Breast Surgery

When you discover a lump or other change in your breast, it is important to find out what it is. It is normal to be alarmed. But you have reasons to be reassured:  Most women, sometime in their lives, develop lumps in their breasts.  Most lumps are NOT breast cancer. In fact, 8 of 10 lumps are harmless.  To be sure that a lump or other change is not breast cancer, you need to have some or all of the lump removed (a biopsy). A diagnosis can then be made by a pathologist, a doctor who looks at the cells under a microscope to find out if the tissue is normal or cancerous.

Core Fine Needle Breast Biopsy

We are the first in Contra Costa County to do biopsy of the breast in our office using ultrasound. The advantage of this procedure is that it can be done in the office and patients can return to normal activity immediately.

  • Performed in the office setting using local anesthetic.
  • Results are available sooner.
  • It is a minimally invasive procedure, and usually only requires a single 1/4-inch incision for biopsy.
  • The physician can selectively sample the target area of a lesion or completely remove small lesions.
  • Patients generally experience minimal discomfort, have a tiny scar, and may return to normal activity immediately following the procedure.

Results and Next Steps

After the specimen is analyzed by a pathologist, your primary care or surgeon will call you with the results. Some types of non-cancerous findings are:

  • Fibrocystic Changes
  • Cysts
  • Fibroadenomas 
  • Interductal papillomas 
  • Traumatic Fat Necrosis

The medical course taken for each of these conditions will be discussed with you. If, however, the pathologists has found breast cancer, you will be asked to visit our surgeons for a secondary visit to go over the many treatment options available. Our unique alignment with Diablo Valley Oncology and Hematology Medical Group allows us to provide a multidisciplinary clinical approach to cancer care.  This partnership integrates a team of specialists who develop the most effective treatment plans for our patients. 

Lumpectomy (Partial Mastectomy)

With a lumpectomy, one of our highly trained surgeons removes the breast cancer along with a little healthy breast tissue around the lump. At this time, they may also remove  and some lymph nodes, located under the arm. The purpose of the procedure is to totally remove the cancer while leaving healthy tissue intact, allowing your breast  to remain as visually similar as possible to pre-surgery. Women may have a change in the shape of the breast that was treated. It is very common for women who choose a lumpectomy to have follow up treatment with radiation therapy. Radiation treatment decreases the risk of cancer redeveloping in the remaining healthy breast tissue. The surgery has possible complications, but is considered a safe and common treatment option. Possible complications include; Infection, poor wound healing, bleeding, and a reaction to anesthesia.

Sentinel Lymph Node Biopsy

Surgeons use sentinel lymph node biopsy to find cancer cells that have escaped the tumor and threaten to infiltrate other parts of the body. The sentinel node, or the first lymph node to which extracellular fluid from a tumor drains, acts as the gateway to the lymphatic system and beyond. Sentinel Lymph Node Biopsy may spare patients who have no trace of disease in their sentinel nodes from the sometimes severe complications of having an entire nodal basin removed: chronic swelling, discomfort, infection, and reduced mobility. The procedure also allows for more thorough pathologic analysis and more accurate staging, perhaps even improving survival rates in patients with certain cancers. In some cases, when the Sentinel Lymph Node Biopsy shows cancer cells, the remainder of the lymph nodes may need to be removed.

 Finding the sentinel node - This technique is based upon the theory that when tumor cells migrate, they spread to one or a few lymph nodes before involving other nodes. These “sentinel” nodes can be identified by injecting a blue dye or radioactive material around the primary tumor prior to the wide local excision, and then searching for the node that has taken up the dye or the radioactive tracer at the time of surgery (termed "lymphatic mapping"). The status of this first draining or "sentinel" lymph node (whether positive or negative for tumor involvement) accurately predicts the status of the remaining regional lymph nodes. The presence and number of tumor cells in the lymph nodes are strong prognostic factors. The accurate staging made possible by such painstaking pathology allows oncologists to choose the most appropriate therapies.

Mastectomy

A mastectomy is the surgical removal of the entire breast. For many decades, it was the only treatment for breast cancer. Today a woman who has a mastectomy is likely to have either a total mastectomy or a modified radical mastectomy. In a partial mastectomy as much breast tissue as possible is removed along with the nipple and some of the overlying skin. The lymph nodes in the armpit are not removed. Comparatively, modified radical mastectomy removes as much breast tissue as possible, the nipple, some of the overlying skin, and some lymph nodes in the armpit. A mastectomy is needed when cancer is found in numerous areas in the breast. Reconstructive surgery is an option for these patients and they will not need radiation therapy. 

Oncoplastic Surgery

Breast reconstruction is a cosmetic surgery meant to “rebuild” a breast. This is a common option for any woman who has lost a breast because of cancer. California law requires that group health insurers pay for reconstruction and for surgery to an unaffected breast in order to obtain a good match. Reconstructive surgery can result in an appearance that looks like a natural breast. You may ask our surgeons for a referral to an experienced plastic surgeon, whom you would meet with prior to your mastectomy. Many women start reconstruction at the same time as their mastectomy, resulting in just one surgery for both procedures; while others wait several months or even years. 

Follow Up Care

No matter the treatment options you choose, follow-up care is important to help maintain health, manage side effects and watch for reoccurrence. Our physicians develop a follow-up care plan which may include physical examinations and diagnostic tests. 

 

For more in-depth information and resources, we recommend visiting breast360.org