Question 1

If I have breast pain, does that mean that I will get breast cancer?

Accepted Answer

Usually breast cancer—unless it is quite advanced—is painless.

Breast pain may have multiple origins, including but not limited to: fibrocystic changes, cysts, infection, hormonal cycle, trauma, dietary factors, inflammation from external sources, etc.

If you have breast pain, it is a good idea to consult your breast physician for a workup, diagnosis and treatment.

Question 2

If my mother had breast cancer, does that mean that I will get breast cancer?

Accepted Answer

Only 5 percent of all breast cancers are related to pathologic genes (i.e., BRCA, amongst other pathologic genes).

However, your family history can put you in a higher risk group for breast cancer.

If you have a family history of breast cancer, you should consult your breast physician for a discussion of the appropriate screening modalities available to you.

Question 3

If I had an abnormality on my mammogram/ultrasound and received a call back for further imaging, does that mean that I have breast cancer?

Accepted Answer

Most breast callbacks are for further diagnostic views and imaging by other modalities and usually result in clarification of the question by imaging alone. Some imaging abnormalities will require biopsy. Most of these can be done with a needle and do not require open surgery. Most breast biopsies will yield benign, noncancerous results (80 percent or more).

Question 4

If my recent biopsy shows cancer, will I need my breast removed?

Accepted Answer

The current treatment of breast cancer is multimodality, involving surgery (breast and plastics), medications (chemotherapy, hormonal therapy, immunotherapy) and radiation (e.g., whole breast vs. partial breast). Treatment recommendations will be discussed based on your personal history, risk assessment, the type, size, and location of the breast cancer you have, your personal habits and your preferences.

Two patients with the exact same breast cancer may elect for treatments at different ends of the treatment spectrum. For example, Patient A with a 2 cm tumor in the upper outer quadrant of her 34C breast may elect for breast conservation and radiation with post-op hormonal therapy. Meanwhile, Patient B with the exact same breast size, tumor size, type and location may elect to have both breasts removed, reconstructed and forego radiation and future imaging. Though these two treatments will yield equal outcomes, each treatment was the correct treatment for the individual patient.

Question 5

If I have cancer in one breast, do I need to have the other breast removed?

Accepted Answer

Current data does not support routine contralateral prophylactic mastectomy (CPM) in normal risk individuals. Fear of getting breast cancer in the opposite breast is the least well-supported reason for having the normal breast removed (i.e., the surgical risks of having the breast removed and reconstructed are greater than the risks of getting cancer in that breast). In fact, unless you have personal risk factors that increase your risk of breast cancer in the normal breast, current research suggests that it may actually be detrimental to your overall health to have routine CPM.

Of course, a thorough discussion of risks, benefits and alternatives should occur with your breast surgeon prior to any breast cancer surgery. In some patients, who do not have a higher biologic risk, CPM may be the right choice for them because of other non-medical factors.

Question 6

If I feel a lump, is it cancer?

Accepted Answer

It is a very good idea to get to know your breasts. A monthly self-exam can make you feel more comfortable with the makeup and appearance of your breasts, but more importantly will allow you to know if something is new (i.e., it wasn’t there before). Most lumps are benign, especially if they have a history and are non-changing. However, new and growing lumps warrant a visit to your breast physician and should usually be investigated.

Question 7

What are the signs of breast cancer?

Accepted Answer

There isn't one specific sign of breast cancer. However, there are a constellation of findings that should warrant a trip to the breast physician. Such signs include, but are not limited, to changing lump, new/changing swelling or edema of the skin, an ulcerating skin wound, retraction (pulling in) of the skin, a change of breast shape, new nipple discharge, a new crusty appearance to the nipple/areola, a new lump in the armpit.

Question 8

Do I need a breast MRI?

Accepted Answer

Most women do not require a screening breast magnetic resonance imaging (MRI) scan. These are usually reserved for high-risk women (lifetime calculated risk over 20 percent), and/or women who had a biopsy showing a high-risk lesion (e.g. atypical hyperplasia, lobular carcinoma in situ).

Breast MRIs are indicated in some breast cancer patients before surgery to exclude disease in the opposite breast and to evaluate the extent of disease in the affected breast. The decision for a breast MRI will usually be made after discussion with your physician and is usually based on your personal risk factors, your age and the type of breast cancer you have.

Breast MRIs are frequently performed for individuals receiving chemotherapy or hormone therapy before surgery to gauge the response of the tumor to therapy.

Question 9

What lifestyle changes can I make to reduce my risk of breast cancer?

