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Breast Surgery Archive Questions

Below are Dr. Kesmodel’s answers to Breast Surgery questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.



Now displaying records 1 to 15 of 15.

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Q : 1

05/26/2012
I had a .2 mm tumor and was diagnosed with HER2+ breast cancer with no lymph node involvement. I had a mastectomy with no additional therapy. Is that appropriate treatment?

If the tumor was truly only 0.2 mm, then it was very early stage and no additional treatment is a reasonable approach. There is some data, however, that suggests even patients with very early stage HER2+ breast cancers have a significant risk of recurrence.


Q : 2

02/07/2012
I have a small simple cyst in my right breast. It is starting to bother me and I'd like to have it removed. Is this something you do?

The cyst can certainly be removed. An alternative approach to surgery would be to remove the fluid with a needle which could lead to complete resolution. If you would like to see me regarding this, please call my office at (410) 328-7320.


Q : 3

01/10/2012
I have a lump on my right breast that I would like removed. Could radiofrequency ablation be used for this?

At this time, radiofrequency is an experimental technique for treatment of breast lumps and breast cancer. I would not recommend this for treatment unless you are enrolled in a clinical trial using this technique.


Q : 4

09/08/2010
I have small tumor that was biopsied as benign, but now has enlarged some and changed shape. My doctors want to remove it surgically. Is laser treatment a possible option?

The first problem with the laser is that it works on the surface. It cannot remove a tumor within the breast. The second problem is that if you do open surgery, then destroy the tumor with laser, radio waves, microwaves or heat or cold, you do not have a good specimen to evaluate to be absolutely sure that the entire tumor was benign. Finally, using the laser during open breast surgery does not offer any advantages. Lasers work great in the eye (accessible to the light rays) or to vaporize warts or destroy the surface of the cervix, but do not offer any real advantage over other methods in open operations.


Q : 5

08/25/2010
In a radical mastectomy, do the lymphatics regenerate in the axillary region?

I would have to guess "no" but have never seen a study of this question. Certainly the risk of lymphedema from division of the lymphatic channels lasts for the rest of the patient's life.


Q : 6

07/25/2010
How do I find a breast surgeon who's willing to do a breast cyst excision on an elective basis? This cyst, ~2.5cm, has been a constant (non-cyclical) source of pain for over two years. It's been aspirated three times and has always refilled rapidly. I constantly ice the area. I also take Tamoxifen for pain and have completely cut off coffee and chocolate and adopted a low-fat diet. I'm also on Fentanyl and Percocet for thoracic radiculopathy. None of this has helped this particular cyst, although it's helped my general breast pain. I've been to seven surgeons and they all refuse to take this cyst out. I am not worried that it's cancerous, I would just like to get rid of the pain.

NCCN guidelines do not recommend excision of a simple cyst. In the past, some surgeons would excise a cyst if it recurred after 3 aspirations. If you do find a surgeon willing to excise a simple cyst, it is possible that your insurance will deny payment, and you will have to pay for the procedure. If the cyst has any solid component, it should be excised. If the fluid is bloody, it should be sent for cytology. If abnormal (atypical) cells are identified, the cyst should then be excised. Excision of the cyst does not assure that it will not recur and will probably not alleviate your breast pain.


Q : 7

05/20/2010
I had a lumpectomy in September 2009, after which I received several weeks of radiation. It was a few months before I recovered, but I am still experiencing breast pain and swelling. My doctor says everything is healing great. Should I still be hurting and swollen?

I have seen many women who have had breast radiation after a lumpectomy and the most common complaint is the breast pain and sensitivity. The swelling should decrease over the next 4-6 months. The pain and tenderness may last for many years. This is normal. Among all of the information that women with breast cancer are presented with when they are diagnosed and presented with treatment options, this is one bit of information that is usually offered but seems insignificant in comparison to all of the other risks and side-effects. But even 5-10 years after the radiation many women still have pain and tenderness. So, in summary, it is probably normal, should become less noticeable over time, and is something that goes along with saving the breast. Of course we are trying to develop better radiation techniques and will hopefully some day have evidence that we can limit the dose of radiation to the area around the tumor (partial breast irradiation). It may also be possible to shorten the course of radiation. These are questions that are being studied at this time.


Q : 8

04/06/2010
Why would a lump be removed with no biopsy first? My sister had some fibroadenomas removed a while back but, did not need a biopsy; they just removed them. I have a lump that needs a mammogram, ultrasound, and core biopsy. What could the reasoning be for these two different routes?

Only if the doctors can be quite certain that there is no cancer would I recommend proceeding directly to excision. In most cases, it is better to complete the radiographic work-up and biopsy masses before scheduling surgery to remove them.


Q : 9

03/17/2010
I had a lumpectomy a month ago. The spot is still painful and feels lumpy inside, but the outer suture has healed. What should I do?

These are normal symptoms for a patient to experience after having a lumpectomy. If you are truly concerned, you should see your surgeon for a follow up appointment.


Q : 10

11/04/2009
I have to have a breast biopsy. In the meantime, I have results of my ultrasound: a lobulated circumscribed tri-lobed hypoechoic mass measuring approx 1cm with some increased vascularity and acoustical shadowing. Does this suggest a benign or malignant mass?

The ultrasound is just a picture. Only the pathology will be able to tell you if it is benign or malignant. I presume you will have an ultrasound-guided core needle biopsy. The results should be ready in 2-3 days. If there are any abnormal cells detected, then the lump should be removed with an operation.


Q : 11

11/02/2009
What is the safest and best way to remove a benign breast lump? Is smoking one cause of a breast lump? What else would cause it?

If a breast lump is relatively small, it may be possible to entirely remove it with a core biopsy instrument under ultrasound guidance. If it is palpable, it will probably require an operation. It is not known why they develop. They are probably not related to smoking. The pathology report from the specimen will indicate whether it is benign or malignant.


Q : 12

06/21/2009
I was diagnosed with breast cancer via a biopsy and I am planning to have a lumpectomy. Would a plastic surgeon be available at the same time to perform a breast reduction? I have been considering having a reduction due to severe neck and shoulder pain.

This is certainly an option which you can discuss with your surgeon. We arrange for this type of joint surgery (two surgeons) regularly, assuming there are no significant added risks in performing the additional surgery.


Q : 13

05/02/2009
My OB detected a cyst and referred me to a specialist. I had both a mammogram and ultrasound. The radiologist said it was a benign tumor, hard, 3.5 cm and recommended surgery instead of biopsy. Why is she not performing a biopsy so that the tissue can be analyzed and checked for cancer? What are the chances that after the surgery, they may discover that it is indeed breast cancer?

There are some inconsistencies in your question. It sounds like your doctor detected a "mass" not a cyst. A cyst is filled with fluid, not generally "hard" and not usually referred to as a "tumor." A radiologist cannot tell you definitively if a solid (not cystic) mass is benign, they can only describe characteristics which might suggest that it is benign or malignant. A needle biopsy can prove that a mass is malignant, but cannot prove that a mass is benign. Thus, a needle biopsy (fine-needle or core) is used more often when a mass is highly suspicious for cancer. If the mass appears to be benign and you have no significant risk factors for breast cancer, then proceeding directly to a surgical excision of the mass makes the most sense.


Q : 14

02/18/2009
My daughter is scheduled for ultrasound-guided breast biopsy at a community hospital. Because of the size of the mass, we have been advised that she should have it removed even if it is benign. She has no health insurance. Wouldn't it be more cost effective to skip the biopsy and just have surgery? Is there any assistance through your hospital for such cases?

I would need to review the imaging findings with our radiologists here before we could determine what the best approach for diagnosis is. Patients here at the University of Maryland either go on medical assistance or through the Baltimore City Cancer Program depending on where they live, which I believe would cover the costs for a biopsy. Surgery, of course, has its risks, so I generally recommend surgery for indeterminate lesions after biopsy, or if there is discordance between imaging and biopsy results. Please feel free to contact our breast program coordinator, Yolanda Sumter, at 410-328-7855 if you have additional questions.


Q : 15

02/13/2009
My daughter is scheduled for ultrasound-guided breast biopsy at a community hospital. Because of the size of the mass, we have been advised that she should have it removed even if it is benign. She has no health insurance. Wouldn't it be more cost effective to skip the biopsy and just have surgery? Is there any assistance through your hospital for such cases?

I would need to review the imaging findings with our radiologists here before we could determine what the best approach for diagnosis is. Patients here at the University of Maryland either go on medical assistance or through the Baltimore City Cancer Program depending on where they live, which I believe would cover the costs for a biopsy. Surgery, of course, has its risks, so I generally recommend surgery for indeterminate lesions after biopsy, or if there is discordance between imaging and biopsy results. Please feel free to contact our breast program coordinator, Yolanda Sumter, at 410-328-7855 if you have additional questions.


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