Breast surgery

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Breast surgery
Specialty plastic surgery or oncological

Breast surgery is a form of surgery performed on the breast.

Contents

Types

Types include:

Complications

After surgical intervention to the breast, complications may arise related to wound healing. As in other types of surgery, hematoma (post-operative bleeding), seroma (fluid accumulation), or incision-site breakdown (wound infection) may occur.

Breast hematoma due to an operation will normally resolve with time [2] but should be followed up with more detailed evaluation if it does not. Breast abscess can occur as post-surgical complication, for example after cancer treatment or reduction mammaplasty. [3] Furthermore, if a breast has already undergone irradiation (as in radiation therapy for treating breast cancer), there is a heightened risk of complications (e.g. reactive inflammation, occurrence of a chronic draining wound, etc.) for breast biopsies or other interventions to the breast, even those often considered "minor" surgeries. [4] The combined effects of radiation and breast cancer surgery can in particular lead to complications such as breast fibrosis, secondary lymphoedema (which may occur in the arm, the breast or the chest, in particular after axillary lymph node dissection [5] [6] ), breast asymmetry, and chronic/recurrent breast cellulitis, each of these having long-term effects. [7]

Ultrasound can be used to distinguish between seroma, hematoma, and edema in the breast. [8] Further possible complications are fat necrosis (premature cell death of fat cells) and scar retraction (shrinking of the area around the surgical scar). In rare cases after breast reconstruction or augmentation, late seroma may occur, defined as seroma occurring more than 12 months postoperatively. [9]

There is preliminary evidence suggesting that negative-pressure wound therapy may be useful in healing complicated breast wounds resulting from surgery. [10]

Postoperative pain is common following breast surgery. The incidence of poorly controlled acute postoperative pain following breast cancer surgery ranges between 14.0% to 54.1%. [11] Regional anaesthesia is superior compared to general anaesthesia for the prevention of persistent postoperative pain three to 12 months after breast cancer surgery. [12]

In post-surgical medical imaging, many findings can easily be mistaken for cancer. [13] In MRI, scars that occurred many years before are normally "silent". [4]

Related Research Articles

<span class="mw-page-title-main">Mastectomy</span> Surgical removal of one or both breasts

Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. A mastectomy is usually carried out to treat breast cancer. In some cases, women believed to be at high risk of breast cancer have the operation as a preventive measure. Alternatively, some women can choose to have a wide local excision, also known as a lumpectomy, an operation in which a small volume of breast tissue containing the tumor and a surrounding margin of healthy tissue is removed to conserve the breast. Both mastectomy and lumpectomy are referred to as "local therapies" for breast cancer, targeting the area of the tumor, as opposed to systemic therapies, such as chemotherapy, hormonal therapy, or immunotherapy.

<span class="mw-page-title-main">Mastitis</span> Medical condition

Mastitis is inflammation of the breast or udder, usually associated with breastfeeding. Symptoms typically include local pain and redness. There is often an associated fever and general soreness. Onset is typically fairly rapid and usually occurs within the first few months of delivery. Complications can include abscess formation.

<span class="mw-page-title-main">Cholecystectomy</span> Surgical removal of the gallbladder

Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. In 2011, cholecystectomy was the eighth most common operating room procedure performed in hospitals in the United States. Cholecystectomy can be performed either laparoscopically, or via an open surgical technique.

Gender-affirming surgery for female-to-male transgender people includes a variety of surgical procedures that alter anatomical traits to provide physical traits more comfortable to the trans man's male identity and functioning.

<span class="mw-page-title-main">Breast augmentation</span> Surgical procedure

Breast augmentation and augmentation mammoplasty is a cosmetic surgery technique using breast-implants and fat-graft mammoplasty techniques to increase the size, change the shape, and alter the texture of the breasts. Augmentation mammoplasty is applied to correct congenital defects of the breasts and the chest wall. As an elective cosmetic surgery, primary augmentation changes the aesthetics – of size, shape, and texture – of healthy breasts.

