Breast Lump Surgery :

OCCURRENCE

A breast lump is more commonly seen in females who are in the age group of 20-50 years. Most often, a breast lump is reported by women who haven't attained menopause. After menopause, their occurrence is rare and only observed in those women who are taking hormones.

BREAST LUMP SYMPTOMS

You should consult your healthcare provider if you notice any of these changes in your breast.

• A round, smooth, or hard lump with irregular edges in your breast or armpit
• Nipple turning inwards
• Dimpling of skin on the breast
• Changes in breast shape and size
• Nipple discharge, e.g., blood coming out of the nipple

BREAST LUMP CAUSES

Some of the common causes of breast lumps are :

• Fibroadenomas : This benign breast lump is the most common non-cancerous tumor, occurring majorly in younger women in their 20s and 30s. A fibroadenoma is diagnosed with the help of an ultrasound.
• Cysts : Cysts are commonly found in women who have not undergone menopause. They are fluid-filled sacs formed when fluid gets trapped in the milk ducts.
• Phyllodes Tumor : This kind of tumor is found in your breast's connective tissue.
• Breast Calcifications : If you have undergone breast reduction, you are highly likely to develop large, benign calcium deposits, which may feel like a hard, large lump.
• Breast Infection : Sometimes, an infection in the breast tissue can form a localized, hardened tissue. Owing to the infection, a breast abscess, a pus-filled lump, can also develop.
• Breast Cancer : A tumor that forms in the breast tissue causes a lump to form

EVALUATION

As part of the evaluation, your healthcare provider will take you through the following steps:

1. Medical History : Your health care provider will ask you questions about your symptoms, medical history, and family health history.
2. Physical Examination : This step involves your health care provider manually checking for any lumps around your breast with their fingers.
3. Diagnostic Examination : This includes a mammogram or an ultrasound imaging test to obtain detailed views of your breast.

BREAST LUMP DIAGNOSIS

To ascertain the presence of breast lumps, you may be asked to undergo these imaging tests as part of the routine diagnosis, which include:

• Ultrasound of the Breast : In breast ultrasound, sound waves form images of the interiors of the breast on a monitor. This imaging technique is especially useful in determining whether the breast lump is solid or fluid-filled.
• Mammogram : This technique uses X-rays to offer a detailed view of any changes in the breast. The images are taken from several angles.
• MRI Scan of the Breast : MRI stands for magnetic resonance imaging, and it uses radio waves and a magnet to create images of the inside of the breast. Sometimes, a dye may be injected intravenously before the MRI to get more detailed images. An MRI is usually advised to detect whether the lump is cancerous.
• Breast Biopsy : In this technique, a sample of the suspected breast tissue is taken and examined under the microscope. Several biopsy techniques are available these days, including fine-needle aspiration biopsy, core needle biopsy, stereotactic biopsy, and vacuum-assisted biopsy, apart from the traditional surgical biopsy technique.

TREATMENT OF BREAST LUMPS

Depending on the cause of the breast lump, the treatment modality is advised. You may either require medications, undergo a fine-needle aspiration procedure or surgical removal of the cancerous breast lump.

1. Medications : Antibiotics may be given to treat simple breast infections.
2. Fine-needle Aspiration : In this procedure, a very fine needle is inserted into the lump to withdraw (aspirate) fluid from a cyst.
3. Surgery : This is advised for a phyllodes tumor or breast cancer.

If you are suffering from a fibroadenoma, it requires no treatment. It usually resolves on its own with time. Surgical removal of breast lumps can either be done by lumpectomy (for benign tumors) or mastectomy (for cancerous tumors).

A lumpectomy is the surgical removal of breast lumps or other abnormal tissue from the breast. It is the most common method of breast lump removal surgery, unlike a mastectomy, in which the entire breast is removed. Following are the various types of surgical procedures that are included under lumpectomy:

• Excisional Biopsy : This is a diagnostic procedure. In this procedure, a part of the lump is removed for biopsy, which involves examining the lump under a microscope to determine whether it is cancerous or benign.
• Wide Local Excision : form of surgery removes part of the healthy tissue along with the lump. This is done to ensure that there are no cancer cells in the marginal tissues of the cancerous lump. The absence of cancer cells in the margin tissues means that the surgery was successfully performed, and no remnant of the cancer is left behind.
• Quadrantectomy : Just like the name suggests, this procedure surgically removes about a quarter of your breast, which includes the lump along with the marginal, healthy tissue and a part of the area containing your milk ducts.
• Re-excision of Margins : This procedure extends the wide local excision method. If the test shows cancerous cells in the margin of healthy tissue, follow-up surgery would be required to remove them.

PROCEDURE OF LUMPECTOMY

A. Pre-operative Procedures : your healthcare provider's advice about what medicines, supplements, herbs, and vitamins you should stop taking before the surgery. Also, arrange for someone to take you home after the surgery, as it is advisable not to drive soon after surgery due to the dizzy effect of anesthesia.

B. During the Procedure : the surgery, you will undergo an imaging test (e.g., mammogram or breast ultrasound) to locate the exact position of the lump. You will be administered with local anesthesia. Small marker clips will be placed at the site of the breast lump after the removal of the tumor. This will help to identify the exact spot where the radiation needs to be given after the surgery. Finally, the surgeon will sew the breast lump excision using sutures, which usually dissolve on the patient's own.

SUCCESS RATE

The success rate is always good for non-cancerous tumors. However, chances of recurrence of breast lumps can be there even after a lumpectomy is performed.

COMPLICATIONS

Even though lumpectomy is considered relatively safe, it does pose some complications. Potential risks of lumpectomy are:

• Infection at the site of incision
• Collection of blood or clear fluid
• Shooting pain in the armpit, arm, or chest
• Swelling and bruising of the hand closest to your breast

ESTIMATED RECOVERY DAYS

On average, it takes approximately two weeks to fully recover after the surgery. Soon after the surgery, you may feel pain, bruising, swelling, and tiredness. To bring the swelling down, your healthcare provider may give you an ice pack to place inside your bra. It is advisable to refrain from lifting heavy objects and not indulge in exercises for a few days after the surgery.

CONSEQUENCES OF DELAYING SURGERY

Ignoring the tell-tale signs of breast lumps might cause breast cancer. Thus, it is recommended that professional help be sought to diagnose the nature of the lump and, if required, to undergo surgery as soon as possible.