Breast Procedures

Patient Education > Breast > Breast Procedures

Self Breast Examination

Patients can best care for themselves by performing a monthly self-breast examination and reporting abnormalities to their doctor. See Breast Care Screening Guide Your physician can review for you the techniques of how to do a self-breast exam. Each patient should have yearly physical exams by their physicians. Screening mammograms are first obtained between ages 35-40. They should be obtained every two years until age 50, then annually thereafter. This may be done more frequently if a patient has a personal or strong family history of breast cancer. Contact your family doctor or surgeon to determine your best screening plan.

Fine Needle Aspiration

A cyst or fluid filled cavity can be evaluated by draining the fluid with a small (fine) needle. The fluid is sometimes sent for further testing. This procedure can be done easily in the office with a local anesthetic. This will usually make the cyst disappear. If a lump or mass is present, it may also be sampled in the office with a fine needle by taking multiple samples. This will not remove the lump, but it can evaluate the cells in the mass. The results of the specimen will help determine additional treatment.

Open Biopsy

If a lump is solid, large or very painful, it may be removed surgically. Each case is evaluated on an individual basis by your physician. If your physician recommends an open biopsy, this is done at the hospital in an operating room on an outpatient basis. Anesthesia is used to ensure patient comfort; usually a combination of local anesthetic with sedation through the IV line, which will allow you to "sleep" through the procedure. Once the area around the lump is numbed, a small cut (incision) is made and the lump is removed through the incision. Often a rim of normal breast tissue will also be removed around the lesion to ensure adequate margins around the lesion. Sutures (stitches) are used to close the incision and minimize scarring.

If an area of concern is not found on physical examination by you or your doctor but is visible by mammography or ultrasound, the area can be removed with the assistance of a needle localization procedure. Before surgery, you will go to the x-ray department where your mammogram was done. The Radiologist will place a very fine wire in the breast using the mammogram to locate the lesion. This wire will mark the abnormal region in the breast to help guide your surgeon to remove site in question. You will then be taken to the surgery suite to undergo the open biopsy as described above.

Lumpectomy

If a cancer is found to be present in the biopsy specimen, then a lumpectomy may be performed. This is a procedure that removes the tumor and a margin of surrounding healthy tissue. This is usually done in conjunction with an axillary dissection (removal of lymph nodes under the arm) or sentinal lymph node biopsy. Sometimes a partial mastectomy is done rather than a lumpectomy. The two procedures are similar, but the margin of tissue removed surrounding the tumor is larger with a partial mastectomy. With both procedures, radiation therapy to the remaining breast is almost always advised as a supplement following surgery. Chemotherapy may be prescribed as well, depending upon the presence of cancer in the axillary (underarm) lymph nodes and other factors. The advantage of this breast conserving treatment is that the breast is left in place. The disadvantages of breast conservation include the potential recurrence of the cancer in the remaining breast and the necessity of radiation (x-ray) treatment following surgery.

Axillary Node Dissection

Axillary (underarm) lymph node dissection is the removal of some of the axillary lymph nodes. This procedure is usually performed with a lumpectomy, as well as a mastectomy (see below). The nodes can then be examined under a microscope by the Pathologist to see if they contain cancer cells. If cancer is present in many axillary lymph nodes, then chemotherapy may be recommended for additional treatment. Lymph node dissection may increase your risk of arm swelling (lymphedema) and arm discomfort on the side of your surgery. However; this risk of swelling is low.

A Jackson-Pratt (J-P) drain will be used after this surgery to collect any fluid from the wound. Axillary node dissection can usually be performed on an outpatient basis.

Modified Radical Mastectomy

A modified radical mastectomy is another commonly performed breast cancer operation and is an alternative to breast conservation therapy. During this procedure the entire breast and a portion of the axillary (underarm) lymph nodes are removed from the chest wall. This procedure does not involve removing any chest wall muscles. Chemotherapy may be advised depending on your individual case or if cancer is present in the removed lymph nodes. Radiation is not routinely prescribed following a modified radical mastectomy, unless the cancer has spread to the local area or many lymph nodes. The strength of your arm is not affected; hand and arm swelling is rare. The disadvantage of this procedure is removal of the breast. Reconstructive surgery is an option, either at the same time of the surgery or at a delayed reconstructive surgery. Wearing a prosthesis (a soft breast form that fits into a bra) is an option after a mastectomy. A simple mastectomy may be recommended in certain cases. This is where only the breast tissue is removed. The muscles and the axillary lymph nodes remain in place.

Modified Radical Mastectomy will result in placement of one or two soft plastic drainage tubes called Jackson Pratt drains. One may be placed in the axilla (arm pit) and the second one (if used) under the skin where the breast was removed. These J-P drains draw off the fluid around the incision to promote healing. These require emptying of the fluid at least 2-3 times per day. Recovery after mastectomy will usually require a 24-hour or less stay in the hospital.

Risks and Complications

The risks and complications of breast procedures include, but are not limited to, infection, bruising, bleeding, swelling, pain, loss of tissue resulting in scarring or cosmetic deformity, stiffness of the shoulder, numbness due to nerve damage, fluid under the arm and under the incision, or long-term swelling of the arm (lymphedema), need for further surgery, reaction to medication, etc.