Mammograms and ultrasounds are valuable aids in the diagnosis of breast disease. We have experienced technicians at both of our hospitals. Many patients do not get their yearly mammograms because the complain that the procedure is too “painful”. Our technicians are very aware of this. All of our technicians are female and understand what it means to have your breast “compressed”. They are very caring and very understanding.
Mammograms are recommended every year for females that are 40 years of age and older. Most insurances cover a yearly “screening” mammogram. If the patient or the physician palpates a new mass, then the insurances will cover an additional mammogram even if you have had one within the past 12 months. The American College of Surgeons also recommend that a female begin having screening mammograms at the age of 35 if there is a family history of breast cancer, otherwise they recommend to start at 40.
The two terms that we use to order mammograms are screening and diagnostic. A screening is just that, we don’t feel a mass, but want to check both breast with a mammogram. A diagnostic on the other hand is when we feel a mass and we want to know the mammographic characteristics of that mass.
Once you get a mammogram and/or ultrasound, you may find out that it is abnormal. You may receive a letter from your family physician and/or may get a letter from the hospital. This does not mean that you have cancer. In general nearly 75% of abnormalities found on a mammogram and/or ultrasound are benign (not cancer). You may hear microcalcifications, you may hear a mass, you may hear a cyst, etc. We will discuss each situation with you.
If we have a mass felt by either the pt or the physician, or the mammogram and/or ultrasound shows an abnormality, then we will likely want to get a biopsy. Most of the time this means a biopsy.
WE OFFER A NUMBER OF NON-SURGICAL BIOPSY TECHNIQUES:
FINE NEEDLE ASPIRATION BIOPSY:
This is a biopsy technique done with a very small needle. This needle is passed in and out of the breast lump using local anesthesia. (this is the like what the dentist uses on your mouth). This pulls out microscopic amounts of breast tissue that is then analyzed by the pathologist by looking at those cells under a microscope. This only take a few minutes and is done in the office. This is no more painful than having a blood test drawn, and most patients say that it is less painful than having the mammogram done. This is a simple way to give us a diagnosis, however this does not always give us the information that we need and an additional biopsy may be required.
ULTRASOUND GUIDED BIOPSY:
This too is an office procedure. It is similar to the procedure just discussed, but usually is done on a lump that can’t be felt, but was found during an ultrasound examination. Sometimes a mass that can be felt is found to show up on ultrasound, therefore the ultrasound is used to guide the biopsy. This procedure takes about 15 minutes and is no more painful the having blood drawn.
STEREOTACTIC BIOPSY:
This technique uses a special biopsy needle and is done in the mammogram suite in the hospital. This technique is usually done when we find microcalcifications on a mammogram. This technique is computer aided and allows a core needle to be inserted into the breast tissue. This is done under local anesthesia. Several biopsies are obtained, the procedure usually takes about 30 minutes and is about as painful as having local anesthesia and a mammogram combined.
SURGICAL BIOPSIES:
Occasionally the physician must perform a surgical biopsy. There is an open biopsy were a small incision is made in the breast and a needle localization biopsy, where a wire is placed into the breast and “directs” the physician to the abnormal tissue within the breast. These procedure are done in the operating room under MAC anesthesia (which means local anesthesia and some sedation from the anesthesia department). This is not general anesthesia. This is an outpatient procedure in which you go home the same day. There are some patients that request general anesthesia to be given, and that is ok as long as we have discussed this preoperatively.
IF BREAST CANCER IS DIAGNOSED BY ONE OF THE BIOPSY TECHNIQUES:
We often get asked about what we do if cancer comes back on the pathology report. Various breast therapeutic procedures and treatment plans are available. We encourage the patient to bring their spouse, significant other, family etc. to our office for a conference. Some of the treatment plans start with surgery and may end with chemotherapy, where others may just take a “pill”. We are part of a breast cancer team and have a “tumor board” which meets every month to plan each treatment. Your case will be discussed at this meeting, but of course you name will not be mentioned, just your case. The “TEAM” concept ensures that the latest and most effective therapies are presented to you and your family so you can make a well-informed decision about your body.
BREAST THERAPEUTIC PROCEDURES:
A number of surgical options are available to you when breast cancer surgery is necessary.
BREAST LUMPECTOMY:
This involves removing the cancerous area of the breast plus an area of normal breast tissue around the cancerous area. We try very hard to preserve the size and shape of the breast tissue. This is also accompanied by removal of a portion of the lymph nodes under the arm. Breast cancer tends to spread to this area first when it spreads. By sampling these nodes, we have an idea of the prognosis of your cancer and whether any chemotherapy is required. After healing is complete, radiation therapy is given to the remaining tissue to minimize the chance of local recurrence in that breast. Once again, the goal of this surgical treatment is to do a cancer operation on the involved breast while preserving most of the other normal breast tissue within that breast. It gives the patient the sense of self preservation. Lumpectomy is one of the most popular current surgical treatment plans for breast cancer. Most patients go home the day of the procedure, but may stay overnight if they desire. The recovery time is usually one week.
MASTECTOMY:
This operation has been available for many years. This involves removing the entire breast, nipple and skin and lymph nodes under the arm. No muscle is removed and rarely are there any side effects. Seldom radiation is required. This operation is usually done for women with large cancers, or when doing a lumpectomy would distort the breast too much or for patients that are unwilling to accept the requirements of lumpectomy which always includes postoperative radiation. Some patients also want their entire breast removed anyway because it is “cancer”. Most patients stay overnite in the hospital and the recovery is about one to two weeks.
SENTINEL LYMPH NODE BIOPSY: (NEW TECHNIQUE)
With either the lumpectomy or the mastectomy, the lymph nodes under the arm must be sampled. This means removed. Within the last two years, surgeons have developed a minimally invasive technique that allows some of these nodes to be removed. In the past, surgeons removed many of the nodes under the arm and this gave rise to the possible complication of lymphedema. This is where the entire arm swelled to tremendous size. This chance of this happening was around 6%, but for those patients it was a tremendous problem. We now how the ability to “sample” the nodes under the arm and remove only a few of them. This significantly reduces the risks of swelling of the arm. In theory, the “sentinel” node is the first node in the chain that drains the breast cancer. By removing this node and examining it under the microscope, the surgeon can stage the breast cancer. Once again, the stage of the cancer determines your prognosis and whether you need further treatment postoperatively. These lymph nodes can be precisely identified and removed by an injection of a radioactive tracer and a blue dye in the area of the cancer just before surgery.
POST-MASTECTOMY RECONSTRUCTION
For patients who wish or require mastectomy, our group has developed an association with our local plastic surgeon. This allows all forms of breast reconstruction to be available locally. We coordinate these operations together. You will have a preoperative consultation with the plastic surgeon if you desire reconstruction. All of the most sophisticated forms of breast reconstruction are available. These procedures are done on an inpatient setting, with hospitalization averaging two to five days. Recovery is usually six weeks.
