Lumpectomies - Members - Focus and Flourish

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Lumpectomies: Basics and Beyond
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What is a lumpectomy:
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Situational Awareness
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Unfortunately, veterinary students receive little formal instruction on lumpectomies when one considers how common this procedure is in small animal practice. In most cases, ‘winging it’ by applying a few basic surgical principles and some common sense will suffice to achieve a successful outcome. But why not increase your level of confidence by having the appropriate information? Also, concerns like: Will the site close? Will it stay closed? Can also be alleviated by having a solid understanding of how to manage it.
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Get ready to perform a Lumpectomy

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All the information you need.
In depth guide and more.
Step by step explanations of the procedure.

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This content is designed for veterinary professionals. If you are a pet owner, please consult your vet if you have any questions about a surgery.

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Reduce tension on skin edges:

Identify tension patterns
Understand how to properly undermine
Undermine sufficiently

Reduce wound dehiscence:

Reducing tension on the skin edges
Preserving vasculature
Proper use of instruments/gentle tissue handling

Have a plan for closing after larger masse removal:

Be prepared (pre and intra op) to undermine more aggressively
Be prepared to do a single pedicle advancement flap
Be prepared to use a drain
Be prepared to manage as open wound (prepare client)

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What the clients need to know:
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The incision will take approximately 10-14 days to heal
Activity should be minimal until incision has healed to prevent undue tension or fluid build up.
Proper care of drain is readily managed by pet owners.

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[av_section min_height=” min_height_pc=’25’ min_height_px=’500px’ shadow=’no-border-styling’ bottom_border=’no-border-styling’ bottom_border_diagonal_color=’#333333′ bottom_border_diagonal_direction=” bottom_border_style=” padding=’default’ custom_margin=’0px’ custom_margin_sync=’true’ av-desktop-custom_margin=” av-desktop-custom_margin_sync=’true’ av-medium-custom_margin=” av-medium-custom_margin_sync=’true’ av-small-custom_margin=” av-small-custom_margin_sync=’true’ av-mini-custom_margin=” av-mini-custom_margin_sync=’true’ svg_div_top=” svg_div_top_color=’#333333′ svg_div_top_width=’100′ svg_div_top_height=’50’ svg_div_top_max_height=’none’ svg_div_top_opacity=” svg_div_bottom=” svg_div_bottom_color=’#333333′ svg_div_bottom_width=’100′ svg_div_bottom_height=’50’ svg_div_bottom_max_height=’none’ svg_div_bottom_opacity=” color=’main_color’ background=’bg_color’ custom_bg=’#f8fcff’ background_gradient_direction=’vertical’ background_gradient_color1=’#000000′ background_gradient_color2=’#ffffff’ background_gradient_color3=” src=” attachment=” attachment_size=” attach=’scroll’ position=’top left’ repeat=’no-repeat’ video=” video_ratio=’16:9′ overlay_opacity=’0.5′ overlay_color=” overlay_pattern=” overlay_custom_pattern=” custom_arrow_bg=” css_position_z_index=” av-desktop-css_position_z_index=” av-medium-css_position_z_index=” av-small-css_position_z_index=” av-mini-css_position_z_index=” id=” custom_class=” template_class=” aria_label=” av_element_hidden_in_editor=’0′ av_uid=’av-68y398′ sc_version=’1.0′]
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Step by Step Undermining
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[av_image src=’http://focusandflourish.com/wp-content/uploads/2022/10/lump-3.jpg’ attachment=’3715′ attachment_size=’full’ copyright=” caption=” image_size=” styling=” box_shadow=’outside’ box_shadow_width=’10’ box_shadow_color=” align=’left’ font_size=” overlay_opacity=’0.4′ overlay_color=’#000000′ overlay_text_color=’#ffffff’ animation=’no-animation’ animation_duration=” animation_custom_bg_color=” animation_z_index_curtain=’100′ parallax_parallax=” parallax_parallax_speed=” av-desktop-parallax_parallax=” av-desktop-parallax_parallax_speed=” av-medium-parallax_parallax=” av-medium-parallax_parallax_speed=” av-small-parallax_parallax=” av-small-parallax_parallax_speed=” av-mini-parallax_parallax=” av-mini-parallax_parallax_speed=” hover=” blur_image=” grayscale_image=” fade_image=” appearance=” css_position=” css_position_location=’,,,’ css_position_z_index=” av-desktop-css_position=” av-desktop-css_position_location=’,,,’ av-desktop-css_position_z_index=” av-medium-css_position=” av-medium-css_position_location=’,,,’ av-medium-css_position_z_index=” av-small-css_position=” av-small-css_position_location=’,,,’ av-small-css_position_z_index=” av-mini-css_position=” av-mini-css_position_location=’,,,’ av-mini-css_position_z_index=” transform_perspective=” transform_rotation=’,,,’ transform_scale=’,,’ transform_skew=’,’ transform_translate=’,,’ av-desktop-transform_perspective=” av-desktop-transform_rotation=’,,,’ av-desktop-transform_scale=’,,’ av-desktop-transform_skew=’,’ av-desktop-transform_translate=’,,’ av-medium-transform_perspective=” av-medium-transform_rotation=’,,,’ av-medium-transform_scale=’,,’ av-medium-transform_skew=’,’ av-medium-transform_translate=’,,’ av-small-transform_perspective=” av-small-transform_rotation=’,,,’ av-small-transform_scale=’,,’ av-small-transform_skew=’,’ av-small-transform_translate=’,,’ av-mini-transform_perspective=” av-mini-transform_rotation=’,,,’ av-mini-transform_scale=’,,’ av-mini-transform_skew=’,’ av-mini-transform_translate=’,,’ mask_overlay=” mask_overlay_shape=’blob’ mask_overlay_size=’contain’ mask_overlay_scale=’100%’ mask_overlay_position=’center center’ mask_overlay_repeat=’no-repeat’ mask_overlay_rotate=” mask_overlay_rad_shape=’circle’ mask_overlay_rad_position=’center center’ mask_overlay_opacity1=’0′ mask_overlay_opacity2=’1′ mask_overlay_opacity3=” link=” target=” title_attr=” alt_attr=” img_scrset=” lazy_loading=’disabled’ id=” custom_class=” template_class=” av_element_hidden_in_editor=’0′ av_uid=’av-1iuxx30′ sc_version=’1.0′ admin_preview_bg=”][/av_image]

