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Posted by Betsy Mullen on 8/14/2000 from 152.163.197.76:

In reply to: Can breast biopsy perform after breast augmentation? posted by Anna on 8/13/2000 from 205.188.199.194:

Dear Anna:

A few things worth discussing. First, have you discussed this situation with the plastic/reconstructive surgeon who performed your breast augmentation? Second, were you offered the option of a breast MRI? Third, with or without implants, mammograms are challenging for premenopausal women because young women your age have dense breast tissue, so abnormalities tend not to show up well or at all on mammograms due to this fact. A digital mammogram might yield somewhat better results, but for a woman your age with breast implants, a breast MRI to evaluate a suspicious lump might be appropriate. You may also want to discuss a needle localization breast biopsy with your surgeons. This type of biopsy is performed to guide surgical excision of nonpalpable lesions. I realize that your lump is palpable, but because you have an implant(s), perhaps this type of biopsy will be beneficial to avoid any contact with your implant. The placement of the small wire may be done with mammography or ultrasound guidance. A stereotactic biospy might be another viable option. A fine needle aspiration may also be feasible. Please bear in mind that I am not a health care provider, so these points I raise should be discussed with your health care team.

I am a strong advocate of second opinions. The good news is, is that over 80% of breast lumps turn out to be benign. Again, I am not a physician, but perhaps you should consult with your plastic surgeon to evaluate the lump. Could it be scar tissue from your recent augmentation, or possibly a hematoma from surgery? I might be off, but it certainly doesn't hurt to ask.

Here are some additional questions and information that perhaps you should discuss with your doctors:

1. Do you have a family history of breast cancer?

2. Do you have any known risk factors?; Do you know what some of the breast cancer risk factors are?

3. Do you know how to do a proper breast exam? You can receive this information and register for monthly breast self-exam reminders right on our web site (www.winabc.org)

4. Are you current on having regular clinical breast exams?

5. Are you current on having regular Pap smears? (I ask that because I want to make sure that you focus on your overall health care and regular Pap smears are a very important part of taking care of yourself.

6. The questions you have raised here on our message board.


Anna, WIN Against Breast Cancer has several resources that I think will be very helpful to you. We will be happy to send you educational materials, free of charge regarding breast self-exam, breast health, understanding breast changes, questions to ask your health plan about exemplary care (found on our web site under help yourself – 10 key questions for women to ask their health plans), breast cancer myths and much, much more depending upon your needs. We have trained information specialists in our offices that can speak with you one on one to determine the best materials to send you (all free of charge). WIN ABC also has published an in-depth resource guide with additional resources and suggested reading.

AN IMPORTANT REMINDER: It is very difficult to render an opinion without knowing all the facts of any one particular case. But one strong recommendation we would like to make is that you pursue your question(s) with your own physicians. You should feel fully empowered to obtain a satisfactory answer and feel free to seek a second or third opinion. We have some great tips on partnering with your health care team and key questions to ask your doctors, communication tips and informed decision-making tips to help you get the information you need. There is a special Personal Profile Form on our web site (blue link at the top of this page) that you can fill out and e-mail to us to help us best meet your needs and you are also welcome to call us at (626) 332-2255. Your information will be kept confidential.


Please feel free to telephone our office and to fill out the Personal Profile Form via the link at the top of this page so that we can best meet your needs. Your information will remain confidential. Please keep us "posted" on how you are doing and how we can best help and support you, Anna.


Here are brief explanations of the two types of biopsies I have referred to:

1. Needle Localization Biopsy

Using a mammogram or an ultrasound as a guide, a doctor places a needle or fine wire into the suspicious area. The area is then removed with a surgical biopsy. A second picture of the biopsy area may be taken later to make sure that the area of concern was entirely removed.

2. Stereotactic Needle Biopsy

This procedure pinpoints the area of concern with a double-view mammogram. A computer plots the exact area and guides a fine needle or a large-core needle so that a doctor can remove a sample of tissue for the pathologist.

If your biopsy result is negative, your treatment is over. It still will be important to have your breasts checked regularly for any future signs of change. If the result is positive, the cells did contain cancer and you will need to make decisions about your treatment options. Remember, "early detection is a key to protection"; and there are people who can help you through this process.
(Adapted from "A Woman's Guide to Breast Cancer Diagnosis and Treatment", published by the California Department of Health Services, and "The Breast Buddy Volunteer Training Curriculum", ©WIN ABC 1994.)


Here is some good information regarding MRI of the breast(s):

One key factor to take into consideration is your age. Premenopausal women particularly women in their 20's and 30's tend to have dense breast tissue which is why traditionally, baseline mammograms begin between the ages of 40-50. So...if you are younger, this might be an option.

Another key question is whether or not you have breast implants. There are some schools of thought that recommend an occasional breast screening with magnetic resonance imaging (MRI) for women with a breast implant(s). MRI does not involve any exposure to radiation, although it is important to keep in mind that such exposure is minimal with mammograms.