<span class="mw-page-title-main">Breast reduction</span> Plastic surgery procedure

Reduction mammoplasty is the plastic surgery procedure for reducing the size of large breasts. In a breast reduction surgery for re-establishing a functional bust that is proportionate to the woman's body, the critical corrective consideration is the tissue viability of the nipple–areola complex (NAC), to ensure the functional sensitivity and lactational capability of the breasts. The indications for breast reduction surgery are three-fold – physical, aesthetic, and psychological – the restoration of the bust, of the woman's self-image, and of her mental health.

<span class="mw-page-title-main">Thoracotomy</span> Surgical procedure

A thoracotomy is a surgical procedure to gain access into the pleural space of the chest. It is performed by surgeons to gain access to the thoracic organs, most commonly the heart, the lungs, or the esophagus, or for access to the thoracic aorta or the anterior spine. A thoracotomy is the first step in thoracic surgeries including lobectomy or pneumonectomy for lung cancer or to gain thoracic access in major trauma.

<span class="mw-page-title-main">Lymphadenectomy</span> Medical procedure

Lymphadenectomy, or lymph node dissection, is the surgical removal of one or more groups of lymph nodes. It is almost always performed as part of the surgical management of cancer. In a regional lymph node dissection, some of the lymph nodes in the tumor area are removed; in a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed.

<span class="mw-page-title-main">Nasal septum deviation</span> Medical condition

Nasal septum deviation is a physical disorder of the nose, involving a displacement of the nasal septum. Some displacement is common, affecting 80% of people, mostly without their knowledge.

<span class="mw-page-title-main">Seroma</span> Pocket of fluid that sometimes develops after surgery

A seroma is a pocket of clear serous fluid. They may sometimes develop in the body after surgery, particularly after breast surgery, abdominal surgery, and reconstructive surgery. They can be diagnosed by physical signs, and with a CT scan.

An incisional hernia is a type of hernia caused by an incompletely-healed surgical wound. Since median incisions in the abdomen are frequent for abdominal exploratory surgery, ventral incisional hernias are often also classified as ventral hernias due to their location. Not all ventral hernias are from incisions, as some may be caused by other trauma or congenital problems.

<span class="mw-page-title-main">Breast implant</span> Prosthesis used to change the size, shape, and contour of a persons breast

A breast implant is a prosthesis used to change the size, shape, and contour of a person's breast. In reconstructive plastic surgery, breast implants can be placed to restore a natural looking breast following a mastectomy, to correct congenital defects and deformities of the chest wall or, cosmetically, to enlarge the appearance of the breast through breast augmentation surgery.

<span class="mw-page-title-main">Anorectal abscess</span> Medical condition

Anorectal abscess is an abscess adjacent to the anus. Most cases of perianal abscesses are sporadic, though there are certain situations which elevate the risk for developing the disease, such as diabetes mellitus, Crohn's disease, chronic corticosteroid treatment and others. It arises as a complication of paraproctitis. Ischiorectal, inter- and intrasphincteric abscesses have been described.

<span class="mw-page-title-main">Breast-conserving surgery</span> Surgical operation

Breast-conserving surgery refers to an operation that aims to remove breast cancer while avoiding a mastectomy. Different forms of this operation include: lumpectomy (tylectomy), wide local excision, segmental resection, and quadrantectomy. Breast-conserving surgery has been increasingly accepted as an alternative to mastectomy in specific patients, as it provides tumor removal while maintaining an acceptable cosmetic outcome. This page reviews the history of this operation, important considerations in decision making and patient selection, and the emerging field of oncoplastic breast conservation surgery.

The term nonpuerperal mastitis describes inflammatory lesions of the breast (mastitis) that occur unrelated to pregnancy and breastfeeding.

<span class="mw-page-title-main">Breast mass</span> Localized swellings that feel different from the surrounding tissue

A breast mass, also known as a breast lump, is a localized swelling that feels different from the surrounding tissue. Breast pain, nipple discharge, or skin changes may be present. Concerning findings include masses that are hard, do not move easily, are of an irregular shape, or are firmly attached to surrounding tissue.