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[av_icon_box icon=’ue885′ font=’entypo-fontello’ title=’Figure 1′ position=’left’ icon_style=’av-icon-style-no-border’ boxed=” font_color=” custom_title=” custom_content=” color=” custom_bg=” custom_font=” custom_border=” custom_title_size=’14’ av-desktop-font-size-title=” av-medium-font-size-title=” av-small-font-size-title=” av-mini-font-size-title=” custom_content_size=” av-desktop-font-size=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=” heading_tag=” heading_class=” link=” linktarget=” linkelement=” id=” custom_class=” template_class=” av_uid=’av-1ggekb0′ sc_version=’1.0′ admin_preview_bg=”]
Undermining is easily and commonly done using fine scissors such as Metzenbaums. The undermining should be deep to cutaneous trunci or fascial planes. Blood vessels should be preserved if possible.
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[av_image src=’http://focusandflourish.com/wp-content/uploads/2022/10/lump-2.jpg’ attachment=’3714′ attachment_size=’full’ copyright=” caption=” image_size=” styling=” box_shadow=’outside’ box_shadow_width=’10’ box_shadow_color=” align=’left’ font_size=” overlay_opacity=’0.4′ overlay_color=’#000000′ overlay_text_color=’#ffffff’ animation=’no-animation’ animation_duration=” animation_custom_bg_color=” animation_z_index_curtain=’100′ parallax_parallax=” parallax_parallax_speed=” av-desktop-parallax_parallax=” av-desktop-parallax_parallax_speed=” av-medium-parallax_parallax=” av-medium-parallax_parallax_speed=” av-small-parallax_parallax=” av-small-parallax_parallax_speed=” av-mini-parallax_parallax=” av-mini-parallax_parallax_speed=” hover=” blur_image=” grayscale_image=” fade_image=” appearance=” css_position=” css_position_location=’,,,’ css_position_z_index=” av-desktop-css_position=” av-desktop-css_position_location=’,,,’ av-desktop-css_position_z_index=” av-medium-css_position=” av-medium-css_position_location=’,,,’ av-medium-css_position_z_index=” av-small-css_position=” av-small-css_position_location=’,,,’ av-small-css_position_z_index=” av-mini-css_position=” av-mini-css_position_location=’,,,’ av-mini-css_position_z_index=” transform_perspective=” transform_rotation=’,,,’ transform_scale=’,,’ transform_skew=’,’ transform_translate=’,,’ av-desktop-transform_perspective=” av-desktop-transform_rotation=’,,,’ av-desktop-transform_scale=’,,’ av-desktop-transform_skew=’,’ av-desktop-transform_translate=’,,’ av-medium-transform_perspective=” av-medium-transform_rotation=’,,,’ av-medium-transform_scale=’,,’ av-medium-transform_skew=’,’ av-medium-transform_translate=’,,’ av-small-transform_perspective=” av-small-transform_rotation=’,,,’ av-small-transform_scale=’,,’ av-small-transform_skew=’,’ av-small-transform_translate=’,,’ av-mini-transform_perspective=” av-mini-transform_rotation=’,,,’ av-mini-transform_scale=’,,’ av-mini-transform_skew=’,’ av-mini-transform_translate=’,,’ mask_overlay=” mask_overlay_shape=’blob’ mask_overlay_size=’contain’ mask_overlay_scale=’100%’ mask_overlay_position=’center center’ mask_overlay_repeat=’no-repeat’ mask_overlay_rotate=” mask_overlay_rad_shape=’circle’ mask_overlay_rad_position=’center center’ mask_overlay_opacity1=’0′ mask_overlay_opacity2=’1′ mask_overlay_opacity3=” link=” target=” title_attr=” alt_attr=” img_scrset=” lazy_loading=’disabled’ id=” custom_class=” template_class=” av_element_hidden_in_editor=’0′ av_uid=’av-1cdzuxo’ sc_version=’1.0′ admin_preview_bg=”][/av_image]

