Breast benign lump excision

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

Complications

• Haematoma/seroma
• Infection
• Recurrence