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Breast Surgery/Biopsy

BREAST BIOPSY

A biopsy may be indicated if you have a palpable lump or if you have had an abnormal mammogram, ultrasound or MRI.

The biopsies are done as an outpatient in the Radiology Department. If you had your initial imaging at another facility you should bring a CD with the images with you so the area is easier to locate. You should also let your doctor know if you are on any blood thinners.

 
Mammography guided vacuum biopsy

The biopsy is usually performed with mammography if micro-calcifications or a questionable density was discovered on your mammogram.

 

When you have your biopsy using mammography you will be seated in a comfortable chair. There is a special attachment to the machine that allows for pinpoint localization of the area to be biopsied. Your breast will be placed in the mammography machine similar to a regular mammogram. An initial image will be taken to optimize the location of the biopsy. The doctor will numb the breast with local anesthetic and then make a small incision for placement of the biopsy device. The biopsy device is attached to a machine that uses a small amount of vacuum pressure to pull the tissue into the device for better tissue sampling. More local anesthetic is used during the biopsy. Several tissue samples are obtained. A localization clip may be placed to help locate the biopsy area on future mammograms. This clip is very tiny and will not be able to be felt by you.

 

 

LUMPECTOMY

A lumpectomy is a surgery used to remove a tumor in the breast and a surrounding margin. It attempts to remove the tumor in entirety while preserving the breast. At times, more than one procedure may be required to fully remove the entirety of the tumor if the margins which were cut are not clear of tumor.

 
When is a patient a good candidate for a lumpectomy?

Lumpectomies have become more common for women with smaller tumors. Patients who are candidates for breast conserving surgery have one tumor in the breast that is easily removed with surrounding tissue to yield a good cosmetic result.

 
When is a patient NOT a candidate for a lumpectomy?

Patients who have multiple tumors in the breast occupying several different quadrants. Also, patients who have had previous lumpectomies with radiation. Patients who refuse to have radiation following surgery.

 

What are the risks?

There is risk of requiring a second surgery if the tumor is not removed with clear borders. There is also risk of breast dimpling where the lump was removed, infection, and fluid collection.

 

 

MASTECTOMY

A mastectomy is the surgical removal of a breast, including the nipple and areola.

 

When is a patient a good candidate for a mastectomy:

Patients who are not good candidates for lumpectomies are better candidates for mastectomies. Patients who have a had radiation to the breast, multiple tumors in the breast tissue, large tumor compared to breast volume, extensive ductal carcinoma in situ, a strong family history of breast cancer, and others that are routinely discussed with the patient by the surgical team.

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SENTINEL NODE BIOPSY

The sentinel lymph node is the lymph node in the axilla, arm pit, where breast cancer will first spread. The surgeon uses a special radioactive isotope and injects it into the breast. The isotope will move from the tumor to the lymphatic system. The first node to contain radioactive material is called the "sentinel node." This is then removed and examined by a pathologist to see if the cancer has moved to the lymph system.

 

What does this mean?

A sentinel node biopsy determines if breast cancer has spread to the lymph nodes. An important part of staging cancer, it impacts recommendations for a patient's treatment.

 
How do sentinel node biopsy results affect treatment?

The sentinel lymph node is will be sent to pathology for analysis and staging of the breast cancer. If the sentinel lymph node is negative for tumor cells, the remaining lymph nodes are left intact This reduces the risk of lymphedema in the future, as well as preserves healthy tissue that doesn't need to be surgically disturbed.

 

If the node is positive, a more comprehensive decision will be made whether other nearby nodes need to be removed and examined for cancer in a future surgery.

 

Knowing if the cancer has spread to the nearby lymph nodes is a critical part of staging, and therefore impacts the recommendations for treatment of the patient's breast cancer.

 

 

 

AXILLARY NODE DISSECTION

Lymph nodes serve as a filtering system for the lymphatic system (a system of vessels that collects fluids from cells for filtration and reentry into the blood). The first node in the armpit area (axillae) that is affected by breast cancer is also called the sentinel node.

 

If the cancer is found to have spread to this specific lymph node or other nodes in the axillary area, then your breast surgeon will probably recommend an axillary node dissection. Each woman has a different number of nodes in her body, so the decision to remove nodes is not based on number, but on location.

 

There are three levels of axillary lymph nodes and options for dissection:

  • Level I - This refers to removal of all tissue below the axillary vein and extending to the side where the axillary vein crosses the tendon of a muscle called the latissimus dorsi

  • Level II - This dissection removes diseased tissues deeper in the middle (medial) area of another muscle called the pectoralis minor

  • Level III - This is the most aggressive dissection and removes all of the nodal tissue from the axillae