breast aesthetics

This leaflet is for anyone who is undergoing an operation to remove a skin lump or lesion. This operation is normally carried out under local anaesthetics, as at the dentist. This leaflet will help you to understand and prepare for the procedure.

It is important that you read and understand this leaflet before agreeing to have the operation. Please bring this leaflet into hospital when you are admitted.

What is a skin biopsy?

It is a minor operation to cut out an area on your skin that is causing concern; it is done under local anaesthetic.

The lump or lesion is removed along with a narrow margin of skin around its edge; your wound will be closed using stitches, a skin graft or another method.

If your lesion is large, your surgeon may, on occasions remove only a small sample to enable diagnosis.

Why are you having the biopsy?

It is not always possible to distinguish between skin cancers and non-cancerous conditions by observation; a biopsy allows the lesion to be removed and analysed under a microscope to make a diagnosis.

What are the risks associated with the operation?
Most operations are straightforward, however with any surgical procedure there is a small chance of side effects or Complications. This list of risks and complications is not intended to put you off having the operation, however you need to be aware of the potential risks and complications before you sign a form consenting to the operation.

Bleeding. There is a risk that you may experience bleeding from the site of the operation; this could result in a collection of blood beneath the stitch line, known as haematoma. If this occurs you could experience pain and swelling in the area, the collection of blood may need to be removed, this may necessitate another operation.

Infection. There is a risk of wound infection, which can occur at any time following surgery. Symptoms of infection may include increased swelling, redness, fluid leakage and increased pain at the site of the operation. If your wound becomes infected you may need treatment with antibiotics. Less commonly an abscess may form warranting drainage. After a wound infection healing could be delayed and you may need dressings for a prolonged period of time.

Scarring. You will have a permanent, visible scar on your skin. Your scar may improve over a period of 18 months following surgery, however some people, for unknown reasons, develop raised, red and lumpy scars; unfortunately this is largely beyond surgical control. Certain areas of the body are prone to developing thicker and more unsightly scars. Scars on your shoulders, chest and ears are more at risk of becoming raised and lumpy than other areas, these are known as keloid scars, the more mild form is know as hypertrophic scars. Scars on your back and limbs are at risk of becoming stretched and may not have as good a cosmetic result as scars in other areas.

Wound breakdown. There is a risk that your wound may break down or gape following surgery. This could happen if the stitch line does not heal appropriately or if the blood supply to the skin becomes interrupted. If wound breakdown happens you will require dressings for a longer period of time than usual and your scar may not have as good a cosmetic result.

Reaction to the local anaesthetic. There is a very slight risk of developing a reaction to the local anaesthetic used to numb the skin before your operation. If this happens you could experience swelling of your lips or mouth and in more severe cases you may experience tightness of your chest or difficulty in breathing. Please inform the surgeon if this occurs during your operation.

There may be other risks specific to your individual case; your surgeon or nurse will discuss any further risks with you.

What preparation will you need?

If your GP prescribes aspirin, clopidogril, ibuprofen or other medications which may cause bruising or bleeding, you may be asked to stop taking these for a period of time before your operation. These medications may increase the risk of bleeding during and after your operation. Your surgeon will advise you about this when you see him / her in clinic.

If you normally take warfarin tablets you may be asked to stop taking these 3 days before your operation. You may also be asked to have a blood test on the day of your operation.

On the day of your operation:

You may eat and drink normally.

Please bring all your medicines into hospital with you including tablets, inhalers and sprays.

Please remove all nail varnish before you come to hospital and keep make-up to a minimum. If possible, please leave all jewellery at home. Please bring in a dressing gown and slippers.

You may have to wait for your operation; it is advisable to bring something with you that will help you pass the time, such as a book or magazine.

What happens when you arrive at the hospital?

Your admission letter will inform you of the venue where the operation will take place.

You will be asked to sign a consent form agreeing to your operation. This will be on the day of surgery and a photograph is usually taken.

You may be asked to change into a gown and to remove any remaining jewellery, make up and nail varnish before your operation.

What type of anaesthetic will you need?

Your operation will be performed under a local anaesthetic. This involves the surgeon giving you an injection to numb the area around your skin lesion before operating.

You will be awake throughout the procedure. Unless you specifically wish to go to sleep, you will need to discuss this at the outpatient appointment.

What happens after the operation?

You may have stitches and a dressing over the wound.

If you have a skin graft you will have two wounds; the skin graft itself and the donor area from where the skin graft was taken.

You will be allowed to go home when your follow up appointments, if required have been arranged, and nursing staff are happy with your wound.

Going home

It is advisable not to drive after a local anaesthetic, so please arrange for someone to take you home.

Your local anaesthetic should wear off after about 2-3 hours. If you experience pain after this you could take a mild painkiller, such as paracetamol.

You will experience some swelling around the site of your operation; elevating the affected area may relieve the swelling. If your operation was on your:

Head or face, you should sleep with an extra pillow.
Leg or foot, you should elevate your leg on a footstool or sofa whilst sitting and should keep your leg on a pillow in bed.
Arm or hand, you may be given a sling to elevate your arm. At night you should sleep with your arm on a pillow.

Please keep your wound or dressing dry. Please do not touch your wound as this could cause infection.

If your wound begins to bleed after you have gone home, apply pressure to the area for 5 minutes using a clean handkerchief or something similar. If you continue to bleed contact the hospital.

Follow up

The sutures are removed in dressing clinic ~ five- seven days in the case of facial surgery and seven- ten days following surgery on the trunk unless a skin graft is involved, then you will see your surgeon in the outpatient clinic few weeks following the surgery.

At this appointment your plastic surgeon will tell you results of the biopsy, and when required will discuss any further treatment.

What can go wrong?

It is normal to have some bruising, swelling and tenderness around your wound following the operation.

However, if you suffer from any of the following symptoms after your discharge from hospital you should telephone the plastic surgery department for advice.

Persistent or increasing levels of pain

Fever, or a feeling of heat in your wound.

Redness or swelling around your wound.

Leaking, or a feeling of wetness around your wound.

When can you resume your normal activities again?

You should ask your surgeon or nurse to advise you about whether you need to take any time away from work or whether you should refrain from driving.

Please ask if you require a doctors' certificate for your work.

Please ask your surgeon or nurse to advise you about when you can resume exercise or sporting activities.

Leaflet information
This information leaflet has been devised by:
Mr A.M. Juma, Consultant Plastic & Reconstructive Surgeon

Protection of health care workers
In accordance with the Department of Health Guidelines for Clinical Health Care Workers 1998 (Protection Against Infection with Blood-borne Viruses), you may be required to provide a blood sample if a member of staff sustains an injury involving a used needle, sharp instrument and/ or contamination with your body fluids.
Your co-operation would be greatly appreciated.