Accepted Answer

Family history and the chromosomes (genes) we receive from our parents are risk factors that we currently cannot change, though splicing and repairing pathologic genes may become available in the not-too-distant future.

Risks that the individual can control include:

Fat cells in women produce extra estrogen hormone.
How much is too much is still being debated. However, most experts agree that alcohol can increase breast cancer risk incrementally.
Not only can smoking increase your risk of getting breast cancer, but smokers with breast cancer may do worse than non-smokers with breast cancer.
Hormone therapy. Hormones, like estrogen, can increase risk of breast cancer. The risk is related to the length of time used and seems to decrease with time once the hormones are stopped.

Question 10

Should I be worried if I have a nipple discharge?

Accepted Answer

In some women, nipple discharge can be associated with breast manipulation and/or hormonal changes. This is especially true if the same discharge is present in both breasts.

Most nipple discharge will be from a benign etiology.

A new, spontaneous, unilateral nipple discharge should initiate a visit with your breast physician.

Question 11

What does the term "sentinel lymph node" refer to?

Accepted Answer

The lymph nodes that receive the initial lymph drainage from a given area of the breast are defined as the sentinel nodes. By using special dyes injected into the part of the breast where the cancer is, the sentinel nodes can be identified. If these nodes do not contain cancer, then the rest of the lymph nodes in the axilla can be left in place. This may reduce the surgical risks associated with a complete lymph node resection.

Question 12

What medications are effective to reduce breast cancer risk?

Accepted Answer

1) Selective estrogen receptor modulators:

Tamoxifen: Original hormone treatment for breast cancer and can be used in premenopausal women.
Raloxifene: Primarily used for osteoporosis and may reduce risk of certain breast cancers in high-risk individuals.
The main risks include blood clot, uterine cancer and menopausal symptoms.

2) Aromatase inhibitors:

Anastrozole, Exemestane: These drugs have been shown to effectively reduce risk of breast cancer in post-menopausal women.
The risks include osteoporosis, bone pain/muscle cramps and menopausal symptoms.

Question 13

Marigns (how much is enough?)

Accepted Answer

When breast cancer is removed, the amount of tissue outside of the cancer cells defines the margin.

Currently, most physicians involved in breast cancer care agree that for invasive cancer—as long as the pathologist can demonstrate that all of the outside surface of the resected tissue (margin) is free of cancer cells—an adequate excision has been done.

For ductal carcinoma in situ, because of the way this grows, a clean margin of at least two mm is recommended.

Inadequate margins are a possible factor in breast cancer recurrence.

Question 14

What is Ductal Carcinoma in Situ?

Accepted Answer

Breast cancer cells are seen, but they are still inside of the breast ducts. They are noninvasive. This is felt to represent a pre-cancer or Stage 0 (The horse is still in the barn).

Ductal Carcinoma is graded (1-3). The higher the grade, the more aggressive it can be.

When diagnosed by needle biopsy, it requires further investigation, as it may be associated with invasive cancer.

Question 15

How soon can I get an appointment?

Accepted Answer

We can be contacted during normal business hours, Monday through Friday from 9:00 A.M. to 5:00 P.M. Please call us directly to schedule an appointment. All urgent appointments will be scheduled as soon as the doctor has availability.

Question 16

How soon after my appointment can a surgical procedure be scheduled?

Accepted Answer

Generally, two weeks, depending on the type of procedure.

Question 17

Where will my surgical procedure be performed?

Accepted Answer

Minor surgical procedures may be performed in the office setting or at a surgery center. For more complex procedures, they are typically scheduled at one of our affiliated hospitals.

Question 18

Do the physicians perform laparoscopic procedures?

Accepted Answer

Absolutely! Several procedures can be performed laparoscopically with minimally invasive techniques.

Question 19

How long will I be out of work after surgery?

Accepted Answer

It will depend on the type of surgery. For minor procedures, time off from work may not be required. For abdominal surgeries, there are lifting restrictions after surgery so it may be anywhere from 4 to 8 weeks. If your job involves heavy lifting and your employer does not offer "light duty," you may need to be out of work during that period of time. Our office will help with filling out FMLA or short-term disability paperwork, as needed.

Question 20

Does someone have to drive me home after surgery?

Accepted Answer

If you are not having anesthesia, then you can drive yourself home.

If you are receiving anesthesia of any type (general, twilight, sedation, etc.) a responsible adult (over 18) will have to drive you home. You cannot take public transportation, taxi, or Uber/Lyft home after having anesthesia.

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