1. Introduction

2. Demonstration of Localizing Device

3. Patient Prep

a. Time-out

b. Inject Local Anesthetic

4. Surgical Approach

5. Incision

6. Flap Raising

7. Seed Localization

8. Excision of Lesion

9. Specimen Orientation

10. Intraoperative Imaging for Confirmation of Margins

11. Resection of Cavity Shave Margins

12. Hemostasis, Shave Margin Orientation, and Results from Radiology

13. Clip Placement to Mark Cavity for Radiation Oncology

14. Closure

15. Post-op Remarks

Breast-conserving surgery with radiation for early stage breast cancers provides equivalent survival rates to mastectomy when all surgical margins are clear of residual cancer. For patients whose tumors are not palpable upon physical examination, pre-operative localization of the malignant tissue to be removed is necessary. While wire localization is the traditional method of localization, a variety of wireless localization devices have become available as viable alternatives. Seed localizations provide several advantages over wire localization, including fewer scheduling issues, less patient anxiety, and reduced patient discomfort. Wire localizations must occur on day of surgery, while seed localizations may occur prior to surgery. Seed localization devices guide the breast surgeon to the target, typically a malignancy that must be removed in its entirety to give the patient the best likelihood of disease-free survival.

Watch full-length, narrated surgical video of a Lumpectomy performed with wireless seed localization for ductal carcinoma in situ.

Massachusetts General Hospital