Mastectomy - Wide Local Excision and Hook Wire Guided Wide Local Excision
A wide local excision is the surgical removal of a tumour, mass or suspicious tissue along with a surrounding margin of normal tissue. Tumours within the breast may be located under image guidance and marked by inserting a wire into the breast tissue with a hook at its tip in the region of the abnormality. This helps to guide your surgeon in performing the local excision.
Breast cancer generally begins in the lobules or ducts of the breast but can also occur in the fatty and fibrous tissues. Left untreated, the tumour cells may invade the lymph nodes of the underarm and then spread to the other parts of the body.
Hook wire guided wide local excision is usually performed on breast lesions that cannot be clinically detected or felt but are identified on imaging studies.
The method of imaging such as mammography, ultrasound or MRI is first selected depending on which one shows the lesion clearly and is ideal for you. The identified region of the breast is sterilized and numbed with local anaesthetic. Under image guidance, a fine needle is inserted into the breast tissue to reach the region of the abnormality. The hook wire is then passed through the needle until its tip is within the tumour. The needle is then removed leaving the wire in place. Further imaging is obtained to verify the position of the tip of the wire. The external part of the wire is then taped to the skin. Later a wide local excision is carried out using the hook wire as reference and the lesion is removed along with the wire. Localization of the tumour and placement of the hook wire takes approximately 30-45 minutes.
Following the procedure, you may have some soreness for which pain medication is prescribed. The scar produced is usually small. A well-fitted, comfortable bra must be worn for support. Exercises are recommended to avoid stiffness of the shoulder and back muscles. Your doctor may suggest a course of radiotherapy or chemotherapy to destroy any unseen cancer cells.
Risks and Complications
Complications associated with a hook wire guided wide local excision are rare but may include:
- Shifting or dislodgement of the wire
- Breakage of the wire leaving fragments in the breast after surgery
- Reaction to anaesthetic or contrast agent used during imaging.
- General complications such as bleeding, swelling, infection and nerve injury.