3-D Tomosynthesis Mammography
A mammogram is a low dose X-ray examination of the breasts. It is a test that is usually performed on a yearly basis to help detect breast cancer in its earliest stages, often before any signs or symptoms of the disease are present. Mammograms are an effective way to detect cancer early with the goal of successfully treating and curing it.
A 3-D mammogram can offer patients faster and more accurate results than a traditional X-ray exam. The state of the art mammogram has the same basic principles as the traditional analog X-ray method. However, instead of capturing the image to film, 3-D mammography captures the image directly to the doctor's computer for fast, easy viewing. The computer allows for example, manipulation of the images to focus in on suspicious areas. Traditional mammography does not have this advantage. The X-ray waves are converted into electrical signals, similar to the technology used in a digital camera. Compression of the breast is still needed to produce an accurate image. 3-D Tomosynthesis mammograms are approved by the FDA and offer results better than the conventional exam. This new technology is especially useful for women with dense breasts
Digital Breast Ultrasound
A breast ultrasound is a diagnostic imaging test used to examine the tissues inside the breast by exposing the breasts to high-frequency sound waves that create images of the breast tissue. These images are captured in real time and can show the movement of the inner organs, along with blood flowing through blood vessels in the area. There is no radiation exposure using ultrasound. We often use ultrasound in addition to a mammogram in order to get more information about the breasts. For example, if a lump is seen on a mammogram, the ultrasound can tell us if it is a cyst with fluid or if it is a solid mass. It has great utility in women with dense and lumpy breasts.
A breast MRI is a noninvasive diagnostic imaging test that produces multiple cross-sectional images of the breast to help screen for breast cancer, especially after abnormal results show up on a mammogram or ultrasound. This procedure generates detailed 2D and 3D images and may be performed in conjunction with a mammogram. It is often useful in determining the extent of a breast cancer as well as other breast conditions after they have been detected by a mammogram, ultrasound or a breast examination. A breast MRI is performed in a special machine, lying face down. There is a painless injection of a special dye during the test that helps us see the breast tissue and any abnormalities. A breast MRI usually takes about 20-30 minutes to complete.
Minimally Invasive Ultrasound Guided Vacuum Assisted Biopsy
Ultrasound is an excellent way to evaluate breast abnormalities detected by mammography, the patient or Dr. Kaufman, but in some cases it is not possible to tell from the imaging studies alone whether a growth is benign or cancerous. Ultrasound-guided breast biopsy is a highly accurate way to evaluate suspicious masses within the breast that are visible on ultrasound, whether or not they can be felt on breast self-examination or clinical examination.
Breast ultrasound is a form of diagnostic imaging performed to help locate and examine any abnormal tissues inside the breast and help to guide the biopsy needle toward them by exposing your breasts to high-frequency sound waves that create images of the breast tissue. These images are captured in real-time and can show the movement of the inner organs, along with blood flowing through blood vessels in the area. A breast biopsy is a minimally invasive procedure that allows Dr. Kaufman to analyze any abnormal breast tissue in great detail to determine whether the tissue is benign (noncancerous) or malignant (cancerous). These biopsies, often performed in an office setting under local anesthesia are safe, very accurate, minimally invasive, and are less expensive than traditional open surgical biopsy with less scarring and minimal recovery time.
Minimally Invasive Stereotactic Vacuum Assisted Biopsy
A breast biopsy is often necessary after a suspicious area is detected in the breast. Various biopsy devices may be utilized to extract tissue samples from the breast and the surrounding area, which are then sent to a pathology lab to determine whether or not it is benign, (non-cancerous) or malignant, (cancerous). Stereotactic breast biopsy is a non-surgical, minimally invasive approach that uses special 3-D mammography equipment to guide the biopsy needle to the suspicious biopsy site, allowing for great precision. These procedures are very accurate, safe and less expensive than traditional open surgical biopsy and they are performed on an outpatient basis under local anesthesia through a small nick in the skin. Recovery is usually fast and uneventful. Most patients return to normal activity the next day.
Sentinel Lymph Node Biopsy
A sentinel lymph node biopsy is a surgical procedure performed to remove lymph node tissue to check if breast cancer has spread outside of the breast. This procedure is usually performed at the same time as a lumpectomy or mastectomy for breast cancer. The sentinel node is the first or main lymph node that cancer could spread to if it travels outside the breast and it is one of the many lymph nodes under the arm. A sentinel lymph node biopsy is extremely accurate, a less invasive procedure than its alternatives and it has a lower risk of complications along with a quicker recovery. Biopsy results are often obtained immediately while the patient is under anesthesia. This allows us to make further surgical decisions while still in the operating room.
