Scarless Breast Lump Surgery - Procedure and Recovery

Scarless breast lump surgery is the surgery to remove a lump that may be cancerous. It is also called a lumpectomy. Scarless breast lump surgery is done through vacuum-assisted breast biopsy (VABB). It is a minimally invasive technique that allows surgeons to remove the lump from the breast through small incisions leaving behind no scars. It is used to treat both malignant and benign breast diseases.

The scarless breast lump surgery has many advantages over the open biopsy.

The benefits of scarless breast lump surgery are:

1. No need for stitches
2. Reduces the likelihood of repeat biopsy
3. Sufficient sample collection in a single insertion
4. Speeds time between detection and diagnosis
5. Faster recovery
6. Single and minimal invasion ( less than 3mm)
7. Higher level of precision
8. Complete removal of the lump
9. No scarring 
10. Minimum discomfort

1.  It is an advanced minimally invasive technique that allows the surgeon to access breast abnormalities through small incisions leaving behind no scars.
2. Scarless breast surgery can help treat both benign and malignant breast diseases.

Why is the surgery performed?

1. The scarless breast surgery removes the breast lump caused by fibroadenomas and examines it.
2. The surgery is also performed in case of infection, trauma, cyst, fat necrosis, and fibrocystic breasts.
3. As it is possible, the lump can be a cancerous tumour. In the absence of timely treatment, it can spread to other body parts.
4. Once cancer spreads, it will become challenging to control and start attacking vital body organs, leading to death.

 

How scarless is breast lump surgery performed?

The scarless breast lump surgery is a minimally invasive procedure. It is done using a vacuum-assisted breast biopsy technique under the guidance of a Mammogram Ultrasound or MRI to detect and excise a lump. Mammotome is a vacuum-assisted device used to excise breast lumps or small-sized tumours, especially benign ones. The incision used for the introduction of mammotome is around 3mm. Then the surgeon uses the vacuum-assistance to draw the lump out through an incision made. The surgeon closes the incision after the surgery and sends the sample to a pathologist for diagnosis.

There are three methods through which vacuum-assisted breast biopsy can be done. These are:

1. Ultrasound-guided VABB: In this type of VABB, the biopsy is done under the guidance of ultrasound. The ultrasound waves allow the surgeon to locate the lesions. It is significantly less invasive as compared to surgical biopsy. Further, it leaves no or minimal scars and does not expose the patient to ionising radiations. (https://www.radiologyinfo.org/en/info/breastbius) 
2. MRI-guided VABB: MRI is emerging as a tool for diagnosing, staging, and evaluating the efficacy of breast cancer treatment. VABB, under MRI guidance, assists the surgeon to detect small lesions and helps in managing breast cancer at an early stage. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6290746/) 
3. Stereotactic-guided VABB: In this method, the surgeon attaches the stereotactic device to the mammography machine. The biopsy is performed with the help of mammograms. In the stereotactic technique, the images of the same location are taken from two different angles. (Hong Kong J Radiol. 2014;17:76-86 | DOI: 10.12809/hkjr1413201) 

What to expect before surgery?

1. It is essential to notify the doctor about:
2. A list of medicines, vitamins, steroids, or herbal supplements (if you are on any)
3. If you are taking blood-thinning medication like warfarin. As they increase the chances of bleeding
4. If you are taking clopidogrel and aspirin, as they increase the risk of bruising
5. If you are or could be pregnant. A small dose of X-ray radiation is used in the mammogram (taking images of the lump), which can cause damage to the developing baby.
6. Take all the medical records, including the breast imaging test reports (e.g. ultrasound, MRI, Mammogram), to the hospital.
7. Avoid drinking or smoking a week before surgery.
8. The doctor may recommend you not to eat or drink anything after midnight a day before the surgery.

What to expect on the day of surgery? 

Follow all the instructions about eating or drinking before the surgery. Take the drugs prescribed by the doctor with a small sip of water. Reach the hospital at the allotted. The doctor may ask you to leave valuable items like jewellery and a watch. Avoid deodorant as it can imitate the calcium spots in the breast, making it harder for radiologists to identify the abnormalities or lumps in the breast. Inform the surgeon if you have any drug allergies, especially with a local anaesthetic. 

The doctor will ask you to change into a hospital gown. You will be taken to the operation theatre.

Procedure

The scarless breast lump surgery is done in the following steps:

1. Firstly, the doctor will ask you to lie on a table on your stomach. The table has a hole through which the breast is placed. 
2. Then, the table is raised, and underneath the table, a special mammogram and biopsy device is placed. 
3. Then the doctor will take a series of X-rays to locate the breast lump.
4. Once the lump is located, the doctor will ask you not to move to excise the lump.
5. The doctor will clean the overlying area with the antiseptic and will administer the local anaesthetic. It helps make the surgery painless and helps in producing numbing effects.
6. The doctor will make a minor incision of 3-4 mm. The doctor then inserts the needle and uses the vacuum-powered instruments, and the tissue sample is taken.
7. The doctor inserts the surgical instruments through the incision and excises the lumps.
8. Once done, the surgical instruments are removed from the breast. 
9. Finally, the surgeon closes the incision with the help of a sterile dressing. No stitches are required.

What to expect after surgery? 

1. After the surgery, the staff will shift you to the recovery room. The trained medical staff will monitor your vitals.
2. You will be discharged from the hospital on the same day of surgery.
3. The drainage tube may remain attached and will be removed on the subsequent follow-up.
4. The doctor will prescribe you some antibiotics and a painkiller. You should take the medications as directed to avoid any complications.
5. In addition, the doctor will instruct you to avoid doing any strenuous physical activity, take plenty of rest, and take care of your dressing. The doctor will also send the tissue sample to pathologists and will share the result on follow-up.

First, follow up after surgery.

1. You will have a first follow-up with the doctor a week after surgery.
2. The doctor will perform some tests to ensure it is okay and then remove the drainage tube.
3. The doctor will also share the result of the biopsy with you.
4. They will explain the result and will give you detailed instructions about when you should have a follow-up appointment for further care.

 

Scarless breast pump surgery is a safe and effective procedure. It is performed by a team of skilled surgeons and radiologists. However, some of the risks and complications associated with the surgery are:

When to call a doctor

 

1. Infection at the site of operation
2. Excessive bleeding 
3. Easy  bruising and slight risk of hematoma
4. Uncontrollable pain, which is getting worse only
5. Hematoma (accumulation of blood under the skin)
6. Seroma (a build-up  of fluid under the skin)
7. Swelling in the arm
8. Swelling in the breast
9. Redness
10. Breast tenderness