Georgia Breast Care

A biopsy is a minimally invasive procedure that removes a sample of abnormal tissue to determine whether it is benign or malignant. A biopsy can be performed on many different areas of the body, but is commonly used to diagnose, and sometimes treat, lumps found in breast tissue. A breast biopsy may be performed after abnormalities have been detected during a self-exam, or after a mammogram or other imaging test has been performed. Other than surgical biopsy, there are several different types of biopsies available for removing abnormal tissue. Many of these procedures are performed with ultrasound or MRI guidance to ensure precise needle placement and minimal damage to surrounding healthy tissue. The Benefits of Breast Biopsy A breast biopsy allows for a determination to be made as to whether abnormal tissue is cancerous or noncancerous. In addition to its diagnostic purpose, a biopsy can remove small tumors or other abnormalities that are found during the procedure, eliminating the need for additional surgery. Patients benefit from shorter recovery times and less surgical trauma. Removal through biopsy also saves a patient money by diagnosing and treating her condition in one simple procedure. The Breast Biopsy Procedure During a breast biopsy, the patient usually lies on her stomach on a special examination table with openings that allow access to the breasts. The procedure is performed from below the table. A biopsy may also be performed with the patient sitting upright in a chair. Breast biopsy is performed on an outpatient basis using local anesthesia. A core needle biopsy removes only one sample of breast tissue per needle insertion, while a vacuum-assisted biopsy can collect multiple samples from a single insertion. The removed breast tissue is sent to a lab for review under a microscope, and results are usually available after 1 to 2 days. Most procedures take less than an hour to perform, and patients can return home shortly thereafter. Pressure or mild discomfort may be experienced during the exam; numbness may be experienced afterward as the anesthesia wears off. There is no suturing needed after a breast biopsy because the incision is so small. Patients can usually return to work and other regular activities after a minimal recovery period. Types of Breast Biopsies There are several types of needle biopsies, each specialized to test a particular type of abnormality. Core Needle Breast Biopsy A core needle breast biopsy is recommended when a nodule is seen only or most clearly with ultrasound. Local anesthetic is applied, a small incision is made and the ultrasound-guided needle is inserted. Small pieces of affected tissue are removed swiftly and painlessly, and sent for testing. Sonotome Sonotome (ultrasound-guided) biopsy is a 10- to 15-minute procedure performed with local anesthesia and a Mammotome® (vacuum-assisted) needle inserted through a small incision in the skin. Tissue samples are taken, and a titanium clip is inserted to mark the location in case surgery is required. Typically, the entire abnormality is removed. Stereotactic Mammotome Biopsy This type of biopsy is most often performed when a mass can be detected with mammography but not with ultrasound. This procedure involves compressing the targeted area with a paddle and administering local anesthesia before inserting a Mammotome (vacuum-assisted) needle. The abnormal tissue is removed swiftly and painlessly with suction. The entire abnormality is removed in most of these procedures. Fine-Needle Aspiration Biopsy During an aspiration procedure, a small needle is inserted to remove a sample of the abnormal tissue, without the need for anesthesia. This procedure is most often performed for very small masses, and can help determine if the abnormality is a fluid-filled cyst or a solid mass. Cyst Aspiration This 5-minute procedure drains fluid from a cyst (fluid-filled nodule) using an ultrasound-guided needle. Local anesthesia is usually not needed. An X-ray may be taken to ensure that the cyst has collapsed. The fluid is sent to pathology to confirm that it is benign. Results from the tests are usually available within 24 to 48 hours.

