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The treatment of breast cancer has moved away from mastectomies and toward removing the tumor and a small area of surrounding breast tissue. Studies have shown this offers the same long-term prognosis for some patients, while avoiding the disfigurement of a mastectomy. In centers specializing in the care of breast cancer most patients can be treated with breast conservation therapy. This form of surgical therapy is usually combined with radiation therapy of the breast.
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The Mammotome biopsy is a minimally invasive procedure used to obtain sufficient tissue to make an accurate diagnosis of a variety of breast problems, including breast cancer. This procedure is done under the direction ofultrasound or mammography in our office, using only local anesthesia. This type of biopsy eliminates the need for patients to go to the operating room and is an excellent way to obtain a diagnosis in appropriately selected patients.
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A sentinel node biopsy offers a less invasive way to determine if lymph nodes under the arm (axilla) are involved with cancer, which has become the standard of care for the staging of breast cancer. A sentinel lymph node biopsy requires the removal of only one to three lymph nodes for close review by a pathologist. If the sentinel nodes do not contain tumor (cancer) cells, this may eliminate the need to remove additional lymph nodes in the axillary area. Sentinel node biopsy is done in the operating room as outpatient surgery and has less long-term complications than the larger axillary dissection. Most patients are candidates for this less invasive procedure.
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Simple or total mastectomy is 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 first one to three axillary lymph nodes. Modified radical mastectomy involves removal of the entire breast, nipple/areolar region, and often the axillary lymph nodes. This is the most common form of mastectomy performed today.
A radical mastectomy is the removal of the entire breast, nipple/areolar region, the pectoral (chest)
major and minor muscles, and lymph nodes. This procedure is rarely performed today.
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Women should have one baseline mammogram between the ages of 35-40, every one to two years between the ages of 40 and 50, and yearly after age 50.
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The MammoSite is a small, soft balloon attached to a thin catheter (tube) that fits inside the lumpectomy cavity (the space left after the tumor is removed). A tiny radioactive source (seed) is placed within the balloon by a computer-controlled machine. Because the source is inside the balloon, radiation is delivered to the area of your breast where cancer is most likely to recur. When used after a lumpectomy, the treatment is given twice a day or 5 days.
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Most masses and mamogram abnormalities can be evaluated with a needle biopsy for diagnosis. We use hand held core needles with and without vacuum assistance and for palpable densities and ultrasound densities. We also use core needles with vacuum assistance under mammogram guidance (stereotactic). These large needles have a diagnostic accuracy of 96-97% comparable to open biopsy.
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A mammogram is a picture of the breast produced by a safe low-dose x-ray technique. Diagnostic
mammography is used to examine a specific problem, while screening mammography is used to identify
any potential problems. Diagnostic mammograms usually take longer than a screening mammogram because
additional views are usually taken. Sometimes, a diagnostic mammogram will be followed by an
ultrasound. Mammograms may not detect about 10% of the cancers, which is why you still need regular
exams by your doctor.
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