~ 287 ~ International Journal of Surgery Science 2019; 3(4): 287-291 E-ISSN: 2616-3470 P-ISSN: 2616-3462 © Surgery Science www.surgeryscience.com 2019; 3(4): 287-291 Received: 28-08-2019 Accepted: 30-09-2019 Dr. Ketan Vagholkar Professor, Department of Surgery. D.Y. Patil University School of Medicine. Navi Mumbai, Maharashtra, India Dr. Shantanu Chandrashekhar Resident, Department of Surgery. D.Y. Patil University School of Medicine. Navi Mumbai, Maharashtra, India Dr. Dhairya Chitalia Resident, Department of Surgery. D.Y. Patil University School of Medicine. Navi Mumbai, Maharashtra, India Dr. Shivangi Garima Resident, Department of Surgery. D.Y. Patil University School of Medicine. Navi Mumbai, Maharashtra, India Dr. Anmol Sahoo Intern, Department of Surgery. D.Y. Patil University School of Medicine. Navi Mumbai, Maharashtra, India Corresponding Author: Dr. Ketan Vagholkar Professor, Department of Surgery. D.Y. Patil University School of Medicine. Navi Mumbai, Maharashtra, India Novel technique of mastectomy for breast cancer presenting as an abscess Dr. Ketan Vagholkar, Dr. Shantanu Chandrashekhar, Dr. Dhairya Chitalia and Dr. Shivangi Garima DOI: https://doi.org/10.33545/surgery.2019.v3.i4e.258 Abstract Association of an abscess with breast cancer is quite uncommon. Breast abscess encountered in a non- lactating woman should be considered as a malignancy until proven otherwise. A case of malignancy of the breast presenting as an abscess is presented along with a novel technique of mastectomy in such uncommon cases. Keywords: Carcinoma breast abscess treatment surgical Introduction Breast abscess is one of the commonest benign diseases of the breast. It is usually encountered during the period of lactation [1, 2] . Many a times breast abscesses presenting in non-lactating women may be misleading, leading to misdiagnosis of an underlying malignancy. Once diagnosed as malignant, special care with respect to the technique needs to be adopted in order to achieve complete resection of the malignancy along with the abscess cavity. A novel technique of mastectomy is presented in the article. Case Report A 77 year old lady presented with swelling and fullness of the right breast over a period of 2 weeks. She was diagnosed with a breast abscess and the abscess was drained under general anaesthesia. Approximately 150cc of pus was drained. Culture of the pus revealed staphylococcus aureus. The wall of the abscess cavity at the time of drainage was palpated. In certain areas excessive hardness was appreciated. In view of this, multiple biopsies were taken from the wall of the abscess cavity. Histopathology of biopsy revealed invasive carcinoma (no special type) with focal squamous metaplasia. Patient also had clinically palpable axillary lymph nodes. Patient underwent modified radical mastectomy. A novel technique to ensure complete resection of the abscess cavity along with the growth was adopted. 5cc of methylene blue with 1cc of hydrogen peroxide was injected into the abscess cavity taking utmost care to prevent spillage of the contrast through the incision (figure 1). The skin incision of the drained abscess cavity was closed with a continuous suture. (Figure 2) A sterile waterproof dressing was applied over the suture line. The mass was marked by a marking pen. The incision for mastectomy was also marked (figure 3). A right modified radical mastectomy with an axillary clearance was done. The resected specimen was turned around and examined for any methylene blue staining as well as the underlying pectoralis major muscle. (Figure 4a& 4b) The operated site was irrigated with 3% hypertonic saline and hydrogen peroxide (100 cc of hypertonic saline mixed with 3cc of hydrogen peroxide) for a period of 20minutes (figure 5). The operated site was then irrigated by normal saline. The axillary vein for a length of 10cm was cleared of all fibro fatty tissues and lymph nodes. The nerve to serratus anterior as well as nerve to latissimus dorsi was safeguarded (figure 6). Two negative suctions were placed, one over the pectoral muscles and one in the axilla. Drain was removed on the 10 th post-operative day ensuring no drainage at all. Staples were removed on the 14 th post-operative day and complete healing was achieved. The patient is undergoing chemotherapy. She has been following up for last 6 months with no evidence of local recurrence. (Figure 7) Histopathology revealed an invasive carcinoma (no special type) with focal squamous metaplasia. (Figure 8) (ER and PgR