Treatment for Breast Conditions

The only certain way to learn whether a breast lump or mammographic abnormality is cancerous is by having a biopsy, a procedure in which tissue is removed by a surgeon or other specialist and examined under a microscope by a pathologist. A pathologist is a doctor who specializes in identifying tissue changes that are characteristic of disease, including cancer.

Tissue samples for biopsy can be obtained by either surgery or needle. The doctor's choice of biopsy technique depends on such things as the nature and location of the lump, as well as the woman's general health.

Excisional biopsy is usually performed in the outpatient department of a hospital.  The surgeon makes an incision along the contour of the breast and removes the entire lump along with a small margin of normal tissue. Because no skin is removed, the biopsy scar is usually small. The procedure typically takes less than an hour. The patient usually spends about 30 – 45 minutes in the recovery room. The patient will be discharged after they eat and feel well.

Wire localization biopsy is a procedure that uses mammography to locate breast abnormalities that can be seen on a mammogram or ultrasound but cannot be felt (nonpalpable abnormalities). For a wire localization surgical biopsy, the radiologist locates the abnormality on a mammogram (or a sonogram) just prior to surgery. Using the mammogram as a guide, the radiologist inserts a fine wire through a needle so the tip rests near the suspicious area. The needle is withdrawn and the wire is anchored with a gauze bandage, and a second mammogram is taken to confirm that the wire is on target. This procedure is done for calcifications or nodules seen on mammograms or ultrasounds but not felt by you or your doctor.

Fine needle aspiration uses a very thin needle and syringe to remove either fluid from a cyst.

Mammotome Stereo Biopsy is an approach that relies on a three-dimensional x-ray to guide the needle biopsy of a nonpalpable mass. The patient lies face down on an examining table with a hole in it that allows the breast to hang through; the x-ray machine and the maneuverable needle "gun" are set up underneath. The breast is x-rayed from two different angles, and a computer plots the exact position of the suspicious area. (Because only a small area of the breast is exposed to the radiation, the doses are similar to those from standard mammography.) Once the target is clearly identified, the radiologist positions the gun and advances the biopsy needle into the lesion taking a sample of tissue. If the results are ambiguous, you may require further biopsy with a wire localization and this occurs approximately in 5 - 10% of these biopsies. 

There are several different types of surgical procedures used to treat breast cancer.

Surgical procedures for breast cancer include:

• Simple mastectomy: removal of the breast, with its skin and nipple, but no lymph nodes. In some cases, a separate sentinel node biopsy is performed to remove only the one to three axillary (armpit) lymph nodes.

• Modified radical mastectomy: removal of the entire breast including the nipple/areolar region, and some of the axillary lymph nodes. This is the most common form of mastectomy performed today.

• Radical mastectomy: removal of the entire breast, nipple/areolar region, the pectoral (chest) major and minor muscles, and lymph nodes. This procedure is rarely performed today, usually when the tumor involves penetration into the muscle.

• Partial mastectomy: removal of a portion of the breast tissue and a margin of normal breast tissue.

• Lumpectomy: removal of the breast cancer tumor with a surrounding margin of normal breast tissue and the removal of some axillary lymph nodes.  The breast then undergoes radiation treatment.

Axillary node dissection, the surgical removal of the axillary (armpit) lymph nodes, is usually performed on patients with invasive cancers. A radical mastectomy, modified radical mastectomy, or lumpectomy operation includes axillary node dissection (this involves a separate incision for lumpectomy patients). After surgery, the axillary lymph nodes are examined under a microscope to determine whether the cancer has spread past the breast and to evaluate treatment options.

Sentinel lymph node biopsy is a new procedure that involves removing only one to three sentinel lymph nodes (the first nodes in the lymphatic chain). To perform sentinel node biopsy, a radioactive tracer is injected into a region of a tumor. The tracer is then carried to the sentinel node (the lymph node most likely to be cancerous if the disease has spread from its original origin). Surgeons detect the sentinel lymph node by measuring a node’s radioactivity with a Geiger counter.