Difference between revisions of "Breast lumpectomy"

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{{Infobox surgical case reference
{{Infobox surgical case reference
| anesthesia_type =  
| anesthesia_type = MAC or General
| airway =  
| airway = LMA/ETT if GA
| lines_access =  
| lines_access = PIV
| monitors =  
| monitors = Standard
| considerations_preoperative =  
| considerations_preoperative =  
| considerations_intraoperative =  
| considerations_intraoperative =  
| considerations_postoperative =  
| considerations_postoperative = PONV
}}Provide a brief summary of this surgical procedure and its indications here.
}}A '''breast lumpectomy''' is the removal of a discrete portion or “lump” of breast tissue. This procedure is sometimes referred to as a '''partial mastectomy'''.   
 
Sometimes the procedure is performed with wire localization, where a radiologist inserts the tip of a wire into the target tissue under fluoroscopic guidance preoperatively. This enables the surgeon to more precisely localize the lesion, and is more commonly performed for deeper lesions.      


== Preoperative management ==
== Preoperative management ==
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|Respiratory
|Pulmonary
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=== Labs and studies <!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
=== Labs and studies ===
=== Operating room setup <!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
=== Operating room setup <!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
=== Patient preparation and premedication <!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
=== Patient preparation and premedication <!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
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== Intraoperative management ==
== Intraoperative management ==
=== Monitoring and access <!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
=== Monitoring and access <!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
* PIV x 1
* Place BP cuff off the surgical field
* Make sure EKG leads are not near the sterile field


=== Induction and airway management <!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
=== Induction and airway management <!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===


=== Positioning <!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
=== Positioning <!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
* Supine
* Arms out


=== Maintenance and surgical considerations <!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
=== Maintenance and surgical considerations <!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
* Consider TIVA or partial TIVA, due to higher risk of PONV (patient population tends to be older females, who are at higher risk of PONV) and faster emergence.


=== Emergence <!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
=== Emergence <!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
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!Variant 1
!Superficial
!Variant 2
!Deep
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|Unique considerations
|Unique considerations
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|More likely MAC
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|More likely GA
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|-
|Position
|Position
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|Surgical time
|Surgical time
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|15-45 mins
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|30-60 mins
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|EBL
|EBL
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|5-10cc
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|5-10cc
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|Postoperative disposition
|Postoperative disposition
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[[Category:Surgical procedures]]
[[Category:Surgical procedures]]
[[Category:General surgery]]
[[Category:Breast surgery]]

Latest revision as of 17:07, 7 August 2022

Breast lumpectomy
Anesthesia type

MAC or General

Airway

LMA/ETT if GA

Lines and access

PIV

Monitors

Standard

Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative

PONV

Article quality
Editor rating
In development
User likes
0

A breast lumpectomy is the removal of a discrete portion or “lump” of breast tissue. This procedure is sometimes referred to as a partial mastectomy.

Sometimes the procedure is performed with wire localization, where a radiologist inserts the tip of a wire into the target tissue under fluoroscopic guidance preoperatively. This enables the surgeon to more precisely localize the lesion, and is more commonly performed for deeper lesions.

Preoperative management

Patient evaluation

System Considerations
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

Intraoperative management

Monitoring and access

  • PIV x 1
  • Place BP cuff off the surgical field
  • Make sure EKG leads are not near the sterile field

Induction and airway management

Positioning

  • Supine
  • Arms out

Maintenance and surgical considerations

  • Consider TIVA or partial TIVA, due to higher risk of PONV (patient population tends to be older females, who are at higher risk of PONV) and faster emergence.

Emergence

Postoperative management

Disposition

Pain management

Potential complications

Procedure variants

Superficial Deep
Unique considerations More likely MAC More likely GA
Position
Surgical time 15-45 mins 30-60 mins
EBL 5-10cc 5-10cc
Postoperative disposition
Pain management
Potential complications

References

Top contributors: Barrett Larson, Chris Rishel, Tony Wang and Ashwini Bhat

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