BREAST LUMPECTOMY

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A breast lumpectomy, also known as breast-conserving surgery or partial mastectomy, is a surgical procedure to remove a cancerous tumor or an area of abnormal tissue from the breast, while preserving as much of the healthy breast tissue as possible. The goal of this surgery is to treat breast cancer while maintaining the natural shape and appearance of the breast.

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It involves the excision of a breast tumor with appropriate tumor-free margins.

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This procedure may be performed in combination with an axillary node dissection.

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A lumpectomy is typically recommended for patients with early-stage breast cancer when the tumor is small and has not spread to other body parts. The procedure is often followed by radiation therapy to kill any remaining cancer cells and reduce the risk of cancer recurrence.

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Breast reconstruction is an option for most women undergoing mastectomy.

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The recovery time for a breast lumpectomy varies depending on the individual and the extent of the surgery. Most patients can go home the same day or the day after the surgery.

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Lumpectomy (also called breast-conserving surgery, partial mastectomy or wide excision)

                                                                                                 

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                                                            Anesthetic Implications for Breast Lumpectomy

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Anesthesia type: General, regional anesthesia, IV sedation/local anesthesia

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Airway: ETT or LMA

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Preoperative:

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• Doxorubicin chemotherapy can cause cardiomyopathies

• Check for anemia and thrombocytopenia after chemotherapy

• The blood pressure cuff and the peripheral IV should be placed on the nonoperative-side arm

• May be performed with wire localization, where a radiologist inserts the tip of a wire into the target tissue under fluoroscopic guidance preoperatively

• Placed EKG leads away from the sterile field

• Patient anxiety associated with breast cancer and altered body image 

• Larger tumors, lymph node involvement, and the lack of estrogen and progesterone receptors are associated with worse prognosis

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Intraoperative:

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• Avoid muscle relaxants for axillary dissection and surgical identification of nerves

• Regional anesthesia: A block from T1-T6 is required

• Position: Supine with the ipsilateral arm abducted

• Avoid brachial plexus stretch

• Surgical time 15-60 minutes

• EBL minimal

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Postoperative:

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• Pain management

• PONV prophylaxis

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Complications:

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• PONV

• Lymphedema

• Seroma

• Infection

• Pneumothorax

• Hematoma

• Injury to axillary neurovascular structures

• Psychological trauma

• Venous thromboembolism

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Sources:

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Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

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Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

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Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

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