SURGERY FOR BREAST DISEASES: BIOPSY, ADAIR’S OPERATION AND MICRODOCHECTOMY
Biopsy of the breast
Some years ago surgeons were taught that if a woman had a lump in her breast, the diagnosis should always be confirmed by excision of the lump and examination of it under a microscope. This procedure has now been almost entirely replaced by the use of fine needle aspiration biopsies or of a wider Tru-Cut needle to remove a core of breast tissue when a more substantive biopsy is required.
Although some women would prefer to have a local anesthetic for an open breast biopsy, this is not usually possible. It is surprisingly difficult, once a small incision has been made in the breast following a local anesthetic injection, for the surgeon to locate a breast lump, and this is more easily done if the patient has had a general anesthetic. Not only is it disconcerting for a surgeon not to be able to find a breast lump which has been hidden by the injection of the local anesthetic, but the surgeon’s concern about the difficulties might also be transferred to the patient.
Adair’s operation
Also known as Hadfield’s operation, this is performed for duct ectasia.
A general anesthetic is used, and a peri-areolar incision is made around the upper or lower half of the nipple. A piece of tissue containing the central breast ducts is then removed. The excised tissue is about the same size as a 50p piece; it is always sent to the pathology laboratory to be looked at under the microscope.
The skin is then closed with a cosmetic subcuticular stitch, i.e. a stitch beneath the surface of the skin. The suture is made using either a non-absorbable material such as Prolene, which is rather like Nylon and must be taken out after 7 to 8 days, or an absorbable material which does not need to be removed. There is a tendency for wounds to leak more if closed with the absorbable material, although there is no associated increased risk of infection.
The most common problem after an Adair’s operation is bruising. There may also be a 10 to 15 per cent risk of recurrence of the previous disease.
Microdochectomy
Occasionally, a small warty growth or a very early cancer can appear in the ducts just underneath the nipple and cause a bloody nipple discharge. If the offending duct can be identified, it is possible to use X-ray mammography to locate the growth. A small cannula is placed into the duct and dye is then injected through it, so that the small warty lesion or papilloma within the duct becomes clearly visible.
The operation to remove the duct is known as microdochectomy, and involves the use of a general anesthetic. A probe is put into the affected duct and then removed through a radial incision made from the tip of the nipple. The probe takes with it the duct containing the lesion and the skin is then closed as described above.
If the warty lesion turns out to be entirely benign, which is usually the case, the operation is complete. If, as happens rarely, an intraductal cancer which is showing some sign of invasion is found, the operation may need to be followed up by more radical surgery.
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