Breast Surgery & Treatment

Usually breast cancer—unless it is quite advanced—is painless.

Breast pain may have multiple origins, including but not limited to: fibrocystic changes, cysts, infection, hormonal cycle, trauma, dietary factors, inflammation from external sources, etc.

If you have breast pain, it is a good idea to consult your breast physician for a workup, diagnosis and treatment.

Only 5 percent of all breast cancers are related to pathologic genes (i.e., BRCA, amongst other pathologic genes).

However, your family history can put you in a higher risk group for breast cancer.

If you have a family history of breast cancer, you should consult your breast physician for a discussion of the appropriate screening modalities available to you.

Most breast callbacks are for further diagnostic views and imaging by other modalities and usually result in clarification of the question by imaging alone. Some imaging abnormalities will require biopsy. Most of these can be done with a needle and do not require open surgery. Most breast biopsies will yield benign, noncancerous results (80 percent or more).

The current treatment of breast cancer is multimodality, involving surgery (breast and plastics), medications (chemotherapy, hormonal therapy, immunotherapy) and radiation (e.g., whole breast vs. partial breast). Treatment recommendations will be discussed based on your personal history, risk assessment, the type, size, and location of the breast cancer you have, your personal habits and your preferences.

Two patients with the exact same breast cancer may elect for treatments at different ends of the treatment spectrum. For example, Patient A with a 2 cm tumor in the upper outer quadrant of her 34C breast may elect for breast conservation and radiation with post-op hormonal therapy. Meanwhile, Patient B with the exact same breast size, tumor size, type and location may elect to have both breasts removed, reconstructed and forego radiation and future imaging. Though these two treatments will yield equal outcomes, each treatment was the correct treatment for the individual patient.

Current data does not support routine contralateral prophylactic mastectomy (CPM) in normal risk individuals. Fear of getting breast cancer in the opposite breast is the least well-supported reason for having the normal breast removed (i.e., the surgical risks of having the breast removed and reconstructed are greater than the risks of getting cancer in that breast). In fact, unless you have personal risk factors that increase your risk of breast cancer in the normal breast, current research suggests that it may actually be detrimental to your overall health to have routine CPM.

Of course, a thorough discussion of risks, benefits and alternatives should occur with your breast surgeon prior to any breast cancer surgery. In some patients, who do not have a higher biologic risk, CPM may be the right choice for them because of other non-medical factors.

It is a very good idea to get to know your breasts. A monthly self-exam can make you feel more comfortable with the makeup and appearance of your breasts, but more importantly will allow you to know if something is new (i.e., it wasn’t there before). Most lumps are benign, especially if they have a history and are non-changing. However, new and growing lumps warrant a visit to your breast physician and should usually be investigated.

There isn't one specific sign of breast cancer. However, there are a constellation of findings that should warrant a trip to the breast physician. Such signs include, but are not limited, to changing lump, new/changing swelling or edema of the skin, an ulcerating skin wound, retraction (pulling in) of the skin, a change of breast shape, new nipple discharge, a new crusty appearance to the nipple/areola, a new lump in the armpit.

Most women do not require a screening breast magnetic resonance imaging (MRI) scan. These are usually reserved for high-risk women (lifetime calculated risk over 20 percent), and/or women who had a biopsy showing a high-risk lesion (e.g. atypical hyperplasia, lobular carcinoma in situ).

Breast MRIs are indicated in some breast cancer patients before surgery to exclude disease in the opposite breast and to evaluate the extent of disease in the affected breast. The decision for a breast MRI will usually be made after discussion with your physician and is usually based on your personal risk factors, your age and the type of breast cancer you have.

Breast MRIs are frequently performed for individuals receiving chemotherapy or hormone therapy before surgery to gauge the response of the tumor to therapy.

Family history and the chromosomes (genes) we receive from our parents are risk factors that we currently cannot change, though splicing and repairing pathologic genes may become available in the not-too-distant future.

Risks that the individual can control include:

• Fat cells in women produce extra estrogen hormone.
• How much is too much is still being debated. However, most experts agree that alcohol can increase breast cancer risk incrementally.
• Not only can smoking increase your risk of getting breast cancer, but smokers with breast cancer may do worse than non-smokers with breast cancer.
• Hormone therapy. Hormones, like estrogen, can increase risk of breast cancer. The risk is related to the length of time used and seems to decrease with time once the hormones are stopped.

