Breast surgery explained

Breast surgery
Specialty:plastic surgery or oncological

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

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]

Notes and References

  1. Book: William E. G. Thomas. Norbert Senninger. Short Stay Surgery. 1 February 2008. Springer Science & Business Media. 978-3-540-69028-3. 136.
  2. Book: Michael S. Sabel. Essentials of Breast Surgery. 2009. Elsevier Health Sciences. 978-0-323-03758-7. 61.
  3. Noel Weidner, Chapter Infections of the breast (pp. 34–43). In: Book: David J Dabbs. Breast Pathology: Expert Consult - Online and Print. 20 December 2011. Elsevier Health Sciences. 978-1-4557-3756-7. 40–41.
  4. Book: Marie Tartar. Christopher E. Comstock. Michael S. Kipper. Breast Cancer Imaging: A Multidisciplinary, Multimodality Approach. 2008. Elsevier Health Sciences. 978-0-323-04677-0. 327.
  5. Book: Jeannie Burt. Gwen White. Lymphedema: A Breast Cancer Patient's Guide to Prevention and Healing. registration. 1 January 2005. Hunter House. 978-0-89793-458-9. 9.
  6. Bromham N, Schmidt-Hansen M, Astin M, Hasler E, Reed MW . Axillary treatment for operable primary breast cancer . The Cochrane Database of Systematic Reviews . 1 . CD004561 . January 2017 . 5 . 28052186 . 6464919 . 10.1002/14651858.cd004561.pub3 .
  7. Book: Michael W. Mulholland. Gerard M. Doherty. Complications in Surgery. 13 November 2012. Lippincott Williams & Wilkins. 978-1-4511-5369-9. 582.
  8. Book: Howard Silberman. Allan W. Silberman. Principles and Practice of Surgical Oncology: A Multidisciplinary Approach to Difficult Problems. 28 March 2012. Lippincott Williams & Wilkins. 978-1-4511-5323-1. 301.
  9. Roubaud MJ, Kulber DA . A malignant late seroma 20 years after breast cancer and saline implants . Plastic and Reconstructive Surgery . 131 . 4 . 655e–7e . April 2013 . 23542297 . 10.1097/PRS.0b013e3182827913 . free .
  10. Kostaras EK, Tansarli GS, Falagas ME . Use of negative-pressure wound therapy in breast tissues: evaluation of the literature . Surgical Infections . 15 . 6 . 679–85 . December 2014 . 24871230 . 10.1089/sur.2013.165 .
  11. Yang MM, Hartley RL, Leung AA, Ronksley PE, Jetté N, Casha S, Riva-Cambrin J . Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis . BMJ Open . 9 . 4 . e025091 . April 2019 . 30940757 . 6500309 . 10.1136/bmjopen-2018-025091 .
  12. Weinstein EJ, Levene JL, Cohen MS, Andreae DA, Chao JY, Johnson M, Hall CB, Andreae MH . 6 . Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children . The Cochrane Database of Systematic Reviews . 6 . CD007105 . June 2018 . 2 . 29926477 . 6377212 . 10.1002/14651858.CD007105.pub4 . Cochrane Anaesthesia Group .
  13. https://emedicine.medscape.com/article/347184-overview Postsurgical breast imaging

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