Breast Surgery

Breast cancer is a tumor that forms in the cells of the breast. This type of cancer usually begins in the milk glands or ducts of the breast, but can spread to adjacent breast tissue, into the underarm lymph nodes, and beyond. Approximately 1 in 8 women will develop breast cancer over their lifetime.

Breast cancer can occur in both men and women, but it is more common in women. Breast cancer is the second most common cancer diagnosed in women in the United States.

Symptoms of Breast Cancer

Any of the following symptoms can be a sign of breast cancer and should be evaluated by a doctor:

Lump in the breast or underarm
Swelling of the breast
Bloody nipple discharge
Dimpling, redness, or pitting of the skin over the breast
Peeling or flaking or scaliness of the nipple skin
Breast pain
Nipple pain or the nipple appearing to turn inward

Causes of Breast Cancer

Breast cancer is caused by a mutation in the genetic code during cell replication. These cellular “mistakes” happen more commonly as a person ages. The cells grow abnormally and divide more rapidly than healthy cells do. The accumulation of cells forms a tumor that grows in the breast and can spread to the lymph nodes or other parts of your body.

Breast cancer most commonly begins with cells in the milk-producing ducts (ductal carcinoma) but it may also begin in the lobules (lobular carcinoma).

Breast cancer is caused by a combination of your genetic makeup and your environment. Certain risk factors have been identified that can increase a person’s risk of breast cancer. About 5-10 percent of breast cancers are linked to a genetic mutation passed through generations of a family. The most common are breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), both of which increase a person’s risk of breast and ovarian cancer.

Risk Factors for Breast Cancer

A risk factor is anything that makes it more likely that you will get a disease. Many risk factors for breast cancer are beyond a person’s control and most women with breast cancer have no known risk factors other than that they are female.

Older caucasian women (over the age of 60) have the highest risk of developing the disease.

A personal or family history of breast cancer increases your risk of developing breast cancer. Inherited genes (BRCA1 and BRCA1) can also increase the risk of developing breast and other cancers. Exposure to radiation also increases a person’s risk of developing breast cancer.

Beginning your period at a younger age (before age 12) or beginning menopause at an older age (after age 55) increases a person’s risk. Also having your first child at an older age (over age 35) increases a person’s risk.

Other factors contributing to breast cancer can be controlled. Maintaining a healthy weight, exercising, limiting alcohol intake, and eating a healthy low fat diet can reduce a woman’s risk.

Staging Breast

Once a diagnosis of breast cancer has been made, the stage of the breast cancer is determined to help determine prognosis and treatment options. The stage of the cancer may not be determined until you undergo breast cancer surgery.

Breast cancer stages range from 0 to IV, with 0 indicating that the cancer is small and noninvasive. Stage IV breast cancer (metastatic breast cancer) is where the cancer has spread to other areas of the body.

Tests and procedures to stage breast cancer may include:

Blood tests
Chest x-ray
Bone scan
CT scan
PET scan
PEM

Not all women need all of these tests and procedures. Your doctor will select the appropriate tests.

Options For Biopsy

If a suspicious lump is discovered in the breast, your doctor will likely want to perform a biopsy, or sampling, of the area. A needle biopsy or a surgical biopsy will be needed to collect a sample of tissue that can be tested for cancer.

Fine Needle Aspiration: Fine needle aspiration can be done for breast cysts or sampling lymph nodes, usually using ultrasound guidance to locate the lesion. Local anesthetic is injected, and a thin, hollow needle is used to remove a sample of liquid or tissue for diagnosis.

Core Needle Biopsy: Core needle biopsy uses local anesthetic and a needle to collect several samples of tissue from the suspicious area. A core needle biopsy is usually guided by ultrasound or mammogram (mammography-assisted biopsies are referred to as stereotactic biopsies). Both aspiration biopsy and core biopsies are performed in the office of Advanced Surgical Associates with ultrasound guidance.

Surgical Biopsy: To test a suspicious lump for the presence of breast cancer, your surgeon will take a biopsy, or tissue sampling, of the area.

The location of the lump may need to first be marked with a needle using ultrasound or mammography guidance if it is not palpable. A needle will be inserted through the skin to mark the target area (lump, calcifications, etc.) before the biopsy is done. A surgical procedure is then done to remove a piece of tissue for analysis. The surgery is an outpatient procedure and patients can return to normal activities in a few days.

