Breast Surgery
Most breast lumps are not cancer. All of them should be checked.
Finding a lump is frightening, and the instinct to wait and see whether it goes away is a common one. The majority of breast lumps turn out to be benign — cysts, fibroadenomas, or normal changes in breast tissue. But the only way to know which kind you have is to have it examined, and the conditions that do need treatment are far more treatable when found early.
Dr. Younes evaluates and treats both benign and malignant breast disease, and holds a diploma in the Advanced Course of Mastology.
When to arrange an evaluation
- A new lump or thickening in the breast or under the arm
- A change in the size or shape of one breast
- Dimpling, puckering, or a change in the texture of the skin
- A nipple that has become pulled inward, or changed direction
- Discharge from the nipple, particularly if it is bloody or comes from one duct
- Persistent pain in one specific area that does not vary with your cycle
- Any change in an area you have been treated for before
Breast changes are common and most have ordinary explanations. But changes that are new, persistent, or affect only one side should be examined rather than watched.
How a breast lump is assessed
Evaluation follows a standard sequence, and you will usually have a clear answer within days rather than weeks.
- Clinical examination
- — history and physical examination of both breasts and the lymph nodes under the arm.
- Imaging
- — ultrasound, mammography, or both, depending on your age and the nature of the finding. Ultrasound is generally used first in younger women, where breast tissue is denser.
- Biopsy, if needed
- — if imaging shows something that requires tissue diagnosis, a core needle biopsy is taken under local anaesthetic. It is a short outpatient procedure, and it is the only way to establish exactly what a lump is.
Dr. Younes will explain each step before it happens, and what the findings mean once they are back.
Benign breast conditions
Most of what is found is benign and much of it needs no surgery at all:
- Fibroadenoma
- — a smooth, mobile, non-cancerous lump, most common in younger women. Often simply monitored; removed if large, growing, or causing distress.
- Breast cysts
- — fluid-filled sacs, sometimes tender, common around the forties. Can be drained if uncomfortable.
- Fibrocystic change
- — lumpiness and tenderness that varies with the menstrual cycle. Normal tissue behaviour rather than disease.
- Breast infection and abscess
- — pain, redness and swelling, most often during breastfeeding. Treated with antibiotics, and drainage if an abscess has formed.
- Duct ectasia and intraductal papilloma
- — causes of nipple discharge, usually benign, though discharge from a single duct should always be assessed.
- Gynaecomastia
- — benign enlargement of breast tissue in men. Evaluated, and treated surgically where appropriate.
Breast cancer surgery
Where a diagnosis of cancer is made, Dr. Younes performs both breast-conserving surgery and mastectomy, together with assessment of the lymph nodes under the arm.
- Breast-conserving surgery
- — removes the tumour with a margin of surrounding tissue while preserving the breast. It is suitable for many patients and is usually followed by radiotherapy.
- Mastectomy
- — removes the whole of the breast tissue, and is recommended where the disease is extensive, multifocal, or where it is the patient's preference.
- Sentinel lymph node biopsy
- — identifies and removes the first nodes the breast drains into, so that the underarm nodes can be assessed without removing all of them unnecessarily. Where nodes are involved, a fuller clearance may be needed.
Breast cancer is not treated by a surgeon alone. Your care will involve radiology, pathology, and medical and radiation oncology, and Dr. Younes will coordinate with them and explain how the pieces of your treatment fit together.
What to bring
Any previous mammogram or ultrasound images and reports, details of any prior breast surgery or biopsy, your current medications, and any family history of breast or ovarian cancer.
If you have imaging on a disc, bring the disc and the written report.