Breast cancer often presents as a painless lump in the breast. It may be associated with bloody nipple discharge or changes in the skin or appearance of the breast as well. Many early breast cancers are now detected by screening mammography alone, often noted as suspicious microcalcifications.
A breast lump should be evaluated by a physician. In addition to a history and physical exam the lump may also be investigated using mammography or ultrasound. It may be necessary to biopsy the lump in order to determine whether the lump is cancerous. Biopsies may be done using a needle and local anesthetic. Sometimes this is done with ultrasound or x-ray guidance (stereotactic biopsy). Other situations require a biopsy done with either sedation or an anesthetic in the operating room, occasionally with direction from a needle placed by the radiologist.
If a lump is determined to be cancer then the tumor will need to be staged using CT scans, bone scans, and maybe a PET scan. The final staging of the tumor cannot be completed until surgical therapy is complete. Please visit the National Cancer Institute website for the detailed criteria for staging breast cancer.
Standard therapy includes surgical treatment of the lump and the lymph nodes in the axilla and at least consideration of whether or not chemotherapy and radiation will be necessary.
Surgical therapy options currently include modified radical mastectomy (removal of the breast and the lymph nodes of the axilla) with or without reconstruction by a plastic surgeon OR lumpectomy and sentinel lymph node biopsy. Radiation is required with lumpectomy.
Sentinel Lymph Node Biopsy
Sentinel lymph node biopsy involves injecting the breast with a radiotracer that accumulates in the “gatekeeper” lymph nodes of the axilla. Usually one or two axillary lymph nodes are removed and examined instead of taking ten or more. If the sentinel lymph nodes do not contain tumor then a full axillary dissection with removal of more lymph nodes may be avoided. If the sentinel lymph node(s) contains tumor then a return to the operating room for a complete axillary dissection will be necessary. There are currently ongoing studies at larger institutions to determine if the completion axillary dissection will continue to be necessary.
After a mastectomy you will stay in the hospital until your pain is adequately controlled with oral medications. You will also have several plastic drain tubes that will remain in place for at least several days after the operation. You may be discharged from the hospital with these. In this case you or your family will be taught to care for them or a home health nurse will be arranged if this is an option.
After a lumpectomy and sentinel lymph node biopsy or an axillary dissection it is possible in some instances for you to go home the same day. Often an overnight stay is required. You will have in most cases a single plastic drain with this operation.
It typically takes three to seven days for the pathology lab results on the breast and lymph node tissue removed to become available.
Your surgeon at Victoria Surgical Associates will discuss with you an individualized plan to evaluate your breast mass. If the mass turns out to be a cancer then your options and the surgeon’s recommendations will be presented to you. We are dedicated to providing women with complete and high quality surgical breast cancer care right here at home in Victoria, where it is convenient for you and your family.
In addition to your preoperative and surgical care we are committed to your care after your operation. For women who undergo mastectomy and choose not to have reconstruction we provide breast prosthetic fitting services right in our office.
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