Breast cancer is the second-most-common cancer, and the second-leading cause of cancer deaths, among women. Most breast cancers are slow-growing, but there are types that are aggressive, which is why early detection is essential. Breast cancer is defined by the type of breast cells in which it begins, and is generally categorized as invasive or noninvasive. Breast cancer can also affect men, but it is 100 times more common in women. Types of Breast Cancer Two types of cancer that occur rarely are inflammatory breast disease, in which cancerous cells block the lymph vessels within the breast, and Paget disease of the nipple, in which the cells in or around the nipple become cancerous. They account for, respectively, approximately one to six percent, and approximately one percent, of breast cancers. The two most common types of breast cancer are ductal carcinoma and lobular carcinoma. Ductal Carcinoma This is the most prevalent type of breast cancer, and it begins in the cells that line the milk ducts. More than half of breast cancer cases diagnosed each year are of this type. There are two kinds of ductal carcinoma: Ductal carcinoma in situ (DCIS) With DCIS, cancer cells are found only in the milk-duct lining, and have not spread to other breast tissue. DCIS is often discovered when a mammogram is done as part of a regular screening. In recent years, the number of DCIS diagnoses has increased dramatically, primarily because the number of screening mammograms has increased. DCIS isn't life-threatening, but requires treatment to make sure the cancer does not spread. Invasive ductal carcinoma (IDC) With IDC, cancer cells have spread from the ducts to other parts of the breast tissue. This is the most common type of invasive breast cancer, requiring treatment at an early stage to make sure it does not spread from the breast tissue to other parts of the body. It accounts for approximately 65 to 85 percent of invasive-type breast cancer cases. Lobular Carcinoma Lobular carcinoma begins in the breast's milk-producing glands, which are called lobules. The breast contains 15 to 20 lobes; the lobules are the smaller lobes within them. There are two types of lobular carcinoma: Lobular carcinoma in situ (LCIS) With LCIS, abnormal (rather than cancerous) cells are found only in the breast lobules; they do not spread to other tissue. LCIS is asymptomatic, and usually does not show up on mammograms. It is often discovered when a biopsy is performed for another reason. Invasive lobular carcinoma (ILC) With ILC, cancer cells spread from the lobules to close-by breast tissue. It requires treatment at an early stage to make sure it does not spread from the breast to other parts of the body. It accounts for approximately 10 to 15 percent of invasive-type breast cancer cases. Risk Factors for Breast Cancer The greatest risk factor for developing breast cancer is being female, probably because men produce much less estrogen and progesterone, hormones that can promote the growth of malignant breast cells. Other risk factors for women may include: Being 55 years of age or older Carrying a BRCA1 or BRCA2 gene mutation Having a family history of breast cancer Having been diagnosed with breast cancer before Having dense breast tissue Having certain benign breast conditions Using, or having used, hormone therapy Signs or Symptoms of Breast Cancer Women are advised to perform a breast self-exam once a month to check for changes or abnormalities, which may include: A lump in the armpit that does not go away after a menstrual cycle Swelling in the armpit Pain or tenderness in the breast A change in the size, contour, texture or temperature of the breast A change in the nipple An unusual discharge from the nipple A flattening or indentation in the breast Diagnosis of Breast Cancer Most testing for breast cancer begins when a woman or her doctor finds an abnormality in the breast through a physical exam, or when a routine mammogram picks up an abnormality. Tests that may be performed to diagnose breast cancer include: Diagnostic mammogram Ultrasound MRI scan Fine-needle-aspiration biopsy Core needle biopsy Surgical biopsy Ductogram Sentinel-node (lymph-node) biopsy Treatment for Breast Cancer Lumpectomy and Partial Mastectomy These are designed to save the breast by removing only the cancer and a small margin of surrounding tissue. Lymph nodes under the arm may also be removed to check to see that the cancer has not spread. Total Mastectomy and Modified Radical Mastectomy These are procedures that remove the entire breast. A total mastectomy, in addition to removing the breast, removes many lymph nodes under the arm, the lining over the chest muscle, and, possibly, the chest muscle itself. Other treatment options that may be used alone or with surgery include chemotherapy, radiation therapy and targeted drug therapy.

A mastectomy is a surgical procedure to remove the breast(s) in a patient with breast cancer. It is one of the most commonly used and effective options for treating breast cancer because it removes all traces of cancer, and reduces the risk of its recurrence. Types of Mastectomy There are several different mastectomy procedures designed to eradicate the cancer but retain as much of the natural breast as possible. Some of the most commonly used techniques include: Subcutaneous Mastectomy A subcutaneous mastectomy removes all breast tissue but leaves the skin, nipple and areola. The breast is then immediately reconstructed. This operation is performed less often than simple or total mastectomy because it leaves behind more breast tissue in which cancer can, potentially, reoccur. Partial Mastectomy In a partial mastectomy, only the malignant breast tissue and some of the healthy tissue around it are removed. Although lumpectomy is considered a form of partial mastectomy, it removes less tissue than a partial mastectomy does. Total (Simple) Mastectomy The entire breast is removed during a total mastectomy. Lymph nodes are not removed unless they are a part of the tissue already being excised. Modified Radical Mastectomy A modified radical mastectomy, in addition to removing the breast, removes lymph nodes