What surgical incisions are used to excise benign breast lumps?

Surgical Incisions for Benign Breast Lumps

For benign breast lumps, place curvilinear incisions following Langer's lines directly over or close to the lesion, using radial incisions for lower breast lesions, and avoid periareolar incisions for peripheral lesions. 1, 2

Incision Type Selection

Curvilinear Incisions (Primary Choice)

• Curvilinear skin incisions following Langer's lines achieve the best cosmetic result for most breast locations and represent the standard approach 1, 2
• Place the incision directly over or close to the tumor, not at the wire entry point for localized lesions 1
• These work best in the upper portions of the breast where natural tension lines minimize visible scarring 2

Radial Incisions (Location-Specific)

• Use radial incisions for larger lesions in the lower breast, particularly when skin removal is necessary 1, 2
• Radial incisions at the 3 o'clock and 9 o'clock positions provide better cosmesis in these specific locations 2
• This pattern prevents distortion of the nipple position or inframammary crease 2

Periareolar Incisions (Limited Use)

• Periareolar incisions are inappropriate for peripheral breast lesions as they do not provide adequate exposure and make obtaining complete excision difficult 1, 2
• Reserve periareolar incisions only for small lesions in the immediate subareolar area 1, 2

Critical Technical Principles

Incision Placement

• Make the skin incision as close to the lesion as possible; avoid tunneling through breast tissue 1
• Ensure adequate incision length to permit removal of the specimen in one piece 1
• In the upper inner breast, some skin retraction may be necessary to keep the incision hidden by clothing 1

Tissue Management

• Remove the lesion in one piece with a rim of grossly normal tissue; never fragment the specimen as this precludes proper margin assessment 1, 3
• Preserve subcutaneous tissue with separate closure to improve cosmetic outcome 1, 3, 2
• Do not reapproximate breast tissue—allow the cavity to fill with serum, as closure that appears adequate supine causes distortion when upright 1, 3, 2

Closure Technique

• Close all skin incisions with subcuticular technique to optimize cosmetic results and minimize visible scarring 1, 3, 2
• Avoid excising skin segments as this may alter nipple position or the inframammary crease 1, 2

Hemostasis Requirements

• Meticulous hemostasis is critically important—hematoma formation produces changes difficult to interpret on physical examination and mammography 1, 3, 2
• These changes may be long-lasting and lead to unnecessary repeat biopsies 1, 3
• Avoid placing drains in the breast 1

Common Pitfalls to Avoid

• Never tunnel from a distant incision to reach the lesion—this compromises cosmesis and complete excision 1
• Do not use periareolar incisions for peripheral lesions—they provide inadequate exposure and compromise margins 1, 2
• Avoid fragmenting the specimen during removal—this prevents accurate size determination and margin assessment 1, 3
• Do not reapproximate breast tissue—this creates distortion when the patient is upright despite appearing adequate supine 1, 3, 2

Alternative Approaches

While transaxillary endoscopic excision has been described for benign breast lumps with excellent cosmetic results (avoiding breast scars entirely), this requires specialized equipment and expertise 4, 5, 6. The standard open approaches described above remain the conventional treatment for most benign breast lumps 7.