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Challenge number seven, retro areola lesions.

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Nobody's friend. So retro areola lesion lesions

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have a number of challenges.

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One, the grid is not in good contact with the breast.

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There you can see there's a big air gap between where the,

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this is diagnostic study, but you've got your grid here

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and where that the breast kind

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of curves off in the sub areola area.

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And so when you try and put your needle in,

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everything pushes away from you.

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You're not gonna have problems with your targeting.

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The second is that's a very sensitive area of the patient.

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The third is it's a very vascular area to biopsy.

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And a fourth is especially in patients with small breasts,

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not so much in this that the breast can get very thin there

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and give you only a very, um, small depth of tissue.

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We'll talk about thin breasts in a

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minute to be able to target.

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You also really wanna be very careful

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biopsying towards the nipple in this case

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because if you biopsy towards the nipple,

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you may end up removing part of the nipple.

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Now, just as a little aside here, um, I was sent one patient

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to biopsy with a quote, retro alar lesion

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that they couldn't see on ultrasound

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and it turned out to be an inverted nipple.

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Um, luckily the lady hadn't seen her nipple, um,

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for her entire life

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because by the time it had been biopsied, um,

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she no longer had a nipple on that side.

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And it was a kind of interesting path report.

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But just, you know, something to be aware of.

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Inverted nipples looked like retro ola acids.

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So one of the things

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that we can do is improve the grid contact

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for retro ola lesions.

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So this is what's gonna happen in the average

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retro ola lesion.

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You'll put your grid here, and as I said, you're gonna try

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and come through the grid

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and everything's gonna push away from you.

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It's difficult to get the can through the skin and so on.

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So we have a little flexible bolster that the Mr.

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Tech just wedges behind the patient's breast.

1:59

On the other side of it, from where you are coming

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and you can see now you have really nice contact

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between the grid and the skin.

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You'd want to have good grid

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to skin contact in the area that you're going to biopsy.

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We can do another couple of things.

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You can see here how we've rolled the breast

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and that's gonna help make it a little bit thicker

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in the area that you are doing.

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If it looks very thin in that area,

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you can use the petite needle with

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that one centimeter chamber

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and the blunt tip do the padding I just showed you.

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And then I would highly recommend

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that you anesthetize this area extremely well,

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preferably using lidocaine with epi to reduce the risk

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of bleeding.