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Excision of Lumps in the Breast

Discovering a lump in the breast can be very frightening. However, a lump in the breast is not always cancerous. According to breastcancer.org, eight out of ten lumps, which develop in breasts, are benign or non-cancerous. However, women should still seek medical consultation is a new lump is felt or if there is any change in an existing one.

 

Benign lumps often need no treatment. If the lump is suspected to be cancerous, the surgeon will first perform a biopsy by extracting tissue from the lump and analyzing it in the laboratory.  If the lump turns out to be cancerous, surgeons can remove it with a procedure called lumpectomy. The patient may also need chemotherapy and radiation therapy after the lumpectomy to reduce the chances of the cancer returning.

Causes of Lumps in the Breast

  • Cysts: These harmless growths in the breast tissue tend to occur with hormonal changes, such as the start of a menstrual period. A surgeon may use a needle to drain the fluid that usually fills a cyst. But after draining, cysts can reoccur.
  • Fibro-Adenoma and Fibrocystic Breasts: These conditions involve hardening and thickening of the tissue within the breast. The tissue is usually harmless.
  • Intraductal Papillomas: This is when hard, rubbery, lumps form in the milk ducts. These are also usually harmless
  • Benign Tumors: These solid growths are not cancerous or dangerous. They can be uncomfortable, and they can sometimes cause leakage from the nipples, depending on their location. Doing a biopsy and examining the cells from the tumor under a microscope is the only way to determine if it is cancerous or benign
  • Hormonal changes: The breasts change over time and during the menstrual cycle. Lumps may come and go regularly. Checking the breasts at the same time each month can help a person keep track of any change that is unusual
  • Fatty Lumps: These can develop after a trauma, and by the use of some medications

Identifying the Lump

If a lump is detected, it is important to consult a doctor immediately in order to identify, what kind of lump it is. The doctor will conduct a physical examination and prescribe imaging tests such a mammogram, MRI or ultrasound. These tests reveal critical details about the lump and the surrounding tissue. Even if the lump is non-cancerous, it may need to be monitored periodically with routine check-ups. If any treatment is required, it should start at the earliest.

Biopsy

If the lump is painful or suspected to be cancerous or malignant, the doctor may prescribe a biopsy. A biopsy is performed by removing a piece of tissue or a part of the lump for laboratory analysis. A biopsy is the only way to make a definite diagnosis of cancer and other conditions.

Types of Biopsy

  • Fine Needle Aspiration Biopsy: The doctor inserts a small needle into the lump and removes a few cells for testing
  • Core Needle Biopsy: The doctor uses a slightly larger needle to remove three to six small cylinders of tissue from the breast. Specialists then look at the samples under a microscope
  • Surgical Biopsy: A surgeon makes a cut into the breast to remove either a small amount of the abnormal tissue or the entire lump. Removing the entire lump is known as an excisional biopsy or lumpectomy
  • Lymph node biopsy: The doctor takes tissue from the lymph nodes under the arm to check for cancer cells

A lumpectomy only removes the lump and surrounding tissue, making no impact on the rest of the breast.

Types of Surgery

There are several different kinds of surgical procedures to remove a lump in the breast, or at times, the entire breast. The type of operation will depend on the location and size of the tumour, the size of the breast and whether the cancer has spread. The doctor will consult the patient before deciding on the type of surgery required also take into account her wishes. Depending on type, the surgery may be an inpatient procedure or outpatient.

Lumpectomy

A lumpectomy only removes the lump in the breast. Initially, the surgeon will remove a small amount of tissue surrounding the tumour and examine it under a microscope. This is known as the border; if there are no cancer cells in the border, it is considered a clear margin. If cancer cells are present, further surgery will be required to remove all the cancer cells.

However, sometimes a more invasive lumpectomy may be necessary. If it is suspected the cancer has spread, the surgeon will also remove some lymph nodes close to the tumour to look for evidence of metastasis. In a lumpectomy, the surgeon must be sure that he or she has removed all the cancerous cells.

Quadranectomy 

As the name suggests, a quadrantectomy removes around one-fourth of the breast along with the tumour. The procedure is less common than a lumpectomy. Reconstructive surgery may be an option to restore the breast after a quadrantectomy.

Mastectomy

A mastectomy becomes necessary when the cancer has spread throughout the breast. The procedure removes the entire breast along with the nipple. A radical mastectomy also extracts the muscles, which make up the chest wall. Reconstructive surgery to create a new breast may be performed at the same or at a later date.

Preparations 

As stated above, most lumpectomies are an outpatient procedure and can be performed in a hospital or surgical clinic. Quadranectomies and mastectomies are inpatient procedures as the surgery and recovery are more sophisticated.

Patients on certain medications like aspirin and blood thinners may need to stop taking them before surgery to reduce the risk of bleeding. Patients are also not allowed to eat or drink for 8-12 hours before surgery.

If the lump within the breast is difficult to pinpoint, a radiologist will place a marker in the lump. A thin wire, acting as a guide, will be inserted into the lump from the surface of the breast. This makes it possible for the surgeon to locate the lump while performing the surgery.

The doctor will discuss the entire process with you. Patients and family members usually meet the surgeon a few days before the surgery to discuss all the instructions.

The Surgery

Depending on the condition, the surgery may be performed under local or general anesthesia. The surgeon will generally use an electric knife to make a curved incision in the breast. This is to reduce the risk of bleeding.

Sometimes, excess fluid that accumulated at the place of the lump will be drained with a connected pipe after the surgery. Lastly, the surgeon stitches up the incision and apply a dressing to the wound.

Complications

As with all surgeries, breast lump removal also carries some risks. Usual complications, which may occur, are bleeding, infection, pain with swelling, scarring and change in breast appearance.

Recovery

The period of convalescence will depend on the type of surgery. The surgeon will advice complete rest and give you detailed instructions for the care to be taken about the dressing during the recovery process and when to return for a follow-up examination. He or she may also prescribe medication to relieve pain. There may be some sensitivity and itching as the nerves grow back. This may go away in time or the person may get used to it. Sometimes, the drainage tube is left in place till the follow-up visit.

The extent of care to be taken during convalescence really depends on the surgery conducted includes:

  • Complete rest
  • Taking sponge-baths instead of showers while stitches are still in place
  • Wearing a support bra or sports bra
  • Arm exercises that the surgeon may recommend

If you notice increasing, swelling, redness or signs of infection, contact your doctor immediately.