Kent Breast and General Surgeon.....

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





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