Key principles
• Palpable verse non-palpable hookwire guided wide local excision • Periareolar incision preferable
I undertake a wide local excision through a preferred peri-areolar incision with orientation marking of specimen after resection. If undertaken using hookwire guidance, I would review pre-localization films to understand 3D relations and obtain a post-localization film to confirm excision before closure.
Specific preoperative preparation
• Hookwire localization as required • Close liaison with mammography/sonographer
Operation Details
• Routine positioning • Peri-areolar incision • Stabilisation of hookwire if in situ and removal of skin portion • Cut down onto wire • Take lesion with Ellis • Margin depends on diagnosis: 5mm to 1cm • Mark • Review • Cavity shave if required • Close
Intraoperative complications & challenges
• Lose wire o Pre-incision - Repeat placement o Post-incision - Palpate for mass - Consider intra-operative ultrasound - If partially localized can take biopsy and post localisation film - Else abandon and repeat localization
Post-operative complications
• Immediate o Bleeding • Early o Bleeding o Infection o Seroma o Nipple necrosis o Hyperalgesia, hypoalgesia • Late o Cosmesis, deformity o Seroma o Skin necrosis