[av_icon_box icon=’ue885′ font=’entypo-fontello’ title=’Figure 2′ position=’left’ icon_style=’av-icon-style-no-border’ boxed=” font_color=” custom_title=” custom_content=” color=” custom_bg=” custom_font=” custom_border=” custom_title_size=’14’ av-desktop-font-size-title=” av-medium-font-size-title=” av-small-font-size-title=” av-mini-font-size-title=” custom_content_size=” av-desktop-font-size=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=” heading_tag=” heading_class=” link=” linktarget=” linkelement=” id=” custom_class=” template_class=” av_uid=’av-1a1o8j0′ sc_version=’1.0′ admin_preview_bg=”]
Skin can also be bluntly undermined using the fingers to gently push through the loose connective tissues located deep to the superficial fascial plane or cutaneous trunci muscle.
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[av_image src=’http://focusandflourish.com/wp-content/uploads/2022/10/lump-1.jpg’ attachment=’3713′ attachment_size=’full’ copyright=” caption=” image_size=” styling=” box_shadow=’outside’ box_shadow_width=’10’ box_shadow_color=” align=’left’ font_size=” overlay_opacity=’0.4′ overlay_color=’#000000′ overlay_text_color=’#ffffff’ animation=’no-animation’ animation_duration=” animation_custom_bg_color=” animation_z_index_curtain=’100′ parallax_parallax=” parallax_parallax_speed=” av-desktop-parallax_parallax=” av-desktop-parallax_parallax_speed=” av-medium-parallax_parallax=” av-medium-parallax_parallax_speed=” av-small-parallax_parallax=” av-small-parallax_parallax_speed=” av-mini-parallax_parallax=” av-mini-parallax_parallax_speed=” hover=” blur_image=” grayscale_image=” fade_image=” appearance=” css_position=” css_position_location=’,,,’ css_position_z_index=” av-desktop-css_position=” av-desktop-css_position_location=’,,,’ av-desktop-css_position_z_index=” av-medium-css_position=” av-medium-css_position_location=’,,,’ av-medium-css_position_z_index=” av-small-css_position=” av-small-css_position_location=’,,,’ av-small-css_position_z_index=” av-mini-css_position=” av-mini-css_position_location=’,,,’ av-mini-css_position_z_index=” transform_perspective=” transform_rotation=’,,,’ transform_scale=’,,’ transform_skew=’,’ transform_translate=’,,’ av-desktop-transform_perspective=” av-desktop-transform_rotation=’,,,’ av-desktop-transform_scale=’,,’ av-desktop-transform_skew=’,’ av-desktop-transform_translate=’,,’ av-medium-transform_perspective=” av-medium-transform_rotation=’,,,’ av-medium-transform_scale=’,,’ av-medium-transform_skew=’,’ av-medium-transform_translate=’,,’ av-small-transform_perspective=” av-small-transform_rotation=’,,,’ av-small-transform_scale=’,,’ av-small-transform_skew=’,’ av-small-transform_translate=’,,’ av-mini-transform_perspective=” av-mini-transform_rotation=’,,,’ av-mini-transform_scale=’,,’ av-mini-transform_skew=’,’ av-mini-transform_translate=’,,’ mask_overlay=” mask_overlay_shape=’blob’ mask_overlay_size=’contain’ mask_overlay_scale=’100%’ mask_overlay_position=’center center’ mask_overlay_repeat=’no-repeat’ mask_overlay_rotate=” mask_overlay_rad_shape=’circle’ mask_overlay_rad_position=’center center’ mask_overlay_opacity1=’0′ mask_overlay_opacity2=’1′ mask_overlay_opacity3=” link=” target=” title_attr=” alt_attr=” img_scrset=” lazy_loading=’disabled’ id=” custom_class=” template_class=” av_element_hidden_in_editor=’0′ av_uid=’av-15lxf7g’ sc_version=’1.0′ admin_preview_bg=”][/av_image]

