Editing Breast benign lump excision (section)

== Indications: ==

* Fibroadenoma
** Generally completely surrounded by a smooth fibrous pseudocapsule surrounded by a thin areolar rim, normally easy to dissect around that or 'enucleate' the lesion
** If concerned about a phyllodes tumour, should take a little more of a rim
** If there are little lobes or extensions of the lesion, need to take them too, to prevent recurrence
* Hamartoma
* Other well-circumscribed benign palpable lesions


=== Incision: ===

* Cosmetically, circumareolar or inframammary incisions are best
* However, shouldn't dissect through a large distance to get to the lesion
* If it's more than a few cm from the areola, use a Langer line incision directly over the tumour (essentially circular)
* Use LA without adrenaline to prevent delayed bleeding

=== Dissection: ===

* Use left hand to manipulate the fibroadenoma towards the incision
* Monopolar diathermy towards lesion, until capsule is identified
* Keep palpating as you go, even using USS if necessary
* Can use a traction stitch on the capsule itself to aid in pulling it towards the incision
* Sharply dissect the fibroadenoma out, staying on the capsule

=== Closure ===

* Don't close dead space - it will be filled in by seroma and gradually replaced by normal tissue
* 3-0 vicryl to subdermal layer
* 4-0 monocryl to skin
* No drain unless very large