Breast Disease Management

Diagnosis of Breast Disease

Dr. Carrato reviewing a mammogram
Generally when talking about breast abnormalities, people automatically think of cancer. Monthly self breast exams are the most important thing a woman can do to prevent breast cancer in addition to her yearly mammogram. According to the American Cancer Society, yearly mammograms are recommended for all women over the age of 40, but breast self-exam (BSE) is important for women beginning in their 20s. Women should know how their breasts normally look and feel and report any change promptly to their health care provider.
 
If an abnormality is found, either by self-exam or mammogram, the abnormality should be further evaluated. In most cases, a biopsy should be done to confirm the diagnosis. There are many ways to obtain tissue for biopsy, but at Carrato Surgical Associates, we believe using the most minimally invasive approach is key. That is why we offer our patients the option of having in-office procedures to obtain the biopsy rather than have them go through an operation to get the same answer. 

Stereotactic Breast Biopsy

Stereotactic needle biopsies are the most minimally invasive way of diagnosing an abnormality in the breast. When a patient has an abnormal finding on her mammogram or ultrasound that is too small to feel on an exam, such as a small mass or breast calcifications, this technique can help us be sure we are taking the biopsy from the exact area of concern.
 
In the comfort of our office using local anesthesia, we can guide a needle to the area of abnormality in the breast while using a live mammogram or ultrasound to ensure the precise area of abnormal tissue is taken for evaluation. Patients normally have little to no discomfort, often feeling only pressure during the procedure. The entire procedure takes about 30 minutes, and patients can not only drive but most return to regular activities or work on the same day as the biopsy. The incision is tiny and the results of the biopsy are in our office in less than a week. Depending on the result, we can then tailor the treatment plan and future visits to each patient individually. 

TruCut Biopsy with Ultrasound Guidance

If a patient has a palpable mass in the breast that can be felt on clinical exam, most of the time these patients can undergo a TruCut needle biopsy in the office on the same day as their initial appointment. Using local anesthesia and ultrasound guidance to ensure the tissue for the biopsy is taken from the correct area of the mass, the needle is used to take several samples for evaluation and patients normally have little or no discomfort and a very small incision that does not even require a stitch. The results can be back in as little as a few days, and from the biopsy result we can make decisions with the patient on what the next step is in treating the breast mass.
 

Treatment of Breast Disease

Depending on the diagnosis yielded from the biopsy, there are many different treatment options for breast abnormalities, for both benign lesions and malignancies. Typically, the most common benign breast finding is called a fibroadenoma (adenofibroma), and these are treated using either cryoablation or excision depending on the size of the mass and the patient's symptoms. If a patient is found to have a cancerous abnormality in the breast, typically each patient is treated as an individual and depending on certain markers that are evaluated from the biopsy, a plan can be made for removing the abnormality and what, if any, aftercare would needed, such as chemotherapy or radiation therapy. 

Cryoablation of Fibroadenomas

Cryoablation is a process that eliminates benign breast masses by freezing them. The mass eventually shrinks away and this can eliminate patients' symptoms of pain caused by the mass. These benign masses are also known as fibroadenomas or adenofibromas of the breast.
 
Proven safe and effective with FDA 510(k) clearance, cryoablation of fibroadenomas is an in-office procedure that results in treatment of the mass and minimal discomfort for the patient. Moreover, the minimally invasive treatment produces excellent cosmetic results. The most important benefit to the procedure is that cryoblation does not interfere with or change the appearance of future mammograms or ultrasounds, whereas the conventional surgical technique of excising the mass from the breast in the operating room will distort the breast tissue and leave scarring behind.
 
Patients who have a fibroadenoma that is 4 cm or smaller could be a good candidate for the cryoablation procedure. The fibroadenoma must be clearly seen on your mammogram or ultrasound, with a tissue diagnosis confirmed by a stereotactic needle biopsy. If you have multiple fibroadenomas, they can all be treated during the same procedure.