Procedures

Breast cancer is the abnormal growth of cells in the breast that can spread to other parts of the body, and it is the most common non-skin cancer in women. The exact cause is multifactorial, with risk factors including gender, age, genetics, radiation exposure, menstrual and reproductive history, breast density, and lifestyle factors like alcohol consumption and obesity. While most cases are sporadic, certain conditions like a past history of atypia can increase the risk, and managing vitamin D deficiency may improve outcomes for some patients.

Breast cancer may present with symptoms like a lump, nipple discharge, retraction, or skin changes, though it is often detected early through mammograms or ultrasounds without noticeable symptoms. Diagnosis typically involves a triple assessment, combining physical exams, imaging, and needle biopsy, with core or vacuum needle biopsies providing the most reliable results. Breast cancer types are generally categorized as ductal or lobular, with treatment tailored to factors such as hormone sensitivity, growth rate, and potential spread to other areas, including the lymph nodes.

Multidisciplinary care (MDC) involves a team of healthcare professionals collaborating to develop personalized treatment plans for cancer patients, ensuring all relevant disciplines contribute to decision-making. This approach, considered best practice in Australia, guarantees that all treatment options are considered, and the care plan is tailored to the individual. The Multidisciplinary Team (MDT) includes specialists like surgeons, oncologists, radiologists, pathologists, and nurses who meet regularly to discuss diagnosis, treatment recommendations, and supportive care plans. The benefits of the MDT include access to evidence-based care, increased patient satisfaction, and coordinated treatment. The entire process is streamlined, with no out-of-pocket costs for patients, as the meeting is covered by Medicare.

Most breast cancers are not linked to inherited genes, with only 5-10% caused by genetic mutations passed down from parents, often appearing in families with multiple cases, especially under the age of 50. Genetic testing, like the Color gene mutation test, can identify mutations such as BRCA1 and BRCA2, which increase the risk of breast and ovarian cancer. Those with a positive test may consider enhanced screening, medications, or preventive surgery to reduce cancer risk, and should seek genetic counseling before testing to understand their options and the implications of the results.

DCIS

Ductal Carcinoma in Situ (DCIS) is a pre-invasive breast cancer confined to the milk ducts, and its detection has increased due to screening programs. While it doesn’t spread outside the ducts, it has a high risk of progressing to invasive cancer, so it is managed with complete excision, often through lumpectomy or mastectomy. Treatment may also include radiotherapy and hormone therapy if the DCIS is hormone-sensitive, and long-term follow-up with annual mammograms and clinical exams is recommended to monitor for recurrence.

LCIS

Lobular Carcinoma in Situ (LCIS) is a non-cancerous change in the breast lobules that increases the lifetime risk of developing breast cancer, though it progresses slowly. It’s often found incidentally on imaging and usually doesn’t require treatment beyond surgical excision if biopsy findings are unclear. Ongoing management involves regular breast surveillance (mammogram, ultrasound, MRI) and may include hormonal therapy to reduce cancer risk. Prophylactic mastectomy is generally not recommended unless there is a strong family history.

Breast augmentation involves surgically placing implants to enhance breast size or shape, often chosen by women seeking fuller breasts, correction of asymmetry, or reconstruction after mastectomy. The procedure should be a well-considered personal decision made after thorough consultation and understanding of options, risks, and expected outcomes. Implants, made of silicone or saline, can be placed in various positions through different incisions, and may eventually need replacement.

While generally safe, potential complications include infection, bleeding, scarring, changes in nipple sensation, implant movement or rupture, and rare but serious issues like capsular contracture or implant extrusion. Recovery typically involves some discomfort, limited activity, and the use of supportive bras, with final results evolving over several months. Despite careful planning, exact cosmetic outcomes cannot be guaranteed, and patients are encouraged to maintain realistic expectations and open communication with their surgeon.

Breast reduction, or reduction mammaplasty, is a surgical procedure to decrease breast size by removing excess tissue and reshaping the breasts. It is commonly performed on women experiencing discomfort from overly large breasts, such as back and shoulder pain, skin irritation, and emotional distress. The surgery also lifts the nipple and areola and may improve posture and physical activity levels.

Like any surgery, there are risks, including infection, bleeding, scarring, asymmetry, and changes in nipple sensation. This procedure may cause permanent scars and this may affect the ability to breastfeed, especially if a free nipple graft is required. Recovery involves several weeks of limited activity, wearing a surgical bra, and proper wound care, with final results taking months to appear. While most women are highly satisfied with the outcome, the final breast shape and size cannot be guaranteed.

Fine needle aspiration, core biopsy, and vacuum-assisted biopsy are techniques used to diagnose breast lumps or cancer. 

Fine needle aspiration involves using a small needle to remove cells from a lump, typically under local anaesthesia, to determine if the lump is benign or malignant. 

Core biopsy uses a larger needle with a blade to obtain a core of tissue, also under local anaesthesia, and provides more detailed tissue information such as presence of invasion and hormone receptor status.

Vacuum biopsy is a needle-based technique that obtains larger tissue samples than a core biopsy, enhancing diagnostic accuracy. The procedure involves inserting a hollow needle into the breast tissue, applying a vacuum to capture tissue into a small chamber for multiple samples without re-inserting the needle.

Vacuum excisional biopsy, a variation of vacuum biopsy, removes the entire lesion using the same method and is typically used for benign lesions like papillomas and fibroadenomas. This technique avoids general anesthesia and open surgery, minimizing scarring and complications. It takes 15-30 minutes and is done with a small incision, with bruising and occasional hematoma as common side effects.

Most biopsies are guided by ultrasound, mammogram, or MRI. While generally well tolerated, these procedures carry a small risk of bruising, hematoma, or rarely, pneumothorax.