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Breast surgery

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Breast surgery
SpecialtyPlastic surgery or oncological

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

Types

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Types include:

Complications

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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]

References

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  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. ^ a b 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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