under the arm, which are then dissected to see if the cancer has spread within the body. However, no muscles are removed from beneath the breast. Radical Mastectomy The most extensive type of mastectomy, a radical mastectomy removes the entire breast, a greater number of lymph nodes than are removed in the modified radical mastectomy, and the chest wall muscles that lie beneath the breast. Radical mastectomy, which used to be a common form of treatment, is now rarely performed. In most instances, modified radical mastectomy has proven to be just as effective and less disfiguring. Preventive Mastectomy A preventive mastectomy is an elective surgery performed on women who have a high genetic or familial risk of breast cancer. Also called prophylactic mastectomy, it usually takes the form of a total or subcutaneous mastectomy, and can reduce the occurrence of breast cancer by 90 percent. Recovery and Reconstruction After Mastectomy Depending on the extent of the procedure, mastectomy usually requires a one- to three-day hospital stay, but some women may be able to go home the same day. A drain, which will be removed approximately two weeks later, may be attached to the chest to collect fluid. If mastectomy and reconstruction are performed at the same time, the hospital stay will be longer. The goal of breast reconstruction, which many women opt for after having a mastectomy, is to match the appearance of the other breast, and to eliminate the need for an external prosthesis. Reconstruction, which may involve a breast implant or skin grafts, can be performed at the same time as the mastectomy or at a later date. A follow-up appointment with the surgeon usually takes place one week after the surgery. The surgeon will check that the incision is healing properly, and that no other complications have arisen. Risks of Mastectomy Certain risks are associated with mastectomy, and may include: Fluid-collection underneath the scar left by the incision Numbness of the skin along the incision site Mild to moderate tenderness in the area adjacent to the incision Heightened sensitivity to touch in the surgical area Delayed healing of the incision Increased risk of infection in the surgical area Formation of scar tissue

A lumpectomy is a surgical procedure performed to remove malignant or other abnormal breast tissue. Since during a lumpectomy the surgeon removes the smallest amount of breast tissue possible, the procedure is sometimes referred to as breast-conserving or breast-sparing surgery. Reasons for a Lumpectomy There are two primary reasons a lumpectomy has to be performed. These involve either a malignancy or a benign growth in the breast tissue. Breast Cancer Most frequently, a lumpectomy is performed after a breast mass has been found during physical examination or through a mammogram and has been confirmed, by ultrasound and a core needle biopsy, to be malignant. Candidates for lumpectomies are patients in whom the cancer is considered to be low grade and not likely to have spread to adjoining tissues, although this cannot be definitively determined until the lumpectomy and subsequent pathology report are completed. When there is suspicion that the cancer may have spread, a sentinel lymph node biopsy will also be done, during which the node, or a part of the node, closest to the breast tumor will be removed for analysis. If the cancer is found to have spread to the sentinel node, other nodes may be removed to see how far the malignancy has traveled. In a sentinel node biopsy, a tracer or contrast dye is injected into the node in order to locate it more exactly. If the breast cancer has already spread or is of a particularly agressive variety, a mastectomy may be necessary. Fibroadenoma Although often performed to remove cancerous breast tissue, a lumpectomy may also performed to excise benign tumors of the breast, such as fibroadenomas. Fibroadenomas are most commonly found in women under 30 years of age, often adolescents, and are composed of fibrous or glandular tissue. The cause of fibroadenomas is not known, although they develop more frequently, and at a younger age, in African-American women than in Caucasian women. The Procedure of Lumpectomy The procedure of a lumpectomy, although often anxiety-producing to patients, is a simple one. Prior to the surgery, the site of the tumor is marked on the patient's breast with an indelible marker and often a metallic marker is implanted in the precise location of the tumor as well. These measures guide the surgeon and assure precision during the operation. The lumpectomy may be performed under general or local anesthesia, depending on individual circumstances, and sometimes a drainage tube will be temporarily implanted under the patient's arm to drain excess fluid. A lumpectomy usually takes between 15 minutes and an hour to complete and the patient is able to return home the same day. Recovery from Lumpectomy After a lumpectomy, the patient returns home after the surgery and can resume normal activities in as few as 5 days. The following measures are commonly taken to assist in healing: Ice packs on the affected area Rest and avoidance of strenuous activity, especially involving the upper body Over-the-counter painkillers for pain and discomfort Caring for incisions according to doctor's instructions Being aware of signs of infection, such as swelling or fever Follow-up appointment with the physician As noted, there is always a chance when a patient has a lumpectomy that the cancer has not been entirely removed. A pathology report is done on the tissue removed, which includes tissue from the tumor itself and a small amount of surrounding tissue. The surgeon's goal is to obtain clean margins around the tumor. If the pathology report shows that the margins are not clear, a second lumpectomy must be performed. This is not at all uncommon since the surgeon removes as little breast tissue as possible during the lumpectomy in an attempt not to disfigure the breast. Radiation may be deemed appropriate as a precaution, particularly if this episode of breast cancer represents a reoccurrence. If the cancer has spread to the sentinal node, a mastectomy and or chemotherapy will usually be necessary to avoid further spread of malignancy. Risks of Lumpectomy There are few risks associated with the simple procedure of a lumpectomy, but, as with any type of surgical procedure, the patient should be aware of possible complications, such as: Infection, signaled by redness or swelling at the site, or fever Edema of the arm in the case of lymph node removal Excessive bleeding Allergic reaction to anesthesia or dye