MRI is gaining recognition as a very effective method to detect a ruptured or leaking breast implant and as a breast screening method that may be more effective than mammography for women who have implants. It takes a skilled MRI technician/expert to detect an area of concern in a breast MRI because when a dye is used w/ MRI, (used to help with the reading of tumor tissue) both the breast tissue and the dye appear bright so a trained eye needs to analyze the images. (Source: The Complete Book of Breast Care by Niels H. Lauerson, MD, PhD and Eileen Stukane)


Here is some additional information that I hope you find helpful:*

*Source: Richard L. Ellis, M.D.
Memorial Medical Center, Department of Radiology
Division of Breast Imaging, Springfield, Illinois 62794


Q: Why is ultrasound performed in addition to mammography?

Ultrasound is an excellent adjunctive examination to mammography, but it cannot be a substitute for the screening mammogram. As noted above, ultrasound is the primary examination in young, pregnant, or lactating women with palpable abnormalities. It is also routinely performed on women with clinical findings whose mammograms are unrevealing and on those whose mammograms show an area that requires further evaluation. Ultrasound is also used to guide interventional procedures, such as needle localization, fine needle aspiration, core biopsy, and percutaneous ductography.

A reliable aid in the diagnoses of most breast cysts, ultrasound can be used to guide benign cyst puncture for those who are symptomatic or do not meet stringent criteria for diagnosis of a benign cyst on ultrasound. In addition, it can provide reassurance that no mass underlies a questionable palpable area. According to recent evidence, ultrasound can aid in the benign-malignant differentiation of solid breast masses and prevent biopsy for many noncancerous masses, such as fibroadenomas.


Q: What other diagnostic procedures are performed in mammography?

Once an abnormality (abnormal mass, calcifications, distortions, etc.) is detected on the screening mammogram, a diagnostic mammographic examination is generally performed in order to obtain special views of the abnormality allowing a more detailed evaluation. This additional mammographic examination may include the use of special X-ray maneuvers and magnification of the abnormality in question as mentioned previously.

Magnetic resonance imaging is a special radiologic scanning method that is extremely accurate for evaluation of breast implants when there is a suspicion of implant rupture or leakage due to trauma or implant breakdown due to age. In addition, MRI is beginning to show promise as a tool that in the future may allow differentiation of benign and malignant lesions in the breast and provide better demarcation of the size of the lesion to assist surgery. In addition, MRI may help determine recurrence of cancer in the breast after treatment.

Nuclear Medicine Imaging, using sestimibi (Miraluma), is currently available as an additional diagnostic examination for selective patients. We are also using monoclonal antibodies for breast cancer under clinical research trials to evaluate their efficacy in selected patients with the hope of helping to differentiate between benign and malignant breast lesions.

Q: What are the procedures used to remove breast tissue for pathologic diagnosis?

The type of breast biopsy performed is predicated upon the type of breast lesion and using the following basic principles, understanding that many breast biopsies are benign (noncancerous):

Most accurate diagnosis with the smallest amount of tissue removed;
Least amount of trauma to the patient; and
Most cost-effective biopsy method.


Fine needle aspiration biopsy removes a small sample of cells from an abnormal breast lesion and requires the aid of the cytotechnologist and cytopathologist for preparation and interpretation. Preliminary results are usually available in a few hours with this procedure. Also, fine needle cyst aspiration is usually performed with ultrasound guidance in order to remove the fluid contained in breast cysts. Although cyst puncture for palpable lesions can be performed without guidance, it is more reliably accomplished when the cyst can be entered and completely evacuated under direct vision with ultrasound.

Core biopsy is performed with either ultrasound guidance or stereotactic guidance and allows the removal of small strips of tissue that the pathologist can analyze. Although this procedure can be performed to confirm malignancy in a highly suspicious lesion, more commonly the biopsy provides verification that a lesion is benign and thus prevents surgical biopsy or multiple follow-up examinations. Results from a core biopsy are generally available in 48 hours.

Needle localization breast biopsy is performed to guide surgical excision of nonpalpable lesions. The placement of the small wire may be done with mammography or ultrasound guidance. Mammography guidance is generally used for lesions presenting with microcalcifications without a mass. Once the small wire is placed in the correct location, the surgeon then has a guide wire to direct the removal of the breast abnormality. Once the abnormal tissue is excised from the breast, a specimen X-ray obtained on the tissue in order to demonstrate that the abnormality was removed from the breast. Generally, results from a needle localization biopsy are available in 48 hours.


I will close with this thought and a saying of mine: "When in doubt, check it out." You know your body well and are your own best advocate. Pursue any concerns with your health care team. And remember, we are strong advocates of second opinions. Please keep us up-to-date on how you are doing, Anna.


My warmest regards,

Betsy Mullen
President/CEO
WIN Against Breast Cancer
www.winabc.org

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