Management of Intraductal Papilloma Using Vacuum Assisted Breast Surgery (VABB/VAE):- A Single Institute Study

Abstract

AbstractIntraductal Papilloma has a higher upgradation rate despite being a benign tumor and warrants an immediate excision. Surgical removal is the gold standard but carries poor cosmetic results and requires general anesthesia. Ultrasound-guided Vacuum Assisted Excision (US-VAE) was used to treat 47 patients after due ethical permissions. 32 patients went US-VAE under local anesthesia and all patients were happy with the cosmetic outcome. The excision was done as a daycare procedure in all patients except indicated by the Anesthetist. Requirements of post-procedure analgesia were also minimal and only 3 patients required prolonged analgesia. The advantages of VABB-guided surgery are faster recovery, scarless procedure, and local anesthesia, thus making it an ideal OPD and daycare procedure for Intraductal Papilloma Excision.IntroductionIntraductal papilloma, although benign, has a high upgradation rate to malignant breast cancer. Surgical excision is necessary, but the rate of complications is high. Ultrasound-guided vacuum-assisted excision (US-VAE) is a new technique derived from the VABB biopsy method that can give better cosmetic results as well as fewer surgical complications.ObjectivesUnderstanding the utility of US-VAE in the diagnosis and treatment of intraductal papillomas of the breast.MethodologyWith permission from the Ethics Board and consent of the patients, records of 47 patients were recruited to undergo the US-VAE procedure. USG was used to stage the tumor with Mammography and CNB as needed and patients with single duct or adjacent duct lesions were included while the rest, including patients with malignant changes, were excluded. The Bard VABB biopsy machine and the 7G probe were used by highly trained breast surgeons to perform the procedure.ResultsOf the 47 patients included, 32 patients under local anesthesia were operated while others were under general anesthesia according to the preference of the patient and the level of apprehension. The patients received oral paracetamol as the only painkiller for 5 days. Only 3 patients required prolonged analgesics. 7 patients had prolonged bruising (lasting more than one week), which was the most common complication. All patients (100%) were happy with the cosmetic result after the procedure.ConclusionsThe advantages of VABB-guided surgery are faster recovery, scarless procedure, and the ability to perform the surgery under local anesthesia, making it an OPD and daycare procedure.