Onco-Plastic Diagnostic Breast Lumpectomy

Healthy breast tissue can be “lumpy and bumpy” and may change a bit during your monthly cycle.  Learning the uniqueness of your breast geography is the focus of frequent breast self-examinations. All young women should learn the technique of breast self-examination as early as the age of 15.

The American Cancer Society Guidelines for the Early Detection of Breast Cancer currently relates that breast cancer low-risk women ages 40-44 be given the choice for annual Screening Mammography (SM). Women ages 45-54, independent of risk, are recommended to proceed with scheduled SM annually in addition to a physician-directed breast exam. Women age 55 or older may consider SM every two years but may continue to elect to continue annual SM with both options being paid for by all forms of US health insurance.

Patients with stable self-breast exams may present with concerning radiographic findings in the setting of a screening mammogram.  Your Breast Radiologist may relate that you may have microcalcifications or contour irregularities that prompt further evaluation by a Diagnostic Mammogram (DM) and breast Ultra Sound (US).  This is how many women with no changes in their self-exam nor on physical examination by their primary care physician present with breast cancer.

Changes in the internal contour of your breast can either present as a self-discovered new or enlarging “lump” or “mass” discovered by your physician. Typical evaluation of a changing breast exam includes a DM and breast US.    Benign, non-cancerous lesions as cysts or fibroadenomas have characteristic radiographic findings.   Many radiographic abnormalities as these do prompt an intervention for confirmation of the correct benign diagnosis.  Cysts are easily aspirated and the fluid is sent to pathology to confirm the lack of a malignancy.  Solid masses can be biopsied using small – Fine Needle Aspiration (FNA) or larger Core Needle Biopsy (CNB) needles either under direct palpation by your physician or with guidance by mammography or ultra sound.  More advanced imaging or biopsy guided by Breast MRI may be required.  These types of studies can cause anxiety and worry for most patients.  Regretfully, many are not scheduled on the same day and waiting for results is a challenge.

Several clinical scenarios prompt an open surgical biopsy of a breast abnormality known as a “breast lumpectomy”.  Often times a Fine Needle Guidewire is placed either by our Radiology Physicians using mammographic guidance or in the Operating Room using ultra sound guidance by specialty-trained breast surgeons.  The tip of the guidewire is placed adjacent to the area of concern within the breast that can’t be appreciated simply on physical examination.  Every attempt is made to keep you as comfortable as possible during all aspects of the procedure.

Incisions for open lumpectomies are planned to provide the most aesthetic outcome should the mass be benign or malignant.  Every attempt is made to achieve a complete removal of the concerning tissue and to provide an aesthetic surgical closure.  Patients with known breast cancer require Sentinel Lymph Node Biopsy at time of open lumpectomy for comprehensive pathologic staging.  All tissue removed is reviewed by our Board-Certified Pathologists with diagnostics to include receptor status (Estrogen ER and Progesterone PR), Ki-67 immunohistochemisty, Her-2-Neu IHC/FISH and Oncotyping.  Genetic Testing is completed on a case-by-case basis based on family history and personal risk review.

The aesthetic outcome after lumpectomy is best understood as a ratio of the amount of breast tissue removed relative to the size of the remaining breast.  A large biopsy removed from a small breast could leave you with an unacceptable breast deformity. Patients with moderate to large breasts may benefit from simultaneous breast lifts or breast reductions at the time of lumpectomy to provide an aesthetically superior outcome.

This area of breast care is referred to as “onco-plastic” as only a surgeon with both general surgical breast cancer care experience AND plastic surgical training may provide an expert surgical recommendation for the best aesthetic outcome after lumpectomy without or with the need for breast conserving radiation thereafter.

Most often, patients are not offered referral to an experienced breast plastic surgical expert prior to lumpectomy for diagnosis nor for treatment for a breast cancer prior to breast conserving radiation.  Shortly after lumpectomy, the lumpectomy cavity fills with fluid and the breast appears unchanged.  Its only after time that the fluid dissipates, and the breast appears dented, contracted and deformed from either a disproportionately large lumpectomy or from the combination of lumpectomy and radiation therapy.

All breast patients deserve a consultation with an experienced breast onco-plastic expert PRIOR to any lumpectomy to achieve the highest level of aesthetics years after surgery.
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Dr. Marga is pleased to evaluate your unique breast concerns to include your radiographic evaluations and physical examination to define the most appropriate onco-plastic surgical outcome with a focus on oncologic safety and superior cosmesis after cancer care.