Case
Pt: 50-year-old female
Surgeon: Sharon Rooney-Gandy, D.O.
Preoperative Dx: Multifocal ductal carcinoma in situ, left breast
Postoperative Dx: Multifocal ductal carcinoma in situ, left breast, pathology pending
Operation performed: Left simple mastectomy
Preop History: The patient was noted to have calcifications on routine mammogram. She does not practice breast self-exam and felt no lumps herself. Upon needle localization left breast biopsy, she was found to have multifocal ductal carcinoma in situ, noncomedo type with tumor extending to margin of excision and microcalcifications. Hx: Grav 0, Para, AB 0, and is in menopause with history of ependymoma and radiation of her spine, paternal grandmother with bilateral breast cancer, paternal aunt with bilateral breast cancer. Physical examination of the right breast was essentially unremarkable. The left breast revealed a well-healed upper medial quadrant curvilinear incision from previous biopsy. There was no retraction, discharge, masses, or axillary nodes. After biopsy she was evaluated by an oncologist for treatment of carcinoma in situ. Dr. Peter, radiation oncologist, evaluated her for radiation therapy. It was felt best that the patient undergo simple mastectomy, not so much because of previous radiation therapy, but because of the residual multicalcifications remaining in her left breast. The patient did understand this. Because of her small breasts, we thought she would be best treated cosmetically with a left simple mastectomy. The patient tolerated the procedure well and was taken to the recovery room in satisfactory condition.
Procedure: The patient was taken to the operating room, given general anesthesia, prepped and draped in a sterile manner. Elliptical incisions were made in a horizontal fashion incorporating the previous biopsy site. The skin was incised with minor bleeding controlled using Bovie cautery. The breast tissue was dissected down to the pectoral fascia and up to the clavicle, elevating the superior skin flap. The lower skin flap was developed using Bovie cautery down to the pectoral fascia. The breast was excised using Bovie cautery, hemostasis secured with Bovie cautery. The incision was irrigated with saline. No other masses or axillary nodes could be palpated. The skin was closed with interrupted 4-0 Vicryl followed by a continuous subcuticular 4-0 Prolene. Prior to closing the skin a JP drain was placed through a separate stab incision. Steri-strips were applied and the drain was sutured in place. A sterile pressure dressing was applied. Postoperative condition was stable. The case was clean and elective.
pertaining to below the epidermis __________________________________
condition creating no sensation ___________________________________
having more than one focus (location) ___________________________________
type of cancer in one location __________________________________
5. was cut apart ________________________________________
6. area under the arm ________________________________________
7. control of blood flow ____________________________________________
8. excision of the breast _______________________________________________
9. breast x-ray ________________________________________________________
10. absence of organisms ____________________________________________________
1 pulling and holding back _______________________________________________________
1 small calcium deposits _______________________________________________________
1 examination of living tissue _______________________________________________________