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RESOURCES

There are many useful sites that we recommend if you are interested in gathering additional information about your diagnosis:

  • Evaluation
  • Risk Assessment
  • Biopsy
  • Surgery
  • Ductoscopy
Patients often are referred to us after experiencing symptoms such as pain or tenderness in the breast, changes to the skin, swelling, discharge from the nipple, or feeling a lump. If a mammogram, sonogram, or ultrasound shows abnormal findings, often additional evaluation is needed. A complete medical history, breast evaluation, review of recent test data, and assessment of symptoms will be performed.

Often it is difficult for a primary care physician to differentiate benign or hormonally related breast changes from suspicious or potentially malignant changes. It is critical to obtain an accurate history when assessing, diagnosing, and treating a patient, as well as referring a patient for further treatment.

A thorough physical examination of the breast is important to differentiate the need for screening or diagnostic mammograms, as well as to feel for any palpable masses, changes in tissue, or to observe any asymmetry.

Risk Assessment means the evaluation of the number of risk factors a person has for breast cancer. According to the National Cancer Institute, risk factors for breast cancer include:

  • Growing older
  • A young age at the time of your first menstrual period.
  • Starting menopause at a later age.
  • Being older at the birth of your first child.
  • Never giving birth.
  • Not breastfeeding.
  • A personal history of breast cancer or some non-cancerous breast diseases.
  • Family History
  • Obesity
  • History of radiation therapy to chest or breast
  • Long-term use of hormone replacement therapy (progesterone/estrogen combined)
  • Drinking more than one alcoholic drink a day
  • Not regularly exercising
  • Changes in breast-cancer related genes

A breast cancer risk assessment includes counseling, education, screening and discussion about the risks and benefits of genetic testing. 

What is BRCA testing?

BRCA1 and BRCA2 are genes that are known as cancer suppressors. If genetic testing shows a mutation of these genes the likelihood of breast and/or ovarian cancer is greatly increased. If a mutation is found, several options are available to help manage the cancer risk.

When breast cancer is suspected or needs to be ruled out, usually a breast biopsy is recommended. We are skilled in minimally invasive techniques such as sonogram or mammogram guided breast biopsies and also in surgical biopsies. If you are interested in learning more about different kinds of biopsies and when they are appropriate, please refer to The American Cancer Society's website.

If breast surgery is deemed necessary in the treatment of your condition, we will discuss your options and recommended course of treatment. This may include procedures such as excisional breast biopsy, breast conserving surgery (to include lumpectomy or a lumpectomy with oncoplastic procedure), sentinel node biopsy/axillary node dissection, mastectomy (simple, skin sparing, nipple areolar sparing, and modified radical), placement of chemotherapy catheters, or prophylactic mastectomies for patients who are at high risk for breast cancer.

We work closely with local plastic surgeons for patient's desiring immediate reconstruction at the time of surgery.

To learn more details about these surgical techniques, click here.

We are part of a very few surgeons in the area who are skilled in performing a ductoscopy. Ductoscopy, also referred to as mammary endoscopy, involves inserting a small fiber-optic scope into the ductal openings of the nipple to look at the lining of the ductal system on a monitor or screen.

Ductoscopy may be appropriate if you are experiencing discharge from your nipple, have a known breast cancer and are undergoing a lumpectomy, or are at high risk for developing cancer but have a normal breast exam and imaging studies. Most often, ductoscopy is performed on a woman who is experiencing a spontaneous nipple discharge that is either bloody or clear and thick, like mucus. A thick or bloody discharge is often caused by an intraductal papilloma, a small wart-like growth on the lining of the duct. These growths are benign but should be removed. On very rare occasions the discharge can be the result of a precancerous condition called ductal carcinoma in situ (DCIS).

Ductoscopy is often performed in the operating room as part of the surgical procedure to identify, remove, and treat the cause of the discharge. By inserting the scope into the ductal orifice with the discharge, the clinician is able to see the abnormality causing the discharge and identify the best place to make a surgical incision to remove the papilloma. Ductoscopy takes a relatively short period of time to perform and causes minimal discomfort. Typically, when done in the outpatient setting, a numbing cream is applied to the nipple anywhere from 30 minutes to 2 hours prior to the procedure. The nipple is then cleaned and made numb with a local anesthetic. A small probe is inserted into the duct that will be examined to dilate the ductal opening. Then, the scope is put inside the duct. Once the scope is inside the ductal system, it can be visualized on a monitor that is connected to the scope. Once the procedure is complete, the scope is removed. Some patients report some pain in the nipple or at the surface of the nipple. Others report a feeling of fullness or pressure in the breast, which usually subsides in less than two days. There are generally no lasting after effects of the ductoscopy procedure. 

For more information visit the Dr. Susan Love Research Foundation's website.