Is making a small horizontal incision along the breast, specifically in the area of maximal tension, considered gross negligence?

From the Guidelines

Making a small horizontal incision along the breast in the area of maximal tension is not inherently gross negligence, as it can be an appropriate surgical technique in certain circumstances. Surgical incision planning should follow established principles of plastic and reconstructive surgery, with consideration for the natural tension lines of the skin (Langer's lines) 1. For breast procedures, incisions are often placed in the inframammary fold, periareolar region, or axillary area to minimize visible scarring. However, in some cases, a horizontal incision along tension lines may be indicated based on the specific procedure, patient anatomy, and surgical goals.

Key Considerations

• The location of the tumor in the breast may be a consideration in the choice of local treatment 1
• A patient with an adequate resection usually involves removal of all or part of the nipple areola complex, and whether this is preferable to mastectomy needs to be assessed by the patient and her physician 1
• The goals of any surgical procedure on the breast are total removal of the suspicious or known malignant tissue and minimal cosmetic deformity 1 Gross negligence would only occur if the surgeon significantly deviated from the standard of care, such as making inappropriate incisions without proper indication, failing to obtain informed consent, or demonstrating a reckless disregard for patient safety. The appropriateness of any surgical incision must be evaluated in the context of the specific procedure, the surgeon's training and experience, and whether the approach follows established surgical principles.

From the Research

Incision Placement and Tension

• Making a small horizontal incision along the breast, specifically in the area of maximal tension, is a technique that may be considered in surgical procedures to minimize scarring and promote healing 2.
• Reducing tension across the healing wound is an important factor in minimizing scarring, and surgeons can support healing by using techniques such as layered closure, undermining, and tissue expansion to relieve tension across the healing wound 2.

Incisional Negative Pressure Wound Therapy (INPWT)

• INPWT has been shown to decrease the incidence of infection, sero-haematoma formation, and re-operation rates when used on surgical incisions 3.
• Preclinical studies have suggested that INPWT reduces lateral tension on incisions, increases wound strength, and reduces scar width upon histological assessment 4.
• Clinical studies have reported improved patient-reported scar satisfaction and observer-reported scar satisfaction when using INPWT 4.

Surgical Scarring

• Pathological scars can result in functional impairment, disfigurement, psychological burden, itch, and chronic pain, and minimizing scarring is an important goal in surgical procedures 4.
• New technologies and techniques, such as INPWT and novel skin closure devices, are being developed to optimize healing of surgical incisions and minimize scarring 3, 4, 5.

Gross Negligence

• There is no direct evidence in the provided studies to suggest that making a small horizontal incision along the breast, specifically in the area of maximal tension, is considered gross negligence.
• However, it is important to note that surgical techniques and incision placement should be carefully considered and planned to minimize scarring and promote healing, and that failure to do so may be considered negligent 2.