Fellowship
 

 


Breast Surgery

Abnormal Mammograms and Ultrasounds

Breast lesions can present as abnormalities seen on a screening mammogram that in many cases are not palpable- that is easily felt. These commonly include microcalcifications-small flecks seen on a mammogram; depending on the pattern produced on a mammogram, these may indicate benign or malignant lesions. On ultrasound a lesion can be identified  as cystic (fluid filled) or solid. These may require aspiration, biopsy, or continued follow-up with your physician.

New Mass on Examination

Other lesions can be felt on examination. The patient's exam is just as valuable as that of the physician. New masses, those that have increased in size, or those affecting the overlying skin (puckering, redness) are biopsied. Many times this can be done in the office safely to obtain a diagnosis.  

Consultation after Breast Biopsy

In many cases, you may have had a biopsy already. Further care may include yearly follow-up, repeat biopsy, or more definitive surgery:

Benign Lesions
Non cancerous lesions occur very commonly in the premenopausal female. The breast and associated ducts and lobules are hormonally reactive; this results in masses that may come and go at different times in the menstrual cycle. These must be evaluated with physical exam, review of family history, as well as radiologic studies such as ultrasound and mammograms. A cystic structure can be aspirated in the office and then followed over the next few months. Surgery is indicated when the lesion does not resolve, causes significant pain, or has features by ultrasound that increase the likelihood of cancerous lesions. Fibrocystic changes refers to lesions in the breast made up of fibrous and cystic lesions. They are usually benign. Changes in size often lead to biopsy.

Pre cancerous Lesions: DCIS
Ductal carcinoma in situ (DCIS) refers to cancer cells in the breast that have not broken through the walls of the ducts allowing for spread throughout the body. DCIS is usually found as an abnormality on mammogram. A stereotactic biopsy makes the diagnosis. Complete excision and frequent check-ups after surgery are required to diagnose a recurrence, DCIS in the opposite breast, and invasive cancer disease. (Patients with DCIS may undergo radiation treatment despite the fact that they do not have cancer- an oncologist will aid in this decision.)

Cancerous Lesions
Invasive breast cancer is treated in a three-fold manner: Control/eradication of disease in the breast (T) Detecting spread to lymph nodes for the chest (N) Detection of spread to other organs (M) Treatment of cancerous lesions is much more involved. The immediate Tumor (T) needs to be assessed for size. Sampling of the lymph nodes in the armpit evaluates nodal spread (N). Physical examination, laboratories and radiographic studies look for metastatic disease (M)- spread to organs other than the breast, such as the lungs and liver. All three stages make up the TNM staging process that physicians use to guide treatment including chemotherapy.

Infection

Infection in the breast occurs both after childbirth in lactating mothers as well as those not breast feeding. In many cases, antibiotics taken by mouth are adequate. In cases with collections of pus- especially when very painful- an ultrasound done in the office diagnoses the problem. Incision and drainage of the abscess can them be done in the office safely. Full recovery is expected.

Nipple Discharge

Nipple discharge refers to constantly leaking fluid or intermittent blood from the breast . This is usually caused by a mass within the duct of the breast.  The lesion needs to be localized to a quadrant of the breast as there are ducts that extend in a spoke-like fashion from the nipple.  The lesion may be found on physical examination, mammogram/ultrasound, ductogram, and mri. Once found, they must be removed to both stop the drainage and make sure there is not a malignancy.  

 

 
     
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