Breast Surgery

Surgery is typically the first step in a treatment plan for breast cancer unless the cancer is very advanced. Surgeons can remove the tumor using one of two types of surgery. Underarm lymph nodes are also removed and sampled at the time of surgery.

Lumpectomy. Also called breast conserving surgery or partial mastectomy, a lumpectomy involves surgically removing the tumor along with some surrounding tissue. As a result, a lumpectomy may allow a woman to preserve much of her breast and avoid the need for reconstructive surgery. The surgery is followed by radiation treatment. Chemotherapy may be needed depending on the size of the tumor and lymph node involvement.
Mastectomy. Mastectomy involves the complete surgical removal of the breast. A simple mastectomy removes all of the breast tissue, including the nipple. A modified radical mastectomy includes removal of all of the breast tissue as well as removal of the axillary lymph nodes. A radical mastectomy (during which surgeons also remove the chest wall muscles in addition to the breast and lymph nodes) is no longer performed. A skin-sparing mastectomy removes the breast tissue including the nipple while leaving much of the breast skin in place for reconstruction of the breast. Breast reconstruction with mastectomy can be done at the same time as the mastectomy (immediate reconstruction) in coordination with a plastic surgeon, or may be done at a later time (delayed reconstruction). Chemotherapy may be needed depending on the size of the tumor and lymph node involvement.
Sentinel Lymph Node Biopsy. Sentinel lymph node biopsy is done at the same time as lumpectomy or mastectomy. The main draining lymph node(s) from the breast are removed and sampled. The lymph node is checked for breast cancer cells. If no cancer is found, the chance of finding cancer in any of the remaining nodes is small and no other nodes need to be removed.
Axillary Lymph Node Dissection. This surgical removal of all of the lymph nodes under the arm is done if cancer is found in the sentinel lymph node or if needle biopsy shows that cancer has spread to the lymph nodes. As with sentinel lymph node biopsy, this can take place with a mastectomy or lumpectomy. Cancer cells found in the lymph nodes increase the risk of the cancer spreading to other areas of the body. This helps determine the best course of treatment, including whether chemotherapy or radiation therapy is needed.



