Editing Breast wide local excision (section)

== '''Technique''' ==

* TT, GA, prep and drape taking care of hookwire, IV Abx, TEDs, incision marked on breast, blue dye
* Supine, ipsilateral arm out, myself standing medial on ipsilateral side
* '''WLE'''
** Curved incision overlying the tumour location, not at hookwire entry site
*** Always safe to plan the incision directly over the tumour
*** Incisions above nipple require curved incision; those below nipple seem to do well with radial incisions
*** Raise a skin flap in every direction over the tumour to prevent dimpling - thickness will vary depending on depth of tumour. Assistant with cat's paws.

* Deliver hookwire into wound (likely coming from lateral side) and apply artery clip to it
* Excise a cone of breast tissue down to fascia, follow hookwire down and avoiding exposing tip of hookwire. Assistant with Langenbeck's at 90 degrees to one other. With my left hand on tumour, ensuring I have a 1cm margin on each side as the cone is developed on each side.
* Elevate the cone out of the wound - if unable, need a bigger incision
* Mark in situ (S, M, L)
* Peel off fascia. Remove and prepare for imaging - placed on a piece of foam, marked and in appropriate orientation
* Can consider doing USS intra-op on specimen if facility available
* Send for imaging

* In meantime, haemostasis, washout, close breast defect with 0 vicryl
* SLNB if required
* Check imaging +/- resect margins
* LA to both wounds
* Close wounds with undyed 3-0 vicryl to deep dermal, and 4-0 monocryl to skin