Breast Lumpectomy - General Principles

1. Markings

Substep Structure Actions Specification

1A Skin Mark Prior to executing a lumpectomy, mark the following landmarks. First the sternal notch and the
sternum. Mark the breast boundaries medially, cranially, in the inframammary fold and laterally,
which can be identified by moving the breast. Finally mark the nipple.

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Breast Lumpectomy - General Principles

2. Different Incisions

Substep Structure Actions Specification

2A Skin - Cranial lesion Mark For a cranial lesion, use a half periareolar incision. When more exposure is needed, the incision
can be extended towards medial and lateral. This is known as the batwing incision and is used
for larger lesions in this area.

2B Skin - Caudal lesion Mark For a caudal lesion, use a periareolar incision with extensions to the inframammary fold. During
closure, suture the medial point in the inframammary fold to the lateral point. To allow this
movement, an incision towards lateral and medial is made in the inframammary fold. Inside
these lines and deepithelialize the skin cranial to the nipple and pull the nipple cranially. The
removal of the caudal lesion pulls the nipple downward, which can be corrected this way.

2C Skin - Upper lateral lesion Mark For a lateral lesion, raise the skin overlying the lesion. Make the incision in the skin lines. Test
their direction by moving the breast caudally. The incision should not exceed the lateral breast
border and should end at the nipple.
For a more detailed elaboration of this, refer to the course Breast Lumpectomy – Upper
Lateral Quadrant.

2D Skin - Upper medial lesion Mark When a lesion is located in the upper medial quadrant, raise the skin overlying the lesion.
Use a periareolar incision. The position of the nipple will change after the lumpectomy. To be
able to reposition the nipple afterwards, the skin surrounding the nipple is deepithelialized.
Close the periareolar skin with a running purse-string suture.
For a more detailed elaboration of this, refer to the course Breast Lumpectomy – Upper
Medial Quadrant.

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