Our Summary

The use of a type of local anesthesia that involves filling the area around a tumor with a large amount of anesthetic solution (tumescent local anesthesia) has made surgeries safer by removing the need for putting patients to sleep (sedation). This is particularly useful for patients with other serious health conditions.

The paper discusses a case of a 78-year-old man with breast cancer, heart failure, and other health issues. Typically, the surgery he required (a modified radical mastectomy, which involves removing the whole breast and some lymph nodes) is done under general anesthesia, where the patient is put to sleep. But general anesthesia can be risky for patients with serious health problems.

In this case, the doctors used the local anesthesia method to perform the surgery while the patient was awake. The procedure was successful and the patient experienced little discomfort. This suggests that this anesthesia method could be a safer option for some patients.

FAQs

  1. What is tumescent local anesthesia and how does it make surgeries safer?
  2. What is a modified radical mastectomy and how is it typically performed?
  3. Can the local anesthesia method be used for patients with serious health conditions undergoing a modified radical mastectomy?

Doctor’s Tip

Additionally, after a radical mastectomy, it is important to follow your doctor’s instructions for post-operative care, including wound care, pain management, and physical therapy. It is also important to attend all follow-up appointments to monitor your recovery and ensure that the cancer has been successfully treated. Remember to communicate any concerns or changes in your condition to your healthcare provider.

Suitable For

Typically, patients who are recommended radical mastectomy are those with early-stage breast cancer that has not spread beyond the breast or nearby lymph nodes. This may include patients with large tumors, tumors that are close to the chest wall, or those with multiple tumors in the same breast. Patients with a strong family history of breast cancer or certain genetic mutations may also be recommended for radical mastectomy.

Additionally, patients who are not good candidates for breast-conserving surgery (such as lumpectomy) due to the size or location of the tumor may also be recommended for radical mastectomy. Patients who have previously undergone radiation therapy to the breast or have connective tissue disorders that may affect wound healing may also be candidates for radical mastectomy.

Overall, the decision to recommend radical mastectomy is based on the individual patient’s specific situation, including the size and location of the tumor, the stage of the cancer, the patient’s overall health, and their personal preferences. It is important for patients to discuss all of their treatment options with their healthcare team to make an informed decision about their care.

Timeline

Before the radical mastectomy:

  1. Patient is diagnosed with breast cancer and discusses treatment options with their healthcare provider.
  2. Patient undergoes pre-operative tests and consultations to determine if they are a candidate for surgery.
  3. Surgery is scheduled and the patient prepares for the procedure, including fasting and possibly stopping certain medications.
  4. Patient arrives at the hospital or surgical center on the day of the surgery and is prepped for the procedure.
  5. Patient is taken into the operating room and given anesthesia (either general anesthesia or tumescent local anesthesia).
  6. Surgery is performed to remove the breast tissue and any affected lymph nodes.
  7. Patient wakes up in the recovery room and begins the healing process.

After the radical mastectomy:

  1. Patient may experience pain, swelling, and discomfort in the days following the surgery.
  2. Patient is monitored for complications such as infection or bleeding.
  3. Patient may require pain medication and physical therapy to aid in recovery.
  4. Patient may undergo additional treatments such as chemotherapy or radiation therapy to prevent cancer recurrence.
  5. Patient attends follow-up appointments with their healthcare provider to monitor their progress and address any concerns.
  6. Patient may undergo breast reconstruction surgery to restore the appearance of the breast.
  7. Patient continues with regular screenings and check-ups to monitor for any signs of cancer recurrence.

What to Ask Your Doctor

  1. Can a radical mastectomy be done under local anesthesia instead of general anesthesia for patients with serious health conditions like mine?
  2. What are the potential risks and benefits of using local anesthesia for a radical mastectomy in my case?
  3. Will using local anesthesia affect the success of the surgery or my recovery process?
  4. Are there any specific criteria or factors that determine whether a patient is a suitable candidate for a radical mastectomy under local anesthesia?
  5. How does the use of local anesthesia for a radical mastectomy compare to general anesthesia in terms of pain management and overall experience during the surgery?
  6. Are there any additional precautions or considerations I should be aware of if I opt for local anesthesia for my radical mastectomy?

Reference

Authors: Pandya SM, Njuguna T, Maina C, Jani P, Lalonde D. Journal: Plast Surg (Oakv). 2024 May;32(2):357-359. doi: 10.1177/22925503221120573. Epub 2022 Sep 15. PMID: 38681242