All our treatments are tailored to each patient's needs.
At Keller Surgical Associates we offer different procedures regarding breasts:
Breast Biopsy
A breast biopsy is a technique for removing cells from a potentially cancerous lesion and examining them under a microscope to try and confirm a diagnosis. This can be done in a variety of ways from image-guided with mammography or ultrasound to an open biopsy in the operating room.
The type of breast biopsy will be determined by the breast surgeon based on the individual’s information.
Stereotactic Core Needle Biopsy
Stereotactic Core Needle Biopsy
Stereotactic biopsy is where mammography is used to guide the needle to biopsy a lesion. An ultrasound cannot detect all lesions, such as very early breast cancer called ductal carcinoma in situ (DCIS) which shows up as microcalcifications only seen on mammography. This is done by a radiologist, a doctor who reads x-rays and ultrasounds, in the radiology suite.
Ultrasound-Guided Fine Needle Aspiration (FNA) or Core Needle Biopsy
Ultrasound-Guided Fine Needle Aspiration (FNA) or Core Needle Biopsy
Ultrasound-guided biopsy is a procedure that can be done in the physician’s office to remove cells from a mass. This is often done the same day as your visit, depending on the type of mass that has been detected.
The procedure uses the ultrasound to help direct either a small needle for a fine needle aspiration or a slightly larger needle for a core needle biopsy. The benefit of using a larger needle is so the pathologist, the doctor who looks at the cells under the microscope, can tell how the cells are arranged.
Knowing how cells are arranged can help distinguish between non-invasive versus invasive cancer.
Open Biopsy
Open Biopsy
Open biopsy is a surgical procedure performed in the operating room to remove the lesion. This is done because either a core needle cannot be done, a previous biopsy did not provide a conclusive diagnosis, or there is a lesion that is at high risk for breast cancer. A small scar will remain but there is little change in the contour of the breast.
Breast Surgery
Breast Lumpectomy or Partial Mastectomy
A lumpectomy is a surgical procedure performed in the operating room to remove a cancerous lump with a margin of normal tissue around it while also trying to preserve as much normal breast as possible. The lesion is either marked with a radioactive seed or a wire that comes out of the breast.
Both the pathologist, a doctor that looks at tissue under a microscope, and radiologist, a doctor that looks at x-rays, review the lesion to make sure that no additional tissue needs to be removed.
Mastectomy
A mastectomy is the removal of all the breast tissue while leaving the muscle intact.
This is usually required for:
- Large and/or multiple lesions.
- When a lumpectomy will not provide a good cosmetic outcome.
- Patients who either can’t or do not wish to have post-operative radiation
A modified radical mastectomy combines both mastectomy and axillary lymph node dissection (removal of the lymph nodes from the armpit).
Most mastectomy patients can have breast reconstruction done at the time of surgery (immediate) or delayed for a later date. Patients that may require radiation after surgery will typically wait for reconstructive breast surgery. With immediate reconstruction, we will usually have patients see a plastic surgeon before the surgery because they are the surgeons who perform the reconstruction part of the surgery.
Sentinel Node Biopsy
A sentinel node biopsy is a surgical procedure usually done in conjunction with a partial or complete mastectomy used to stage (to determine the severity of) certain types of breast cancers by examining the lymph nodes. Lymph nodes drain extra fluid from the breast and bring the fluid back to the systemic circulation.
This procedure is commonly used for breast cancer but can also be used for other types of cancer, such as malignant melanoma, a type of skin cancer.
The surgeon will use this type of biopsy to determine if the first lymph node that drains the breast, called the sentinel node, tests positive for breast cancer cells. The sentinel node is examined during surgery and if negative for cancer cells then it is not necessary to remove the remaining lymph nodes. If the node is positive, more lymph nodes may have to be removed.
Axillary Lymph Node Dissection
This is the name of the procedure where most of the lymph nodes from the axilla, the armpit area, are removed.
This is usually done after a positive sentinel lymph node biopsy or when cancer is already known to be in the lymph nodes preoperatively.
Breast Imaging
The following types of breast imaging may be used to help Dr. Keller decide on the best treatment plan.
Breast Ultrasound
The breast ultrasound is performed in the office and test results are given immediately. The breast ultrasound does not use radiation but uses sound waves called “echoes”. The echoes are converted into an image and help distinguish between solid masses, fluid-filled cysts, as well as possible cancerous lesions.
Breast Mammography
Mammography is the standard type of imaging used for screening breast cancer or further investigation of breast lumps that may have been spotted during a screening. Mammograms use low dose x-rays in multiple views. These images are taken in the radiology suite and reviewed by a radiologist before sending the results to your physician.
Breast MRI
Breast MRI uses magnetic waves to make an image of the breast. No radiation is used although the MRI is usually performed in the radiology suite. Breast MRIs are not routinely used except for special cases.
Genetic Testing for Cancer
Genetic testing is important for patients with breast, ovarian, or colon cancer diagnosis. The outcome of their tests can impact decisions for family members as well as themselves.
If the results show the presence of a gene mutation that can be passed down from generation to generation, family members can choose to start screening earlier and may consider the test results when making decisions about preventive measures.
There are also many other cancer genes that can be looked for such as prostate and pancreatic cancer. With continuing research these genes are constantly being updated.