A mammogram is an X-ray examination of the breast. It is performed to detect breast cancer in its earliest stages, often before any signs or symptoms of the disease are present. Mammography allows doctors to detect small tumors that are easier to treat than larger, more developed tumors. And it can also detect small abnormal growths in the milk ducts of the breast, called ductal carcinoma in situ (DCIS). Early removal of these growths will remove the risk of future harm. Mammograms are an effective way to detect cancer early and can aid in the goal of successfully treating and beating the disease. Reasons for a Mammogram A mammogram can show abnormalities, such as a tumor, in the breast tissue long before they can be felt. Mammograms may be performed for screening or diagnostic purposes. Screening Mammograms Screenings involve producing images of both breasts in order to detect any tumors that cannot yet be felt under the skin. They can also detect calcium deposits that may indicate breast cancer. Diagnostic Mammograms Diagnostic mammograms are performed after a lump or other sign of breast cancer has been detected or after abnormalities were present during a screening mammogram. This procedure targets a specific area of the breast and takes more detailed images from many different angles. Both screening and diagnostic mammography can help diagnose breast diseases, lumps, cysts and benign and malignant tumors. Candidates for a Mammogram It is recommended that women older than 40 have mammograms annually. Patients with the following risk factors should take extra care to be screened regularly: Personal or family history of breast cancer Abnormal changes in the breast Long-term use of hormone therapy Studies have shown that regular screenings can help reduce the number of breast cancer deaths in women. Detecting cancer early and treating it immediately, before it spreads, increases a patient's chance of remission. Preparing for the Procedure Patients should not schedule a mammogram the week before they have their period, as the breasts are usually tender at this time. The doctor may ask the patient not to wear deodorant or lotion under the arms or on the breasts on the day of the mammogram. Otherwise, there is no special preparation needed for the procedure. The Mammogram Procedure During a mammogram, the breast is placed on a small platform and compressed with a paddle while it is exposed to a very low dose of radiation. Compression helps even out the thickness of the breast so that all breast tissue can be visualized, and it also holds the breast still to minimize blurring of the image caused by patient movement. Images of the breast tissue are produced and then displayed on a computer screen for the doctor to view. The patient may experience pressure on the breast from the compression, which may be uncomfortable if the breasts are sensitive. Most patients tolerate the mammogram procedure with no problem. Risks of a Mammogram A mammogram is considered to be a safe procedure for most women, including those with breast implants. Patients should advise their doctors if they are pregnant or have any preexisting medical conditions.

A breast MRI (magnetic-resonance imaging) scan is a noninvasive diagnostic imaging test that produces multiple cross-sectional images of the breast to help screen for breast cancer. This advanced procedure is capable of detecting certain abnormalities that may not be found by other imaging techniques. It is the only procedure to produce images of both hard and soft tissue. An MRI scan is often performed after a mammogram, and may be helpful in staging breast cancer. The Purpose of a Breast MRI Scan This procedure is most often performed on women with a high risk of breast cancer, including those who: Are older than 50 Have a family or personal history of breast cancer Are obese Had a late onset of menopause Have no children An MRI scan can help diagnose serious conditions to determine the best treatment options. It may also be used to help with early detection of breast cancer. With the injection of contrast material, a breast MRI scan can help identify: Cysts Enlarged ducts Enlarged lymph nodes Hematomas Other breast abnormalities, as well as their size and location An MRI scan can also be used during a follow-up biopsy to precisely guide the needle to the targeted area in order to effectively remove tissue samples. The Benefits of a Breast MRI Scan A breast MRI scan is effective in detecting a wide range of breast-tissue abnormalities, including many that may be missed by a mammogram. Minimally invasive, the procedure can be used for many different purposes, including: Breast-cancer diagnosis and staging Confirming abnormalities detected by other imaging exams Monitoring chemotherapy treatment Evaluating the status of breast implants An MRI scan is an effective diagnostic tool that does not involve any exposure to radiation. Unlike X-rays, radioisotopes, CT scans and other methods that use radiation, MRI scans use radiofrequency waves, which detect differences in water concentration and distribution in body tissues. The procedure is safe for nearly all patients, and is constantly being improved to make it more comfortable for patients with claustrophobia. The Breast MRI Scan Procedure During a breast MRI scan, the patient lies facedown on a moveable padded table; the breasts fit into hollow depressions that are connected to the MRI scanner through magnetic signals. A contrast dye may be injected into the body to help easily identify any abnormalities. The table then slides into the opening of the machine, and a magnetic field is created around the patient. A breast MRI scan takes about one hour to perform.

