Breast biopsy

Breast biopsy

Anesthesia type	Depends on size of lesion, depth of lesion, and amount of tissue to be sampled. Includes local, local with IV sedation, or GA.
Airway	Natural airway, LMA or ETT
Lines and access	PIV 18-20G x 1 if sedation is to be used
Monitors	Standard monitors
Primary anesthetic considerations
Preoperative	Patients with previous history of breast cancer may have had prior lymph node involvement and one arm may be unavailable for lines
Intraoperative
Postoperative	Urine, emesis or stool may be blue for 24-48h if dye is injected
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A breast biopsy is the surgical removal of breast tissue for histopathological analysis, usually in the setting of suspicious findings discovered on mammography or ultrasonography. This procedure can take many forms, including fine-needle aspiration cytology (FNA), core needle biopsy, open breast biopsy, excisional biopsy, and lumpectomy, and may be associated with sentinel lymph node biopsy.

Preoperative management

Patient evaluation

System	Considerations
Neurologic
Cardiovascular
Respiratory
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

• Only as indicated from H&P

Patient preparation and premedication

• Can be a high-anxiety procedure, consider midazolam
• Consider scopolamine patch in young women at high risk for PONV

Intraoperative management

Monitoring and access

• Standard ASA monitors
• 18-20G PIV x 1

Induction and airway management

• Natural airway for procedures that can be done under local +/- sedation including FNA, core needle biospy
• LMA vs. ETT for deeper lesions, resections, and sentinel node biopsies

Positioning

• Supine with ipsilateral arm abducted
• Table may be airplaned to center breast

Maintenance and surgical considerations

• Standard maintenance, muscle relaxants often not required

Emergence

• No special considerations

Postoperative management

Disposition

• PACU > home

Pain management

• Pain score 2-5
• PO analgesics

Potential complications

• Hematoma formation
• Infection
• Seeding of tumor to other sites

Procedure variants

	FNA/Core Needle Biopsy	Open Breast Biopsy	Lumpectomy/Excisional Biospy
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications