Why would I be referred for breast surgery?

There are many reasons why a physician would refer you to a general surgeon for consideration for breast surgery. These reasons include treatments for already diagnosed breast cancer, assessment of a suspicious breast lump, breast infection, or management of benign breast disease.

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What should I expect prior to coming to my appointment?

Prior to your appointment with a general surgeon, your family doctor may send you for a:

• Mammogram: a low radiation X-ray of your breasts used for screening and diagnosis of breast cancer.

• Breast Ultrasound: Uses sound waves to assess masses found in the breast.

• Breast Biopsy: During a mammogram or breast ultrasound the radiologist may also take a small tissue sample of a suspicious mass to send to pathology.

 

What should I expect at my appointment?

On the day of your appointment please bring your health card and a list of any medications that you are taking. You also may want to bring a list of questions and a loved one who can act as a second set of ears.

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Your surgeon will discuss any mammograms, ultrasounds, and biopsies that are relevant, do a breast exam, and come up with a treatment plan. Your treatment will greatly depend on if your breast disease is benign (non-cancerous) or malignant (cancerous).

 

Benign breast disease

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What is benign breast disease?

Most breast lumps found in the breast are benign, meaning that they are non-cancerous. These lumps are usually movable and smooth and can be found in both breasts.

 

What causes benign breast lumps?

• Benign breast changes

• Infection or injury

• Medications (such as hormonal birth control, or hormone replacement therapy)

• Breast tissue can also change due to the fluctuating hormones during a menstrual cycle.

 

What are some of the different types of benign breast conditions?

• Fibrocystic breast changes – These are the most common non-cancerous lumps characterized by lumpy, sometimes uncomfortable breasts. Women are typically affected between the ages of 30-50. It is caused by changes in hormone balance during a regular monthly menstrual cycle. This does not require any treatment.

• Simple cysts – These are non-cancerous fluid-filled sacs. They can be treated with a fine needle aspiration to remove the fluid causing the sac to collapse.

• Fibroadenomas – These are solid, usually painless, non-cancerous growths that usually occur in women aged 20-40. They may be removed surgically only if they continue to grow, are large, or have other concerning features.

• Traumatic fat necrosis - This condition occurs when there is trauma (sudden injury) or surgery to the breast. This causes fat to form in lumps. The lumps are usually round, firm, hard, painless and in the area of a surgical scar.

• Gynecomastia – This refers to tender breast enlargement occurring in males, often related to certain medication or supplement use.

• Mastitis – This refers to infection located in the breast, usually a painful lump with or without redness. Mastitis is usually treated with warm compresses and antibiotic medications.

 

Treatment for your benign breast disease will depend on many factors and your surgeon will discuss all the options with you.

 

Breast Cancer

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What is Breast Cancer?

Breast cancer occurs when some cells in the breast start to grow out of control and invade the cells surrounding them or spread into other tissues of the body (metastasize).

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What is my risk of having Breast Cancer?

Breast cancer is more common in women and currently 1 in 9 women in Canada will be diagnosed with breast cancer during their lifetime. Risk factors include:

• Age: The older you are the higher your risk for developing breast cancer.

• Genetics: If a close blood relative has or has had breast cancer, your risk is higher. Women who carry the BRCA1 and BRAC2 genes carry a high risk of developing breast cancer, ovarian cancer or both. These genes can be inherited.

• History of Breast Cancer: A previous diagnosis of breast cancer increases your risk of developing a new breast cancer.

• Estrogen exposure: Being exposed to estrogen over a longer period of time increases your risk for breast cancer. This can be due to starting periods earlier and going through menopause later than average, causing longer period of estrogen.

• Obesity: Women who are overweight are at a higher risk of developing breast cancer.

• Alcohol consumption: Consuming more than 3 drinks of alcohol per day increases your risk.

• Radiation exposure: Undergoing radiation treatment for a cancer that is not breast cancer increases the risk of breast cancer later in life.

• Hormone Treatments: The use of hormone replacement therapy (HRT) has been linked to breast cancer, due to increased levels of estrogen.

 

What are the symptoms of Breast Cancer?

The most common symptom of breast cancer is a new lump or thickness in the breast. It is usually a painless, hard lump with irregular edges. Other potential symptoms of breast cancer are:

• Pitting or redness of the skin of the breast, like the skin of an orange

• A rash around or on one of the nipples

• A discharge from a nipple, possibly containing blood

• A sunken or inverted nipple

• A change in the size or shape of the breast

• Peeling, flaking, or scaling of the skin on the breast or nipple

 

It is unusual to have pain with breast cancer.

