Breast
Care
Breast
Clinic
I
run breast clinics both on the NHS and privately for the diagnosis
and treatment of breast cancer and benign breast based on the
guidelines of the British Association of Surgical Oncology (BASO).
A multidisciplinary approach to all breast care is provided with
an experienced team of consultant radiologists, pathologists,
oncologists and specialist breast care nurses. Evaluation of breast
symptoms is based on the triple assessment of clinical examination,
breast imaging and pathology. Some of the conditions assessed
in the clinic include:
• Breast lumps and lumpiness
• Family history assessment
• Breast pain (mastalgia)
• Nipple conditions –
discharge, inversion
•
Breast infections and abscesses
•
Male breast problems
Breast
Imaging
Mammograms
These are x-rays normally performed
on both breasts lasting about 10-15 minutes. Each breast is x-rayed
in two different directions, top to bottom and side to side with
gentle compression between the two plates of the mammogram machine.
A comparison is made of both breasts and with any previous available
mammograms. Extra views are sometimes done to provide more detail
of a particular area of the breast. Due to the relatively denser
breasts in younger women, mammograms are not very sensitive and
may lead to loss of detail. For this reason mammograms are usually
only carried out in women over the age of 35 years.
Ultrasound
Ultrasound
is increasingly being used to evaluate the breast. It employs
inaudible very high frequency sound waves emitted from a hand
held probe which are reflected at different rates off different
densities of breast tissue forming a pattern which can be viewed
on a screen. Similar to the scans done in pregnancy, a small amount
of gel placed on the skin is essential to improve transmission
of the sound wave. It is very effective in distinguishing between
solid and cystic masses, in estimating tumour size and in evaluating
the dense breasts of young women. It is often used to further
investigate an abnormality found on mammography. Ultrasound is
also employed to biopsy breast lesions, for pre-operative localisation
of tumours and to assess the axillary lymph glands.
MRI
MRI
is not used in the routine assessment of the breast. It is useful
in young patients with very dense patients especially with a strong
family history or genetic mutation where mammography has a low
sensitivity. It is increasingly used to exclude multifocal and
bilateral disease in patients with lobular breast cancers prior
to surgery and the assessment of patients with breast implants
where an implant rupture is suspected.
Pathology
Fine needle aspiration cytology (FNAC)
This
form of biopsy is usually done freehand in the clinic or with
ultrasound guidance where the lesion is not palpable. A fine needle
attached to a syringe is employed. A local anaesthetic is not
usually necessary. The aspirate, consisting of fluid with groups
of breast cells is immediately spread on a glass slide to be examined
under a microscope by a Cytopathologist. In a one stop clinic,
a result may be available within 30-45 minutes. It is useful in
evaluating palpable breast lumps and if due to a simple cyst,
provides immediate relief and reassurance.
Core
Needle Biopsy
A
core biopsy provides tissue for more detailed histological assessment
using a 14 gauge spring loaded needle. Ultrasound improves the
accuracy in small poorly defined lumps. After infiltration with
a local anaesthetic, a scalpel is used to nick the skin allowing
passage of the needle. Some bruising is to be expected after the
procedure and results are available after about 48 hours. An imprint
of cells from the core biopsy on a glass slide (rolled core cytology)
can be analyzed by a Cytopathologist providing a provisional immediate
report.
Stereoctatic breast biopsy
This is similar to a core biopsy
but is performed using a mammogram when a breast abnormality is
not visible on ultrasound.
Breast Surgery
The full spectrum of breast surgery
is provided:
•
Breast cancer surgery – wide local excision (lumpectomy),
mastectomy
•
Axillary lymph node surgery – sentinel node biopsy using
a combination of radioactivity and blue dye is the standard method
of staging the axilla. Axillary clearance is usually advised for
a positive sentinel node either macro or micrometastasis.
•
Excision of breast lumps – such as Fibroadenomas and Phyllodes
tumours
•
Surgery for nipple conditions - Microdochectomy; Excision of major
ducts (Hadfield's Procedure)
•
Image guided breast surgery – usually for impalpable breast
lesions in which a localisation wire is inserted beforehand by
a Radiologist using either mammography or ultrasound. This is
often for screen-detected abnormalities including Ductal Carcinoma
in Situ (DCIS). For an impalpable lesion visible on ultrasound,
an ink marker placed on the overlying skin with ultrasound may
be used for pre-operative localisation.
• Breast reconstruction
either immediate or delayed is offered in conjunction with a Plastic
surgeon
Oncology Services
Following surgery or in some situations,
prior to surgery, patients requiring oncological treatment are
referred to a Consultant Oncologist. Treatments include:
• Chemotherapy
• Radiotherapy
•
Hormone Therapy
General
Surgery Services
