General Surgery

Wide Local Excision

OPERATION: Wide Local Excision of Breast Lump
ANAESTHETIC: General anaesthesia
POSITION: Supine with ipsilateral arm abducted

INDICATION:
[Breast carcinoma / indeterminate lesion]. Preoperative imaging: USS / mammogram [results]. [Wire-guided / radio-guided / SAVI Scout localisation performed if impalpable].

PROCEDURE:
WHO Checklist performed. Skin marked preoperatively with patient sitting upright. Circumareolar / radial / skin crease incision made over [tumour location].

Dissection deepened in the subcutaneous plane. Tumour identified [palpably / localisation wire / gamma probe]. Wide local excision performed with a [1 cm] margin of macroscopically normal breast tissue on all surfaces including deep margin (including deep fascia if appropriate). Orientation sutures placed: [short = superior, long = lateral / as per unit convention].

Cavity haemostasis achieved. Specimen orientated and sent for histopathology with specimen radiograph [if wire-guided]. [Cavity margins assessed with intraoperative frozen section / shave margins].

[Cavity closed with absorbable sutures to minimise seroma / drain placed / left open]. Skin closed with subcuticular absorbable suture.

FINDINGS:
[Tumour location, size on imaging, macroscopic appearance of specimen]. [Wire / localisation device in specimen confirmed on radiograph].

SPECIMEN: Wide local excision specimen, orientated, to histopathology. Specimen radiograph: [confirms lesion in specimen / wire in situ].

EBL: Minimal. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Regular analgesia. Appropriate support bra. Results at multidisciplinary team. Outpatient review in [1–2 weeks] with histology.