Breast Surgery

Breast Biopsy

If you have a lump that you can feel in the breast or you have an abnormality on your mammogram or ultrasound you may require a breast biopsy.

The purpose of the biopsy is to determine what the lump or abnormality is. After your biopsy a pathologist examines the tissue under a microscope. We generally have a diagnosis within three to five days. Depending on the situation and your wishes the lump or abnormality may or may not be completely removed during the biopsy procedure.

In the past, virtually all biopsies required some sort of surgical procedure. Now, in conjunction with our radiology colleagues, we are able to do most biopsies without formal surgery.

Open Breast Biopsy (Surgical Biopsy)

This procedure is done in the operating room.  It can be done with either local or general anesthesia.  An incision is made on the breast and the area of concern is removed.  If the area of concern can not be felt a procedure called wire localized biopsy is performed.  In this procedure the radiologist uses an ultrasound or mammogram to place a thin wire in the area of concern.  The surgeon then uses the wire as a “trail” to guide the removal of the area in question.  Surgical breast biopsy is an outpatient procedure.  You will likely be able to resume your usual activities within several days of the procedure.

Fine needle aspiration (FNA)

A thin needle is placed into the lump and cells are withdrawn for examination. If the lump proves to be a cyst (a fluid filled cavity), the fluid can be removed using this technique often resulting in complete resolution of the lump.

Core biopsy

Under local anesthesia a spring loaded device is used to obtain pieces of the lump. Often ultrasound is used as a guide to ensure the area of concern is biopsied. Dr. King has an ultrasound machine in his office. This makes it very easy to arrange this type of biopsy.

Stereotactic needle core biopsy (mammotome)

Mammographic images are used to obtain a core biopsy of an abnormality seen on mammogram. This technique is also done using only local anesthesia and a very small (1/4 inch) incision. For further information go to: http://www.breastinfo.com/mbiopsy.htm.  Dr. King generally performs this procedure at the Laura Drier Breast Center at Good Samaritan Hospital. http://www.bannerhealthaz.com/community/breastcancer/breast_Center.HTML

Breast Cancer Surgery

Unfortunately, breast cancer is a very common disease. It is the most common cancer among women. One out of every eight women will develop breast cancer in her lifetime. What follows is a brief description of the surgical options for breast cancer. There is a great deal of good information on the Internet regarding breast cancer. The links at the end of this section will help answer many of your questions.

Surgery for breast cancer involves either a lumpectomy (removal of the cancer and the tissue surrounding it) or mastectomy (removal of the entire breast). In addition, a sentinal node biopsy and/or an axillary dissection is done.

Mastectomy

The entire breast is removed including the nipple. Reconstruction by a plastic surgeon using either an implant or your own tissues may be done either at time of the mastectomy or at a later date. Patients usually stay in the hospital overnight. Drainage tubes are left in and are removed anywhere from several days to two weeks after surgery.

The advantage of mastectomy is that radiation is rarely needed and further surgery for cancer is very unusual.

Lumpectomy

In a lumpectomy only the tumor and the tissue around it are removed. Most women are candidates for this procedure. However, in certain situations, such as large or multiple tumors lumpectomy is not a good option.

Lumpectomy has the obvious advantage of preservation of the breast. However, radiation is nearly always required. This requires daily visits for treatment for typically six weeks. If a pathologist finds tumor at the edge of the lumpectomy specimen another surgery is usually required. Depending on the situation a repeat lumpectomy may be done or a mastectomy may be required. Fortunately, this is a rare occurrence. Because a fairly large piece of tissue is removed there will be some deformity of the breast. This varies from patient to patient and depends on such factors as tumor size and breast size.

Sentinal node biopsy/axillary dissection

Surgery for breast cancer always involves evaluation of the lymph nodes in the armpit. The information gained from looking at the lymph nodes helps determine prognosis and whether or not chemotherapy is needed. In the past most of the lymph nodes in the armpit were removed. This procedure is called an axillary dissection. This sometimes resulted in chronic swelling of the arm (lymphedema).

A sentinal node biopsy involves removing the first lymph node(s) that the tumor drains to. I am often able to do this procedure instead of an axillary dissection. The procedure involves injection of a small amount of radioactive material around the tumor several hours before the operation. In the operating room, after the patient is asleep, some blue dye is injected as well. The radioactive material and blue dye travel to the sentinal node(s) which is/are identified and removed during the operation.

The sentinal node biopsy has several advantages over a standard axillary dissection. First of all, the pathologist looks at the sentinal nodes very closely. Therefore, if the cancer has spread to the lymph nodes there is a greater chance it will be identified. This results in more accurate staging of the cancer. Secondly, because fewer lymph nodes are removed the risk of lymphedema is much less. Finally, a sentinal node biopsy is less painful than a standard axillary dissection.

Chemotherapy

Depending on the stage of the cancer chemotherapy may be required. In some cases chemotherapy is given before surgery. However, it is usually started several weeks after the operation. It is important to remember that the operation performed (lumpectomy or mastectomy) has no bearing on whether or not chemotherapy is recommended.