HILTON HEAD GENERAL & LAPAROSCOPIC SURGERY, PA

SURGICAL SPECIALISTS

 

Richard L. Hussong, Jr, MD

Thomas P. Rzeczycki, MD

Robert L. Soares, Jr, MD

SURGICAL EVALUATION OF THE BREAST

Women are usually referred to a surgeon when there have been changes on her mammogram or breast examination.  Changes in the breast examination that are concerning are multiple and may be: a new lump or mass, nipple inversion, nipple discharge, and skin changes such as redness, scaling, swelling, or pitting.  Many of the changes that prompt a referral to the surgeon will ultimately turn out to be benign (not cancerous).

 

COMPONENTS OF A BREAST EVALUATION

The most important aspect of the evaluation is the clinical breast examination (CBE).  During the CBE both breasts and axillae (armpits) are visually inspected and palpated by the surgeon looking for any changes out of the ordinary.  If changes are found or the mammogram has a reported abnormality then an ultrasound will likely be performed.  The ultrasound is valuable in determining if the abnormality is solid or cystic.

 

BIOPSY

The surgeon uses the mammogram, ultrasound and physical findings to decide how suspicious a change is and if it warrants a biopsy.  A biopsy is a sampling of the breast tissue for evaluation by a pathologist for the presence of cancer cells.  Even if there is not a great degree of suspicion a biopsy may be warranted to alleviate patient anxiety.

More than 1.2 million breast biopsies are performed annually in the US, and 80% of these biopsies prove to be benign.  Therefore, every attempt is made to perform the biopsy in the least invasive manner possible.

 

KINDS OF BREAST BIOPSIES

There are several different ways to perform a breast biopsy.  The method used is dependent upon the features of the breast change, patient characteristics, and physician preference.  Fortunately, most women are now able to get an accurate biopsy without going to the operating room.

FINE NEEDLE ASPIRATE (FNA)—A FNA is performed in the office with a small amount of local anesthetic, numbing medication, injected into the skin.  A thin needle is passed into the breast lesion several times to obtain the tissue or fluid to be sampled.  There is minimal discomfort afterwards and no stitches are necessary.

CORE BIOPSY—This type of biopsy is also performed in the office and also requires a small amount of anesthetic to numb the skin and breast tissue.  Unlike the FNA, the needle is larger and requires a small quarter inch incision to allow for its insertion.  The needle is then inserted four or six times to remove cores or “plugs” of tissue for evaluation by the pathologist.  No stitches are required and discomfort afterwards is minimal.

STEREOTACTIC BIOPSY—This method of biopsy is usually performed in a radiology department or an outpatient facility. In this technique a computer analyzes mammograms

 

Complete Breast Care