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A breast biopsy for a palpable mass or mammogram abnormality can be a stressful
experience. Grand River Surgery's staff have significant experience in
helping women navigate this frequently challenging course. We provide our
patients with a significant amount of reading material that can help you
understand the choices you're being presented. The
National Cancer Institute has a
calculator which can help you understand your risk for breast cancer.
They also have a
comprehensive
review, which is one of our favorite information sources.
There are several different types of surgery that might be performed on the
breast to evaluate an abnormality, including:
A Core Needle Biopsy is a procedure to take a "core" from a palpable
mass in the office; or a radiologist may perform the procedure using a special
type of mammogram machine. If this is done in the office, most women
tolerate the procedure well. There is usually minimal discomfort at the
time of the procedure and pain may last for a few to several days afterwards,
but generally narcotic pain pills are not required. This is a "diagnostic"
study meaning that the tissue will aid in the diagnosis of the problem and help
establish a definitive treatment plan. Further surgery may be indicated
after this procedure. You should wear your bra day and night for one week
following this procedure to help control swelling and bruising. You will
be seen approximately five days after the procedure to discuss the results and
decide upon a treatment or surveillance plan.
An Excisional Breast Biopsy is also done to achieve a diagnosis.
This is usually done to evaluate abnormalities on a mammogram. Generally a
"wire" will be needed to guide the surgeon to the area of interest. On the
day of your surgery, the radiologist will place the guide wire in the area of
interest using a special mammogram machine. Then, you'll return to the
preop area until surgery. Surgery is generally done with moderate sedation
administered by an anesthesiologist and takes about 45 minutes. We always
confirm removal of the abnormal tissue before you wake up, just in case more
tissue needs to be removed. Most women go back to the pre-op area, where
your family can be with you. Most women sleep comfortably through surgery
and don't remember the experience. This is also a diagnostic procedure.
Occasionally, if a cancer is discovered, it is completely removed and no further
breast surgery is indicated, although lymph node sampling may be indicated.
You should wear a bra day and night for a week after surgery. Most women
will take 3-5 days off from work and may use narcotic pain pills for a few days.
You will be seen approximately five days after the procedure to discuss the
results and decide upon a treatment or surveillance plan. Most women will
not appreciate a cosmetic change after this procedure, but the breast tissue
will feel different.
If no cancer is detected with the above options, a repeat mammogram will be
ordered for three month's time to establish a new baseline for future
comparisons. On occasion, if a cancer is detected, it may not be all
removed and a lumpectomy will be required as described below. Lumpectomy
with sentinel node biopsy is demonstrated to have excellent results in terms of
survival and low recurrence, in comparison to mastectomy. Lumpectomy does
usually require radiation therapy to the breast to achieve success. If
radiation therapy is not an option due to distance or prior radiation therapy,
then mastectomy is generally indicated. The use of chemotherapy and
hormone medications to decrease the risk of future cancers is variable and will
be discussed after lymph node status (cancer or not) is known.
A Lumpectomy is performed after one of the options
above to achieve definitive local control of a breast cancer. This is an
outpatient surgery for most women. Usually it can be done under sedation,
but if it is combined with a sentinel lymph node biopsy, general anesthesia is
occasionally used. Most women will need 1-2 weeks off work and will take
pain pills for 3-5 days after the procedure. It is important to wear a bra
day and night for two weeks afterwards to help maintain the shape of the breast.
On occasion, not all of the cancer will be able to be removed and a second
lumpectomy will be required. Depending upon the size of the breast, this
may or may not result in an acceptable cosmetic outcome and mastectomy with
breast reconstruction may be indicated. You will be seen 5-7 days after
surgery to review the results and establish a definitive treatment plan.
A Mastectomy is indicated for some women because of
the size of the mass or the location of the mass; also if you have had radiation
before or live too far away from a radiation therapy center to visit it every
day for 5-7 weeks (M-F). This surgery is only done after you have been
diagnosed with a cancer. Most women undergo some form of reconstruction
surgery at the same time. You will be offered the opportunity to discuss
reconstruction options with a well-qualified plastic surgeon prior to your
surgery being scheduled. Most women will spend 2-3 days in the hospital
after this surgery. A team of individuals will meet with you during your
hospitalization, this includes physical & occupational therapists, social
workers, dieticians, and the physicians involved in your care. Pathology
is generally not finalized during your hospitalization and will be reviewed in
the office after you are discharged from the hospital. You will generally
have drains in place which help drawn fluids out from the surgical area and
result in better cosmetic results. You will be taught about how to care
for these drains during your stay. There are organizations which sell
garments which you may find helpful in managing the drains -- they have
removable pouches for the drains. Safety pins also work well.
Lymph nodes are assessed in two different ways --
Sentinel Lymph Node Biopsy (SNLB) and Axillary Dissection. SNLB
is usually performed at the same time as a lumpectomy, but also may be used with
mastectomy. SNLB uses two different strategies to locate the lymph nodes
that the breast drains to first. Research shows that we can remove a small
number of nodes identified as the sentinel nodes, and if there is no cancer
detected, we can reliably predict that the tumor has not metastasized. If
tumor is detected in the sentinel nodes, a formal axillary dissection will be
required. This carries substantially more risk of nerve and lymphatic
drainage damage than a SNLB, but is still well-tolerated by most women.
SNLB uses a radioactive tracer which can be followed with a special device, and
a blue-dye to visually identify lymph vessels and nodes. The results of
the biopsy will be reviewed in the office, again, 5-7 days after surgery.
Axillary dissection causes more pain and post-operative stiffness than SNLB
does; specific exercises will be given to you to help stretch your shoulder
muscles and regain mobility. After a SNLB, most women experience a few
days of discomfort and limited mobility. Pain medications are used for a
few days. Most women would take a few days off from work if just a SNLB is
being performed. Axillary dissection is more painful and most women will
take at least 1-2 weeks off from work and may use narcotic pain pills for 7-10
days. |