Free-flap breast reconstruction is a type of autologous-tissue breast reconstruction applied after mastectomy for breast cancer, without the emplacement of a breast implant prosthesis. As a type of plastic surgery, the free-flap procedure for breast reconstruction employs tissues, harvested from another part of the woman's body, to create a vascularised flap, which is equipped with its own blood vessels. Breast-reconstruction mammoplasty can sometimes be realised with the application of a pedicled flap of tissue that has been harvested from the latissimus dorsi muscle, which is the broadest muscle of the back, to which the pedicle (“foot”) of the tissue flap remains attached until it successfully grafts to the recipient site, the mastectomy wound. Moreover, if the volume of breast-tissue excised was of relatively small mass, breast augmentation procedures, such as autologous-fat grafting, also can be applied to reconstruct the breast lost to mastectomy.

Microdochectomy is the surgical removal (excision) of a lactiferous duct. A mere incision of a mammary duct is called microdochotomy.

Central duct excision is the surgical removal (excision) of all lactiferous duct under the nipple. The excision of a single duct is called microdochectomy, a mere incision of a mammary duct is microdochotomy.

Breast hematoma is a collection of blood within the breast. It arises from internal bleeding (hemorrhage) and may arise due to trauma or due to a non-traumatic cause.

References

  1. ↑ William E. G. Thomas; Norbert Senninger (1 February 2008). Short Stay Surgery. Springer Science & Business Media. p. 136. ISBN   978-3-540-69028-3.
  2. ↑ Michael S. Sabel (2009). Essentials of Breast Surgery. Elsevier Health Sciences. p. 61. ISBN   978-0-323-03758-7.
  3. ↑ Noel Weidner, Chapter Infections of the breast (pp. 34–43). In: David J Dabbs (20 December 2011). Breast Pathology: Expert Consult - Online and Print. Elsevier Health Sciences. pp. 40–41. ISBN   978-1-4557-3756-7.
  4. 1 2 Marie Tartar; Christopher E. Comstock; Michael S. Kipper (2008). Breast Cancer Imaging: A Multidisciplinary, Multimodality Approach. Elsevier Health Sciences. p. 327. ISBN   978-0-323-04677-0.
  5. ↑ Jeannie Burt; Gwen White (1 January 2005). Lymphedema: A Breast Cancer Patient's Guide to Prevention and Healing . Hunter House. pp.  9. ISBN   978-0-89793-458-9.
  6. ↑ Bromham N, Schmidt-Hansen M, Astin M, Hasler E, Reed MW (January 2017). "Axillary treatment for operable primary breast cancer". The Cochrane Database of Systematic Reviews. 1 (5): CD004561. doi:10.1002/14651858.cd004561.pub3. PMC   6464919 . PMID   28052186.
  7. ↑ Michael W. Mulholland; Gerard M. Doherty (13 November 2012). Complications in Surgery. Lippincott Williams & Wilkins. p. 582. ISBN   978-1-4511-5369-9.
  8. ↑ Howard Silberman; Allan W. Silberman (28 March 2012). Principles and Practice of Surgical Oncology: A Multidisciplinary Approach to Difficult Problems. Lippincott Williams & Wilkins. p. 301. ISBN   978-1-4511-5323-1.
  9. ↑ Roubaud MJ, Kulber DA (April 2013). "A malignant late seroma 20 years after breast cancer and saline implants". Plastic and Reconstructive Surgery. 131 (4): 655e–7e. doi: 10.1097/PRS.0b013e3182827913 . PMID   23542297.
  10. ↑ Kostaras EK, Tansarli GS, Falagas ME (December 2014). "Use of negative-pressure wound therapy in breast tissues: evaluation of the literature". Surgical Infections. 15 (6): 679–85. doi:10.1089/sur.2013.165. PMID   24871230.
  11. ↑ Yang MM, Hartley RL, Leung AA, Ronksley PE, Jetté N, Casha S, Riva-Cambrin J (April 2019). "Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis". BMJ Open. 9 (4): e025091. doi:10.1136/bmjopen-2018-025091. PMC   6500309 . PMID   30940757.
  12. ↑ Weinstein EJ, Levene JL, Cohen MS, Andreae DA, Chao JY, Johnson M, et al. (June 2018). Cochrane Anaesthesia Group (ed.). "Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children". The Cochrane Database of Systematic Reviews. 6 (2): CD007105. doi:10.1002/14651858.CD007105.pub4. PMC   6377212 . PMID   29926477.
  13. ↑ Postsurgical breast imaging, Medscape, last updated 11 November 2013
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