Perioperative Considerations in Breast Cancer Surgery

There are many considerations in perioperative evaluation and management of the breast cancer patient. A literature review was performed to identify evidence for best perioperative practices of venous thromboembolism (VTE) prophylaxis, antibiotic prophylaxis, and axillary mapping. VTE risk after surgery for breast cancer is lower than for other oncologic procedures, but for patients identified as high risk, pharmacologic VTE prophylaxis may be used without increased risk of hematoma. There is conflicting data on whether preoperative antibiotic is required for all breast cancer surgery. Various tracers may be used in axillary and reverse axillary mapping to improve axillary node identification or decrease arm morbidity. Dual tracer technique may not be necessary for every patient undergoing axillary staging. Perioperative management recommendations for VTE, antibiotic prophylaxis and sentinel node localization should be based on individual patient characteristics and risks as well as procedure type.