Nipple Sparing Mastectomy
A mastectomy is a surgical procedure that removes the entire breast in patients with breast cancer, as well as those high risk patients who wish to prevent the disease from occurring. Historically, this is one of the most commonly used and most effective treatment options for breast cancer, as it effectively removes all traces of cancer and reduces a patient's risk of recurrence. Along with skin-sparing mastectomy techniques, a nipple sparing mastectomy, (NSM) allows for an more natural appearing reconstruction result, as the nipple will be saved and will not need to be reconstructed. This allows us to create a much more natural appearing breast with its native nipple intact. However, it is important for patients to note that leaving the nipple intact may leave a very small amount of breast tissue, which may be at risk for developing breast cancer. Patients should still be screened regularly for breast cancer after this procedure.
A skin-sparing mastectomy (SSM) is similar to a traditional mastectomy, but the procedure is less invasive because only the nipple and it's surrounding areola need to be replaced. An SSM allows the patient to maintain all or most of the skin envelope of the breast, so the breast looks natural and matches the other breast, after the implant is inserted. With SSM, breast reconstruction is performed immediately after the mastectomy in order to take advantage of the spared skin.
During an SSM, Dr. Kaufman will make an incision through which the breast tissue, connective tissue and milk ducts are removed, creating an empty pouch within the breast. An implant or the patient’s own tissue is then inserted in to the pouch followed by nipple and areola reconstruction. The initial mastectomy procedure typically takes two hours and generally requires a one night hospital stay.
A skin-sparing mastectomy is a safe and effective procedure for women requesting breast reconstruction after a mastectomy. The greatest benefit is a more natural appearing breast.
Localization and Excision of Lesions Seen on Mammogram
A breast lesion is an abnormality in the breast tissue that usually manifests itself as a lump, swelling or calcifications. Breast lesions are typically found through self-exams, breast exams by physicians or through a mammogram, ultrasound or an MRI.
Although most breast lesions are benign, a breast surgeon should always be consulted if a lesion is detected. Suspicious findings may include the presence of a lump in the breast, bloody nipple discharge, calcifications or changes to the skin around the breast. Often, these suspicious lesions need to be removed surgically. However, not all lesions are easily seen with the naked eye nor can they be felt on examination. In these cases we will employ a technique that allows us to identify the location of a lesion using a mammogram or sonogram image. Using these images we can place a very fine wire or a tiny marker smaller than a grain of rice directly in to the suspicious area in the breast. The tissue in question is then injected with a special blue colored dye that enables us to accurately find and remove the lesion in the operating room.
Oncoplastic surgery of the breast is performed to provide effective medical and cosmetic results for breast cancer patients often without the need for additional reconstructive procedures. This new technology combines the best of tumor surgery, (Onco) with the best of cosmetic reconstructive surgery, (plastic). The goal is to maintain and in many cases improve the shape and appearance of the breast following surgery. It has allowed for the development of advanced skin and nipple sparing mastectomy procedures that remove the cancerous tissue while leaving the overlying skin and nipple completely intact.
Other oncoplastic procedures include breast conserving surgery or lumpectomy that saves the breast while removing the entire tumor. We then transfer surrounding breast tissue into the lumpectomy cavity or surgical defect for an improved cosmetic outcome. Patients can benefit from less invasive cancer treatments and a wider range of reconstruction options, as well as less scarring from surgery.
This multidisciplinary surgical approach is best carried out by experts in the field such as a breast surgeon like Dr. Kaufman along with a plastic and reconstructive surgeon. These techniques offer the woman the most advanced breast cancer surgery procedures available anywhere in the world and deliver exceptional medical and cosmetic results.
Treatment of Nipple Discharge and Bleeding
Nipple discharge occurs when there is fluid coming out of a breast nipple. It can have many causes including pregnancy, breast infection, hormone imbalance, breast cancer, injury to the breast, fibroadenomas, papillomas, breast tumors and cysts to name a few. Nipple discharge is more common in pregnant women and older women. Regardless of the age of the patient, all nipple discharge needs to be evaluated by a physician, particularly if there is a lump in the breast, blood in the discharge, or if only one of the breasts is affected.
Nipple discharge is rarely cancerous, but may be a sign of an underlying problem that requires treatment.