Surgical Reports

(Brief information in blue)

Under 10-15 min
Relevant Anatomy-

The mammary glands are located anterior to pectoralis major, nipples lie at the level of the 5 th rib.

Diagnostic exams- palpation of the breasts, mammography

Special considerations-

Surgical team must be sensitive to the fact that when under local anesthesia the patient may still be
alert enough to hear the conversations taking place the report from pathology should be communicated
to the surgeon in a confidential manner in the OR and not through speaker phone the surg tech and
circulator should communicate before the patient is brought in if they need a frozen section and if
pathology has been notified tissue being sent to pathology for frozen section must not be placed in
formalin if the patient has gone through a needle localization procedure just prior to the breast biopsy
everyone needs to be extremely careful to not dislodge the needle while applying paint solution or while
draping

Anesthesia- General anesthesia but local anesthesia with IV conscious sedation

Positioning- will be supine

Skin prep- (What area is prepped)

Only paint solution is gently applied starting at the site of the lesion extending to the level of the clavicle
to the sternum downward including a wide margin of the abdomen and laterally as far as possible to
include the axilla Surgeon can order the paint to be applied by spraying the prep area

Draping-

4 blue towels to square off the entire breast when mastectomy or axillary dissection is possible towels
will be placed to expose the breast surrounding skin and axilla stockinette may be used depending on
surgeons preference chest/breast drape or laparotomy drape for the biopsy only

Incision-

Curvilinear is made to follow the skin lines directly over the tumor mass or along the border of the
areola called the circumareolar incision if it is a centrally located massn or the lacrimal duct is involved

Supplies-

¼ in Penrose drain
 Surgical Reports
(Brief information in blue)
Under 10-15 min
Equipment-

Minor instrument set

Instruments- 2 #15 knife blades

Procedural steps-

1. Make the curvilinear incision if they have a needle localization from radiology right before ther
incision will be placed directly over the location of the tumor mass as possible using the needle
as a guide this needle should not be removed
2. The incision is carried down to the tumor mass with the knife and metz scissors electrocautery
will be used to control the bleeding with needle localization the surgeon will follow the needle
down to the mass
3. The surgeon will the use debakey, babcock, or allis to grasp the tumor. A small margin of tissue
will be excised along with the tumor mass as the surgeon works in a circular fashion using the
metz to free up the mass
4. The tissue specimen is removed en bloc with the needle localization the tissue with wire is sent
to pathology for frozen section closure is not performed until the report is back from pathology
while waiting the surgeon will gently irrigate the wound and control small bleeders with
electrocautery, Non needle localization the surgeon will use a sterile marking pen or silk suture
ligature to mark the breast tissue as to its anatomical position to the breast the superior and
inferior poles will most likely be marked the tech should cut the suture in such a manner that it
has long tags, Do not pass off the tissue specimen on a counted 4X4 raytec sponge if it doesn’t
have a needle you should use debakeys to place the specimen into the specimen cup and if a
needle is present the tech should place it on a telfa pad and pass to the circulator
5. When the pathology report has been received hemostasis will be checked one last time the
surgical wound is closed with interrupted absorbable suture the skin will be closed with a
running subcuticular closure and skin closure tapes
6. Wound is dressed to surgeons preference

Counts-

Dressing material surgeons preference

Specimen care

Given to the circulator to take to pathology or dispose of

 Surgical Reports
(Brief information in blue)
Under 10-15 min
Prognosis-

No complications discharged same day as surgery return to normal activities in 1-2 weeks

Complications-

Hemorrhage or SSI

Wound class/ management-

Class 1: clean