A prospective audit of simple mastectomy under local anaesthesia

The treatment options for breast cancer in elderly or unfit patients can be complicated by their coexistent medical problems. This study assesses the feasibility of simple mastectomy under local anaesthesia by means of a prospective audit on 36 patients with breast carcinoma and an ASA grade of 3 or worse. In 27 patients the tumour had escaped from tamoxifen control, no patients having had previous radiotherapy. Operation time ranged from 40 to 70 min, average blood loss was 200 ml and an average inpatient stay of 5 days. Only two patients had a resection margin less than 1 cm and in none was there significant morbidity or mortality despite the patients' poor pre-operative medical condition. This confirms the potential of using local anaesthetic for simple mastectomy. Eliminating the morbidity/mortality due to general anaesthesia widens the range of treatment available (especially to medically unfit patients) giving them the option of a rapid resolution to what could be a distressing protracted condition.