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What are the different types of Breast Cancer?

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There are several types of breast cancer:

• Ductal Carcinoma in situ: A pre-cancerous change located in the ducts of the breasts. This has a high likelihood of progressing to cancer if left untreated.  

• Lobular Carcinoma in situ: Occurs in the glands of the breast. This is non-invasive and not considered a true cancer but is an indicator of a higher risk of developing breast cancer.

• Invasive Ductal Carcinoma: Cancer that starts in the cells that line a milk duct in the breast, breaks through the wall of the duct, and grows into the nearby breast tissues. At this point, it may be able to spread (metastasize) to other parts of the body through the lymphatic system and bloodstream. Accounts for 80% of breast cancers.

• Invasive Lobular Carcinoma: Cancer that starts in the breast glands and can then spread (metastasize) to other areas of the body. Accounts for 10% of breast cancers.

• Inflammatory Breast Cancer: Begins in the milk ducts and spread to the lymph nodes. This cancer has a high chance of spreading and can be more aggressive than ductal or lobular carcinoma. Only accounts for 1-3% of breast cancers.

• Paget’s disease of the nipple: Cancer that grows in and around the nipple and is very uncommon.

• Phyllodes Tumor: Phyllodes tumors are rare fast-growing types of breast cancers. They tend to occur in younger women (ages 30-50) and they can be difficult to distinguish from a fibroadenoma on exam.

 

This is not a complete list of breast cancer; there are several other subtypes and rare forms of breast cancer.

 

What is the treatment for Breast Cancer?

Treatment for breast cancer depends on many factors including the type of breast cancer, the staging of the cancer, the sensitivity to hormones, results of genetic testing, the patient’s overall age, health status, and preferences.

Treatment for breast cancer can include: Breast surgery, chemotherapy, radiation, and hormone therapy. There are options available for immediate or delayed breast reconstruction. Your surgeon will evaluate your options with you and with your health care team to determine the best treatment plan.

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Types of Breast Surgery:

1. Lumpectomy / partial mastectomy

This type of surgery removes only the breast tumor and parts of the surrounding tissue

   

 

 

 

 

 

 

 

 

 

 

 

   2. Mastectomy surgery

Total mastectomy is a removal of all breast tissue

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   3. Surgeries on the lymph nodes

These may be done if you have been diagnosed with cancer or for suspected cancer.

• Sentinel lymph node biopsy: this is done by injecting dye near the tumor. The dye flows into the lymph nodes and the first node that it reaches is called the “sentinel” node. The surgeon locates this node and removes it. The sample is sent to the hospital laboratory and checked for cancer cells. This surgery involves a small incision in the armpit and is usually done in combination with a lumpectomy or mastectomy.

• Axillary lymph node dissection: this is a procedure in which the surgeon removes most of the lymph nodes in the armpit. These nodes are then sent to the hospital laboratory to be checked for cancer cells. This surgery involves an incision in the armpit and can be done at the same time as a lumpectomy or mastectomy or may be done as a second surgery.

 

Chemotherapy:  Chemotherapy is a method to destroy cancer cells using medication. It is a systemic therapy meaning that it affects your entire body and is administered either through pills or an intravenous line. Depending on the size and type of breast cancer present will determine if you require chemotherapy, and if chemotherapy will be initiated before or following surgery. Your surgeon will refer you to the North East Cancer Center located in Sudbury to speak with a Medical Oncologist about any chemotherapy treatments.

 

Radiation: Radiation therapy is one of the main methods of breast cancer treatment. It uses a high energy beam to destroy cancer cells. This works by damaging the DNA of cancer cells so that they can’t continue to grow. Radiation is a local treatment because it is applied and takes effect in a specific part of the body (where the tumor is located). Your surgeon will refer you to the North East Cancer Center located in Sudbury to speak with a Radiation Oncologist about any radiation treatments.

 

Hormone Therapy: Hormonal therapy is sometimes used to treat breast cancer. It is a treatment that blocks the effect of hormones on the breast cancer cells. Hormonal therapy is only used for breast cancer that is hormone receptor positive. This means that the cancer cells may or may not have receptors for estrogen, progesterone, or Her-2.  Research has shown that giving hormonal therapy after surgery and radiation therapy lowers the risk that the breast cancer will come back and improves survival. Your surgeon will refer you to the North East Cancer Center located in Sudbury to speak with a Medical Oncologist about any hormone therapy.

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Please see attached useful links for breast cancer.