DIAGNOSTIC BREAST PROCEDURES
The diagnosis of a breast problem can usually be completed by taking the history of the patient and having a physical examination by one of our experienced breast surgeons. Mammograms and ultrasounds are also valuable aids in the diagnosis of breast problems. When further diagnostic methods are needed, our surgeons have many techniques available including office ultrasound.
Occasionally various breast biopsy procedures are needed to help determine the diagnosis. We offer a number of minimally invasive biopsy techniques.
Breast Biopsy Techniques
- Fine needle aspiration (FNA): FNA is a biopsy technique performed with a very small needle. This needle is passed into the breast while suction is applied. The sample is microscopically analyzed for suspicious cells using a technique similar to Pap smears. It is the least invasive biopsy technique available and takes only 1-2 minutes. The results are available within 48-72 hours.
- Ultrasound guided biopsy: This biopsy technique is used in our office frequently. Using our office ultrasound unit, a special biopsy needle is guided into the area of interest. When the needle is in the area of concern, the biopsy needle is activated by the surgeon and quickly harvests a small core sample of breast tissue. This is usually done 2 or 3 times to make sure the region has been adequately sampled. This procedure takes about 5 minutes and is easily tolerated. The results are usually quite precise and are available in 48-72 hours.
- Stereotactic biopsy: This technique uses the same type of special biopsy needle as the ultrasound guided biopsy; however, the guidance mechanism used is a digital mammogram technique that is computer aided. This biopsy technique is performed by our surgeons in the radiology suite at the hospital. This technique is usually used in cases where the abnormality can only be seen on a mammogram and may be invisible on ultrasound. It is also done using local anesthetic techniques and requires no preparation. Several biopsies are taken to ensure accuracy and the results are available in approximately 72 hours.
These three techniques are all office or outpatient procedures. All can be done quickly with the patient able to resume normal activities immediately following the procedure.
SURGICAL BIOPSIES are occasionally required when less invasive biopsy techniques are not feasible or insufficient for diagnosis. Occasionally a needle localization wire will be placed by a radiologist before a surgical biopsy. These biopsies are performed at the hospital or at a local outpatient surgery center.
While the vast majority of all breast biopsies are benign (non-cancerous), we occasionally make the diagnosis of breast cancer. Our surgeons offer all accepted procedures for breast cancer treatment. Our breast surgeons chair local and community breast screening and treatment committees. They meet regularly to ensure that the latest and most effective therapies are available including investigational therapies.
THERAPEUTIC BREAST PROCEDURES
A number of surgical options are available to the patient when breast cancer surgery is necessary.
- BREAST LUMPECTOMY: This surgery involves removing the cancerous area of the breast plus a surrounding area of normal breast tissue. Every attempt is made to preserve breast shape and size. This approach is appropriate for most small breast cancers and some larger breast cancers. It is accompanied by removal of one or more of the lymph nodes under the arm, where breast cancer tends to spread first (see Sentinel lymph node biopsy). After healing is complete, radiation treatment is given to the remaining breast tissue to minimize the chance of recurrence. Lumpectomy is one of the most popular current surgical treatments for breast cancer. The lumpectomy procedure is usually done as an outpatient. Average recovery time is one week.
- MASTECTOMY: This operation is the oldest surgical treatment for breast cancer. This operation involves the removal of all breast tissue; however, in recent years it has been modified to remove only the nipple and a small amount of surrounding skin along with the underlying breast tissue. Additionally, some lymph glands under the arm are removed. No muscles are removed and seldom is radiation required. This operation is used often for very large or extensive tumors, or for patients who are unacceptable candidates for lumpectomy. This surgery is also usually done in conjunction with immediate breast reconstruction, which is performed by a plastic surgeon. There are many different types of breast reconstruction including breast implants and muscle transfer flaps. Consultation with a plastic surgeon is strongly encouraged before proceeding with mastectomy.
- SENTINEL LYMPH NODE BIOPSY: Over the past ten years, surgeons have developed a surgical technique to reliably identify the specific lymph nodes draining the area of a breast cancer. These lymph nodes can be precisely identified by an injection of a radioactive tracer and a blue dye into the breast just before surgery. These lymph nodes have a great deal of prognostic significance, but until now were difficult to locate with precision. The lymph nodes undergo special microscopic testing to determine, with the highest possible accuracy, the stage of the breast cancer.
In some situations, sentinel lymph node removal will suffice without requiring the standard axillary lymph node dissection. This very new and exciting procedure is available through our breast surgeons and is integrated into our team approach with radiologists, pathologists, radiation oncologists and medical oncologists.