Procedures

• Breast Conditions
• Breast Biopsy
• Breast Cancer
• Hernia Conditions
• Inguinal (Groin) Hernia
• Femoral Hernia
• Umbilical Hernia
• Ventral Hernia
• Abdominal Conditions
• Gallbladder
• Laparoscopic Cholecystectomy
• Robotic Single Incision Cholecystectomy
• Gastroesophageal Reflux Disease (GERD)
• Transoral Incisionless Fundoplication (Tif)
• Nissen Fundoplication (Heartburn Surgery)
• Colon Conditions
• Colon Cancer
• Diverticulitis
• Endocrine Conditions
• Thyroid
• Parathyroid
• Skin Cancer / Melanoma /
  Lumps & Bumps

Breast Conditions

Breast Conditions That May Require Biopsy

When you find a lump or other change in your breast, you should see your doctor for an examination. Many breast lumps and other breast changes turn out to be benign. These include:

• Cysts: Fluid-filled lumps that may grow larger and may be painful.
• Adenosis: Small, round lumps caused by enlarged breast lobules (small lobes of the breast).
• Fat necrosis: Round, firm lumps that are usually painless. The lumps most often appear after a breast injury, surgery, or radiation therapy.
• Fibroadenomas: Hard, round lumps that move around easily and usually do not hurt.
• Intraductal papilloma: A wart-like growth in a milk duct of the breast.

Sometimes a mammogram or ultrasound can reveal breast abnormalities that could increase your chances of cancer, may become cancer or may indicate the presence of cancer. A biopsy is often recommended to determine a proper course of treatment. These conditions include:

• Atypical lobular hyperplasia (ALH): Abnormal cells in the breast lobules.
• Lobular carcinoma in situ (LCIS): A significant number of abnormal cells in the breast lobules (more than with ALH).
• Ductal carconoma in situ (DCIS): Abnormal cells in the lining of a breast duct. Called "in situ" because the cells have not spread outside the duct to the breast tissue.

When you require a breast biopsy to determine whether you have breast cancer, be assured that we at Estrella Surgical Group are sensitive to the anxiety you may be feeling. We make every effort to provide a swift diagnosis, and to recommend the most minimally-invasive procedure depending on the size and location of your mass. Also depending on the situation and your wishes, the lump or abnormality may be completely removed during the biopsy procedure.

Diagnosis

We offer the following biopsies:

• Fine needle aspiration (FNA): After the area is numbed with local anesthesia, the surgeon inserts a fine needle into the breast lump and withdraws a small sample of tissue for examination under a microscope.
• Core biopsy: This kind of breast biopsy is performed using ultrasound to locate the mass. The surgeon guides a spring-loaded device to withdraw tissue samples for examination. This type of biopsy also involves local anesthesia.
• Stereotactic needle core biopsy (mammotome): During this type of biopsy, a mammography machine is used to project mammographic images onto a computer screen while the surgeon guides a needle into the suspicious mass to take tissue samples. This procedure is also done using only local anesthesia and a very small (1/4 inch) incision.
• Open Breast Biopsy (Surgical Biopsy): During this kind of biopsy, the surgeon makes an incision in the breast and removes tissue from the suspicious area. It is then sent to a pathologist for a diagnosis. This procedure is performed in the operating room, and may be done with either local or general anesthesia. Surgical breast biopsy is an outpatient procedure. You will likely be able to resume your usual activities within several days of the procedure.

Breast Cancer

There are two main types of breast cancer. Most breast cancers are of the type called ductal carcinoma which starts in the breast milk ducts. The other type, Lobular carcinoma, starts in the lobules of the breast. Breast cancer can be invasive, meaning it has spread from the lobule or duct where it originated to other breast tissue. Ductal carcinoma in situ refers to breast cancer that has not spread to other breast tissue.

Treatment

At Estrella Surgical Group, our surgeons offer a full range of the latest surgical procedures to treat patients with breast cancer. Our doctors provide you with the careful diagnosis and information needed to help determine the surgical treatment option that’s most appropriate for you.

Surgical procedures we perform for breast cancer treatment include:

Breast Conservation Therapy (Lumpectomy): surgery in which only the cancerous tumor and some surrounding tissue are removed. On rare occasions, additional cancerous tissue is discovered during the procedure, which may result in the need for a repeat lumpectomy or a mastectomy. The amount of tissue that is removed in a lumpectomy can vary greatly and will affect the size of breast deformity that results.

Lumpectomy is a form of "breast-conserving" surgery and has the obvious advantage of preservation of the breast. However, in certain situations, such as large or multiple tumors, a lumpectomy is not a good option.

Another factor to consider regarding this method of treatment is that after breast conservation therapy, radiation is nearly always required to complete treatment. Typically radiation requires six weeks of daily treatments. Estrella Surgical Group also offers catheter-based radiation (brachytherapy), which reduces the radiation treatment period to 1 week.

Mastectomy: surgery to remove the whole breast, including the nipple. The surgery is performed in a hospital, generally with an overnight stay. You can choose to have a plastic surgeon perform reconstructive surgery at the same time as your mastectomy or wait and have it later. Estrella Surgical Group surgeons can partner with breast reconstruction specialists to give you an immediate breast reconstruction along with your mastectomy. Some women choose not to have reconstructive surgery and to wear a prosthesis. In the final stages of the surgery, your breast surgeon will insert surgical drains into your breast area or armpit. These tubes are left in place to collect excess fluid that can accumulate and are removed several days to two weeks after surgery.

The advantage of mastectomy is that radiation is rarely needed and further surgery for cancer is very unusual.

Sentinel-Node Biopsy: is a type of surgery in which the surgeon removes a few lymph nodes from the underarm for testing. Sentinel nodes are the first node(s) the tumor drains to. Knowing whether cancer is in the underarm lymph nodes can help your surgeon decide if you need chemotherapy or other treatment in addition to surgery. To perform a sentinel node biopsy, the surgeon injects a small amount of radioactive material and some blue dye around the tumor. The radioactive material and blue dye travel to the sentinal node(s) and help the surgeon identify them. The nodes are then removed and examined to see if they have cancer. If they do not contain cancer, it is unlikely that the other nodes under the arm have cancer. Usually this means that the surgeon will not need to remove any other lymph nodes. Having fewer lymph nodes removed results in a less painful recovery and lowers the likelihood that you will develop lymphedema and other problems caused by damage to lymph vessels and lymph nodes.

Axillary Dissection: During a mastectomy, and sometimes during or after a lumpectomy, the surgeon will remove axillary (underarm) lymph nodes that show evidence of cancer. The surgeon will generally remove between five and thirty nodes during a traditional axillary dissection. Once the surgeon removes the nodes, they will be examined by a pathologist to determine if they are cancerous.

Chemotherapy: a course of drug treatment designed to stop the growth of cancer cells. There are a variety of chemotherapy drugs used to treat breast cancer, and they may be administered intravenously or orally. In some cases, chemotherapy may be required after breast conservation therapy or mastectomy. Occasionally, chemotherapy is given before surgery in order to shrink the tumor so it can be removed more easily.