Breast Surgery: Tools of the Trade

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One of first words that comes to mind when you think of an operation is SCALPEL!  But what else is used for performing surgery? Traditionally scissors and sutures were used by surgeons for dissection and controlling bleeding. Now surgeons use additional technologies to help them.

Monopolar Electrocautery
Monopolar electrocautery uses electrical currents. The tool used is called a “Bovie,” which is connected to a source that generates the current. The current goes into the tissue through the “Bovie” tip when the surgeon activates the device. The energy concentrates on the area around where the “Bovie” tip touches. The current must then pass out of the body. A “Bovie” pad is placed on the patient so that the current can pass out of the body through this grounding pad. The “Bovie” allows the surgeon to perform dissection and seal small blood vessels and lymphatics.

Bipolar Electrocautery
Bipolar Electrocautery also uses electrical current, but it is delivered by an instrument resembling a tweezers. The current passes between the 2 tweezer prongs.  The bipolar electrocautery is more precise than monopolar electrocautery and is excellent for sealing blood vessels and lymphatics. It is not as useful in dissection as a “Bovie.” Bipolar electrocautery is used in patients who are pacemaker dependent as there is much less chance of current traveling and short-circuiting the pacemaker generator.

Ultrasonic Frequency Dissection
Ultrasonic surgical devices (Harmonic Scalpel) use ultrasonic vibration for dissection and sealing blood vessels and lymphatics. The tip of ultrasonic frequency device resembles a scissors. Tissue is grasped between the tips and the surgeon then activates the ultrasonic vibration for dissection and for sealing blood vessels and lymphatics. There is no risk of electrical currents passing through the body. However the tip of the device can become quite hot. Care must be taken not to “burn” other tissue or the operative drapes.

Radiofrequency Energy Dissection
The newest tool in the toolbox uses brief pulsed radiofrequency energy for dissection and bleeding control. The device (PEAK PlasmaBlade™) handles like a “Bovie” but the amount of energy delivered is significantly less than the traditional monopolar electrocautery device. Only the very tip of the PEAK PlasmaBlade™ device delivers the energy, compared to the entire spatula shaped tip of the “Bovie.” The PEAK PlasmaBlade™ is associated with less collateral tissue damage, improved healing and better cosmetic results.

Which devices your surgeon uses will depend on their preference and your medical conditions.