0:00

So patients who have very thin breasts

0:04

or they have breast implants can

0:06

be particularly challenging.

0:07

And I'm gonna show you some techniques

0:09

that may help you in these circumstances.

0:12

So biopsies can be, uh, safely

0:14

and successfully performed on extremely thin breasts, um,

0:18

as well as in patients who have breast implants.

0:21

Uh, the risk of perforation a breast implant is

0:25

very small, but not impossible.

0:27

It's not happened to me,

0:28

but I know it has happened to people.

0:30

And really using very slow, careful

0:32

and modified techniques is, is the, uh, key here.

0:37

So do please consent patients who have implants

0:40

for implant rupture.

0:42

You know, as I say, that's just gonna be a,

0:44

a very unlikely outcome,

0:46

but it is good to have that on the consent form

0:50

so you can use local anesthetic to be able

0:51

to thicken up the breast skin.

0:53

There's, uh, these works particularly well in patients

0:55

who have dense breasts, which these often are.

0:59

You need to insert your needle very slowly, very steadily.

1:04

You need to be able to keep an eye on that tip at all times.

1:08

And, um, you know,

1:09

your needle's gonna be much more parallel to the skin.

1:11

Obviously, considering using the open needle technique

1:14

that I described earlier,

1:16

it can be quite helpful in these patients, um,

1:18

as you don't have that spring deploy in those cases

1:22

and only vacuum if you really feel there is sufficient

1:25

tissue depth to be able to do

1:26

that safely without suctioning in skin.

1:30

This was a biopsy in the patient who had had, uh,

1:33

mastectomies with implant placement

1:37

and they had what turned out

1:38

to be a recurrence in their breast.

1:41

So, you know, we really have very little, uh,

1:43

breast tissue here to deal with.

1:45

And what I'm doing is hydro dissecting

1:47

that lesion off the implant.

1:49

I'm just, you can see my tip at all times.

1:52

I'm injecting local anesthetic ahead of it, um,

1:55

and just giving us a little bit more of a cushion

1:58

between the lesion and the implant.

2:01

This is the same patient when I'm doing the biopsy.

2:03

In this case, I've gone in with, um, my open, uh, chamber.

2:08

I've not used an introducer in this case.

2:10

And you can see here, this is the chamber, um,

2:13

just open in the lesion

2:15

post deploy in the longitudinal axis.

2:18

You can see I'm through this little lesion.

2:20

This lesion is under five millimeters.

2:23

Um, and then I've turned my probe perpendicular

2:26

because this is a small lesion to make sure

2:29

that my needle is indeed within the lesion.

2:32

I'm getting adequate sampling.

2:35

And just to show you that even with a vacuum biopsy,

2:38

if you're very careful and you are, uh, watching it, that,

2:41

um, these biopsies can be performed.

2:43

This was biopsy of calcifications in a patient who had, uh,

2:48

virtually no native breast tissue, uh, anterior

2:51

to their implant, but they did have calcifications.

2:54

We couldn't do a stereo in them.

2:56

And so this was a vacuum biopsy

2:57

and being done of that patient

2:59

and say, you do need to watch your skin very closely,

3:02

but you really only need a few millimeters, uh, of, uh,

3:05

distance between the two to do a safe biopsy.