Prophylactic and Gender Affirmation Mastectomy

Auto Text: “Insert Breast Prophylactic Mastectomy”


  1. Verify that the orientation on the requisition matches the container label and the actual specimen.
  2. Weigh.
  3. Measure medial to lateral, superior to inferior, anterior to posterior.
  4. Measure skin ellipse, areola, nipple.
  5. Ink all cases as follows:
    • Deep/posterior surface = black
    • Anterior-superior surface = blue (sky!)
    • Anterior-inferior surface = green (grass!)
  6. Dry off excess ink!  Apply vinegar to help ink stick to tissue.
  7. Serially section the specimen at the DEEP surface from medial to lateral, NOT cutting all the way through.
  8. Take note of any identifiable lesions (size, location, slice #, distance to margin).
  9. Wrap strips of gauze in between the slices in order to wick formalin between the slices.
  10. Fix in formalin.
  11. Note the time the specimen is placed in formalin.
  12. Ensure that the specimen is in a container in which the volume of formalin is 10-times the volume of the tissue.


  1. If lesions are identified, submit, stating size, location (quadrant), slice #, and distance to margins.
  2. Take ONE representative section of fibrous tissue from each of the four quadrants AND CENTRAL BREAST:  UOQ, UIQ, LOQ, LIQ, central breast (5 sections total).  Remember the goal is to sample throughout the fibrous breast tissue.
  3. Fibrous tissue present here under nipple: 
  4. Take a single representative section of skin.
  5. Take a single representative section of nipple with areola.
  6. For ALL breast cases, dictate the following: Tissue fixed for at least 6 hours in 10% NBF and no more than 72 hours. (Auto Text: “Insert Breast Fixation”)

Updated 06-05-2021 NAC

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