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Procedures > Breast Surgery Breast Surgery Breast cancer is a tumor that forms in the cells of the breast. This type of cancer usually begins in the milk glands or ducts of the breast, but can spread to adjacent breast tissue, into the underarm lymph nodes, and beyond. Approximately 1 in 8 women will develop breast cancer over their lifetime. Breast cancer can occur in both men and women, but it is more common in women. Breast cancer is the second most common cancer diagnosed in women in the United States. Symptoms of Breast Cancer Any of the following symptoms can be a sign of breast cancer and should be evaluated by a doctor: Lump in the breast or underarm Swelling of the breast Bloody nipple discharge Dimpling, redness, or pitting of the skin over the breast Peeling or flaking or scaliness of the nipple skin Breast pain Nipple pain or the nipple appearing to turn inward Causes of Breast Cancer Breast cancer is caused by a mutation in the genetic code during cell replication. These cellular “mistakes” happen more commonly as a person ages. The cells grow abnormally and divide more rapidly than healthy cells do. The accumulation of cells forms a tumor that grows in the breast and can spread to the lymph nodes or other parts of your body. Breast cancer most commonly begins with cells in the milk-producing ducts (ductal carcinoma) but it may also begin in the lobules (lobular carcinoma). Breast cancer is caused by a combination of your genetic makeup and your environment. Certain risk factors have been identified that can increase a person’s risk of breast cancer. About 5-10 percent of breast cancers are linked to a genetic mutation passed through generations of a family. The most common are breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), both of which increase a person’s risk of breast and ovarian cancer. Risk Factors for Breast Cancer A risk factor is anything that makes it more likely that you will get a disease. Many risk factors for breast cancer are beyond a person’s control and most women with breast cancer have no known risk factors other than that they are female. Older caucasian women (over the age of 60) have the highest risk of developing the disease. A personal or family history of breast cancer increases your risk of developing breast cancer. Inherited genes (BRCA1 and BRCA1) can also increase the risk of developing breast and other cancers. Exposure to radiation also increases a person’s risk of developing breast cancer. Beginning your period at a younger age (before age 12) or beginning menopause at an older age (after age 55) increases a person’s risk. Also having your first child at an older age (over age 35) increases a person’s risk. Other factors contributing to breast cancer can be controlled. Maintaining a healthy weight, exercising, limiting alcohol intake, and eating a healthy low fat diet can reduce a woman’s risk. Staging Breast Once a diagnosis of breast cancer has been made, the stage of the breast cancer is determined to help determine prognosis and treatment options. The stage of the cancer may not be determined until you undergo breast cancer surgery. Breast cancer stages range from 0 to IV, with 0 indicating that the cancer is small and noninvasive. Stage IV breast cancer (metastatic breast cancer) is where the cancer has spread to other areas of the body. Tests and procedures to stage breast cancer may include: Blood tests Chest x-ray Bone scan CT scan PET scan PEM Not all women need all of these tests and procedures. Your doctor will select the appropriate tests. Options For Biopsy If a suspicious lump is discovered in the breast, your doctor will likely want to perform a biopsy, or sampling, of the area. A needle biopsy or a surgical biopsy will be needed to collect a sample of tissue that can be tested for cancer. Fine Needle Aspiration: Fine needle aspiration can be done for breast cysts or sampling lymph nodes, usually using ultrasound guidance to locate the lesion. Local anesthetic is injected, and a thin, hollow needle is used to remove a sample of liquid or tissue for diagnosis. Core Needle Biopsy: Core needle biopsy uses local anesthetic and a needle to collect several samples of tissue from the suspicious area. A core needle biopsy is usually guided by ultrasound or mammogram (mammography-assisted biopsies are referred to as stereotactic biopsies). Both aspiration biopsy and core biopsies are performed in the office of Advanced Surgical Associates with ultrasound guidance. Surgical Biopsy: To test a suspicious lump for the presence of breast cancer, your surgeon will take a biopsy, or tissue sampling, of the area. The location of the lump may need to first be marked with a needle using ultrasound or mammography guidance if it is not palpable. A needle will be inserted through the skin to mark the target area (lump, calcifications, etc.) before the biopsy is done. A surgical procedure is then done to remove a piece of tissue for analysis. The surgery is an outpatient procedure and patients can return to normal activities in a few days. Breast Surgery Surgery is typically the first step in a treatment plan for breast cancer unless the cancer is very advanced. Surgeons can remove the tumor using one of two types of surgery. Underarm lymph nodes are also removed and sampled at the time of surgery. *Lumpectomy. Also called breast conserving surgery* or partial mastectomy, a lumpectomy involves surgically removing the tumor along with some surrounding tissue. As a result, a lumpectomy may allow a woman to preserve much of her breast and avoid the need for reconstructive surgery. The surgery is followed by radiation treatment. Chemotherapy may be needed depending on the size of the tumor and lymph node involvement. *Mastectomy. Mastectomy involves the complete surgical removal of the breast. A simple* mastectomy removes all of the breast tissue, including the nipple. A modified radical mastectomy includes removal of all of the breast tissue as well as removal of the axillary lymph nodes. A radical mastectomy (during which surgeons also remove the chest wall muscles in addition to the breast and lymph nodes) is no longer performed. A skin-sparing mastectomy removes the breast tissue including the nipple while leaving much of the breast skin in place for reconstruction of the breast. Breast reconstruction with mastectomy can be done at the same time as the mastectomy (immediate reconstruction) in coordination with a plastic surgeon, or may be done at a later time (delayed reconstruction). Chemotherapy may be needed depending on the size of the tumor and lymph node involvement. *Sentinel Lymph Node Biopsy. Sentinel lymph node biopsy is done at the same time as lumpectomy or mastectomy. The main draining lymph node(s) from the breast are removed and sampled. The lymph node is checked for breast cancer cells. If no cancer is found, the chance of finding cancer in any of the remaining nodes is small and no other nodes need to be removed. Axillary Lymph Node Dissection.* This surgical removal of all of the lymph nodes under the arm is done if cancer is found in the sentinel lymph node or if needle biopsy shows that cancer has spread to the lymph nodes. As with sentinel lymph node biopsy, this can take place with a mastectomy or lumpectomy. Cancer cells found in the lymph nodes increase the risk of the cancer spreading to other areas of the body. This helps determine the best course of treatment, including whether chemotherapy or radiation therapy is needed.	Advanced Laparoscopy General Surgery Breast Surgery Surgical Oncology Colorectal Surgery Did You Know? There are new techiques in radiation treatment for breast cancer that has shortened therapy time from six weeks to five days.