In some women, nipple discharge can be associated with breast manipulation and/or hormonal changes. This is especially true if the same discharge is present in both breasts.

Most nipple discharge will be from a benign etiology.

A new, spontaneous, unilateral nipple discharge should initiate a visit with your breast physician.

1) Selective estrogen receptor modulators:

• Tamoxifen: Original hormone treatment for breast cancer and can be used in premenopausal women.
• Raloxifene: Primarily used for osteoporosis and may reduce risk of certain breast cancers in high-risk individuals. The main risks include blood clot, uterine cancer and menopausal symptoms.

2) Aromatase inhibitors:

• Anastrozole, Exemestane: These drugs have been shown to effectively reduce risk of breast cancer in post-menopausal women.
  The risks include osteoporosis, bone pain/muscle cramps and menopausal symptoms.

Current data does not support routine contralateral prophylactic mastectomy (CPM) in normal risk individuals. Fear of getting breast cancer in the opposite breast is the least well-supported reason for having the normal breast removed (i.e., the surgical risks of having the breast removed and reconstructed are greater than the risks of getting cancer in that breast). In fact, unless you have personal risk factors that increase your risk of breast cancer in the normal breast, current research suggests that it may actually be detrimental to your overall health to have routine CPM.

Of course, a thorough discussion of risks, benefits and alternatives should occur with your breast surgeon prior to any breast cancer surgery. In some patients, who do not have a higher biologic risk, CPM may be the right choice for them because of other non-medical factors.

Breast cancer cells are seen, but they are still inside of the breast ducts. They are noninvasive. This is felt to represent a pre-cancer or Stage 0 (The horse is still in the barn).

Ductal Carcinoma is graded (1-3). The higher the grade, the more aggressive it can be.

When diagnosed by needle biopsy, it requires further investigation, as it may be associated with invasive cancer.

Only 5 percent of all breast cancers are related to pathologic genes (i.e., BRCA, amongst other pathologic genes). However, your family history can put you in a higher risk group for breast cancer. If you have a family history of breast cancer, you should consult your breast physician for a discussion of the appropriate screening modalities available to you.

Generally, two weeks, depending on the type of procedure.

Minor surgical procedures may be performed in the office setting or at a surgery center. For more complex procedures, they are typically scheduled at one of our affiliated hospitals.

Absolutely! Several procedures can be performed laparoscopically with minimally invasive techniques.

Only 5 percent of all breast cancers are related to pathologic genes (i.e., BRCA, amongst other pathologic genes). However, your family history can put you in a higher risk group for breast cancer. If you have a family history of breast cancer, you should consult your breast physician for a discussion of the appropriate screening modalities available to you.

It will depend on the type of surgery. For minor procedures, time off from work may not be required. For abdominal surgeries, there are lifting restrictions after surgery so it may be anywhere from 4 to 8 weeks. If your job involves heavy lifting and your employer does not offer "light duty," you may need to be out of work during that period of time. Our office will help with filling out FMLA or short-term disability paperwork, as needed.

If you are not having anesthesia, then you can drive yourself home.

If you are receiving anesthesia of any type (general, twilight, sedation, etc.) a responsible adult (over 18) will have to drive you home. You cannot take public transportation, taxi, or Uber/Lyft home after having anesthesia.

Only 5 percent of all breast cancers are related to pathologic genes (i.e., BRCA, amongst other pathologic genes). However, your family history can put you in a higher risk group for breast cancer. If you have a family history of breast cancer, you should consult your breast physician for a discussion of the appropriate screening modalities available to you.

Current data does not support routine contralateral prophylactic mastectomy (CPM) in normal risk individuals. Fear of getting breast cancer in the opposite breast is the least well-supported reason for having the normal breast removed (i.e., the surgical risks of having the breast removed and reconstructed are greater than the risks of getting cancer in that breast). In fact, unless you have personal risk factors that increase your risk of breast cancer in the normal breast, current research suggests that it may actually be detrimental to your overall health to have routine CPM.

Of course, a thorough discussion of risks, benefits and alternatives should occur with your breast surgeon prior to any breast cancer surgery. In some patients, who do not have a higher biologic risk, CPM may be the right choice for them because of other non-medical factors.