Breast cancer affects a significant number of women each year. It is the second-most-common cancer, and the second-leading cause of cancer death, among women. Most breast cancers are slow-growing, but there are types that are aggressive, which is why early detection is essential. Regular screenings are the best way to detect breast cancer in its early stages. The most common screenings are mammograms and doctor-performed clinical breast exams. Official recommendations are that, starting at 20 years old, a woman should have a clinical breast exam every three years. At 40 years of age, a woman should have a yearly clinical breast exam. The second recommendation is for a screening mammogram, but there is some dispute about the age at which women should start getting them, and how frequently. One recommendation calls for yearly exams once a woman turns 40 years old; another specifies biannual exams for women between 50 and 74 years old. A woman should check with her doctor to determine her best course of action. It may also be helpful for a woman to examine her breasts once a month, usually about a week after her menstrual period, to identify any changes or abnormalities such as a lump, swelling, irritation or pain. Breast self-exams are not officially recommended as a screening tool for breast cancer because their success in detecting early-stage cancers and increasing the survival rate have not been proven. But, by becoming familiar with the way her breasts normally look and feel, a woman may recognize changes indicating an abnormality.

While the specific cause of breast cancer is often unknown, a certain number of women may be genetically predisposed to developing this disease. Women with the BRCA 1 or BRCA 2 gene mutation carry an inherited risk of developing breast cancer. These gene mutations likely occur in women with: A family history of breast or ovarian cancer Early diagnosis of breast cancer (before age 45) Another family member with BRCA gene mutation Women who carry the BRCA gene may have up to an 85 percent chance of developing breast cancer at some point in their lives. Hereditary factors usually account for only 5 to 10 percent of all breast cancer cases, but it is still important for women to undergo testing if they are considered at high risk for developing breast cancer. The BRCA genetic test involves a simple blood test that is performed in the doctor's office through a vein in the arm. The drawn blood is sent to a lab for DNA analysis. It may take three to four weeks for results to be available. Patients with positive results will work with their doctor to develop an appropriate prevention plan. It is important for women who receive negative test results to realize that they still face the same risk for developing breast cancer as anyone else in the general population and should be screened on a regular basis. With an increased risk of developing breast cancer in both breasts, women with the BRCA gene mutation often seek preventive care to reduce their chances of developing cancer. There are several surgical and nonsurgical treatment options available to protect even those women at the highest risk from developing cancer and maintain breast and overall health. We provide specialized care for these patients in the form of preventive and reconstructive options. Preventive Options Women who test positive for the BRCA 1 or BRCA 2 gene mutation should take special precautions to reduce their risk of breast cancer. It is vitally important to increase the frequency of cancer screenings to detect any lumps as soon as possible. Regular mammography, clinical breast examinations and sometimes other forms of imaging can help identify cancer in its earliest, most treatable stage. Precautionary measures may also include chemoprevention medication to kill cancerous cells as soon as they occur or preventive breast cancer surgery, known as a prophylactic mastectomy, which involves the surgical removal of the healthy breast tissue. Prophylactic mastectomy is performed using the same techniques as a treatment mastectomy procedure, and may involve removal of the breast tissue, nipple, areola and lymph nodes, depending on the risk of cancer and the patient's personal preference. This procedure often reduces a patient's risk of developing breast cancer by as much as 90 percent. Reconstructive Options Many women with the BRCA gene who have cancer in one breast may choose to undergo a prophylactic mastectomy on the unaffected breast at the time of treatment. This eliminates the need for additional surgery and further reduces the risk of recurrence. Being tested for the mutation after a breast cancer diagnosis, can help in making the decision for treatment. Taking into account each patient's individual risk of recurrence prior to initial treatment and reconstruction is an important decision that should be discussed with your surgeon. Women who undergo a single mastectomy procedure and breast reconstruction, and then develop breast cancer in the other breast will be left with fewer reconstruction options for the second mastectomy procedure. If too much skin is taken from other areas of the body during the first procedure, there may not be enough available for a second procedure. Your surgeon will help determine the most effective treatment and prevention procedures for you, which may include implant, tissue-based or fat transfer reconstruction for one or both breasts. It is important to discuss all preventive and reconstructive treatment options with your doctor before making any final decisions. To learn more about prophylactic mastectomy, and to determine your risk for breast cancer, please call us today to schedule an appointment.