[av_icon_box icon=’ue885′ font=’entypo-fontello’ title=’Figure 3′ position=’left’ icon_style=’av-icon-style-no-border’ boxed=” font_color=” custom_title=” custom_content=” color=” custom_bg=” custom_font=” custom_border=” custom_title_size=’14’ av-desktop-font-size-title=” av-medium-font-size-title=” av-small-font-size-title=” av-mini-font-size-title=” custom_content_size=” av-desktop-font-size=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=” heading_tag=” heading_class=” link=” linktarget=” linkelement=” id=” custom_class=” template_class=” av_uid=’av-3vxlsc’ sc_version=’1.0′ admin_preview_bg=”]
It is important to undermine sufficiently to remove tension at the skin edges
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Preferred instrumentation:

General instrument pack.
Extra towel clamps to help manipulate and approximate skin.
Jackson-Pratt drain and grenade over the Penrose drain.

Post-operative Considerations:

Restricted activity for 10-14 days to allow skin to heal.
Potential Elizabethan collar or bandage to protect the site from being damaged by the patient.
Recheck and remove sutures in 10-14 days
Drain covering and management if necessary.
Client education on drain management.

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Detailed, narrated information on
- Basic principles of excising benign dermal and subdermal masses
- How to successfully manage more aggressive dermal and subdermal masses
- Burying a subcutaneous knot: why and how
- How to properly undermine so that the larger lumps are not a problem
- Single pedicle advancement flaps
- Free skin grafts
- Placing drains
- Reconstructive techniques to avoid
- Areas that are more difficult and how to manage (if you can’t avoid)
- Back up plans if a primary closure is elusive.

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How long will it take for my dog to heal from a lumpectomy?

Most lumpectomy site will heal in 10-14 days
Larger lumps that require more reconstruction techniques usually also take about 14 days barring any complications such as fluid accumulating under the skin.

Will the pet require a bandage after a lumpectomy? if so for how long?:

Most lumpectomies do not require bandages. However a veterinarian may opt to place a bandage to help protect the incision from being licked or to try and minimize motion and/0r fluid accumulation at the site surgical site

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