abnormalities

Breast Biopsy -- Complications

bleeding or hematoma formation

infection

scarring or changes in breast contour

potential false negatives

Breast Biopsy -- Post-Procedure Care

ice packs for swelling or bruising

avoid strenuous activity

analgesics