Mastectomy and SNL
Preop Diagnosis - LEFT/RIGHT breast cancer
Postop Diagnosis - same
Surgeon - Dr. Luk/Dr. Dan Tran
Assistant Surgeon -
Anesthesia - General
Blood Loss - Minimal
Complication - None
Findings - RIGHT breast cancer
LEFT breast cancer
Sentinel lymph node x
Specimens - same
Indication-
Procedure Performed-
RIGHT/LEFT Mastectomy
Sentinel Lymph Node Biopsy x
Layered Closure of the entire incision
This is a patient with the above diagnosis. The patient was consented for the above procedure. Risks, benefits, and alternatives were discussed with the patient. Risks include, but are not limited to, bleeding, infection, damage to surrounding structures, nerves, or vessels, seroma, hematoma, abscess, dehiscence, lymphedema, discovery of metastasis, and even systemic complications such as cardiopulmonary, thromboembolic, hepatic, renal, neurologic or infectious complications which may even lead to death. All questions were answered. The patient agreed to proceed.
TECHNIQUE:
-Prior to start of surgery, patient had lymphoscintigraphy done of the axillary lymph node of the affected side by the hospital's radiology department. After lymphoscintigraphy was performed, I evaluated the film/report.
The site was marked with a consent in the preop holding area. She was given preop antibiotics.
She was then brought back to the operating for surgery.
In the operating room, 1 cc of Lymphazurin blue was injected intradermally around the nipple areolar complex.
Sentinel Lymph Node Biopsy
Using the Geiger counter, I identified the area that has a high count in the affected axilla. This corresponds to the imaging.
A small linear incision was performed in the axilla. This was done using 10. Scalpel.
Dissection was carried down to the subcutaneous tissue into the clavipectoral fascia.
Using the Geiger counter, I directed my dissection towards the hottest area.
Eventually we were able to identify the sentinel lymph node was hot and blue.
The node was removed utilizing Harmonic focus maintaining good hemostasis.
This was the sentinel lymph node and was sent off for pathology.
Utilizing a 10% rule, ------- additional sentinel lymph node was removed, it is hot and blue.
Upon completion, this no additional hot, blue, or palpable suspicious symptoms noted.
After ensuring that we had good hemostasis, local anesthetic was injected at the site.
The axillary wound was irrigated and closed using absorbable sutures.
Mastectomy
Next item attention to the affected breast.
An elliptical incision was performed using 10. Scalpel.
Incision was performed to encompass the entire nipple-areolar complex.
After the incision was made down to the skin subcutaneous tissue, then we raised the flaps superiorly and inferiorly.
The mastectomy was performed using the electrocautery maintaining good hemostasis.
We created and skin flaps were raise in all directions, medially to the sternum, laterally to the anterior axillary line, superiorly to the clavicle, and inferiorly to the inframammary fold. All breast tissue including the tail of Spence were excised including the deep margin which is the anterior fascia of the pectoralis major. Hemostasis was excellent.
The breast was then sent to pathology, marked with short stitch superior, long stitch lateral.
Wound was then irrigated with copious saline irrigation. Any bleeding edges or vessel was ligated using silk sutures or cauterized. We have good hemostasis at completion.
2 JP drain was placed into the wound cavity and brought out through small incisions, secured with drain stitch.
At the end of the case, counts were carried out. Instrument, sponge, and needle counts were completed and reported to me as correct.
The skin incision was then closed using 3 Vicryl suture, followed by 4 Monocryl suture in the layered closure fashion.
The patient tolerated procedure well, no complications, extubated, and was transferred recovery room stable satisfactory condition.