31 Old Broad Street
Breast Care in London
Breast Care at London Bridge Hospital
Breast surgery includes a wide range of procedures. We have outlined many of the common procedures below. It is important that you have a full discussion with your surgeon to understand the details of your operation as well as the benefits and risks involved.
A breast ultrasound is the scanning of the breast tissue using high frequency sound waves, similar to that carried out during pregnancy. The breast ultrasound scan is performed by running a hand held probe over the breast. Clear gel is used to enhance the contact between the probe and the skin.
Breast ultrasound is usually used to concentrate on one particular area of the breast. It is suitable for use in all ages, but is particularly effective in younger women with dense breast tissue. Many women will be advised to have an ultrasound in conjunction with a mammogram.
Ultrasound scans at London Bridge and Old Broad Street are carried out by a Consultant Breast Radiologist. The appearance of the inside of the breast is shown on a black and white screen and this will help give the radiologist the information they require to assist with diagnosis.
Core Needle Biopsy
This is a breast biopsy carried out using a needle that takes a small slither of breast tissue, rather than individual cells like a Fine Needle Aspiration Cytology (FNAC). As the tissue is intact, more information is derived from this type of test than an FNAC.
A core needle biopsy is carried out with local anaesthetic under ultrasound control so that we can be sure the needle is in the right place. The needle mechanism is worked by a hand held machine that makes a sharp snapping noise when the biopsy is taken. The biopsy is usually done two-three times with the needle being removed between each biopsy.
There can be some bruising of the breast over the next 24-48 hours post procedure. The local anaesthetic lasts for approximately two hours and if any soreness remains following this, you can safely take paracetamol (not aspirin) to relieve the pain.
The analysis of the tissue obtained takes around 48 hours. It is possible to provide a much faster provisional result from a core needle biopsy by taking individual cells from the surface of the tissue (core imprint). More information about the core imprint process can be obtained during your visit to Old Broad Street.
Fine needle aspirate cytology (FNAC)
This is a needle biopsy of the breast using a very thin needle. FNAC is carried out under ultrasound control. Small clusters of breast cells are obtained which are placed on a glass slide and examined under a microscope by our Consultant Breast Pathologist.
This test is very quick and is usually no more uncomfortable than having a blood test. The results can be available within 45-60 minutes.
A mammogram is an x-ray of the breast. The mammogram machine compresses the breast before the x-ray is taken. Each breast is x-rayed from two angles, which gives four images in total. A mammogram is one of the most effective types of investigations for breast problems in women over the age of 35.
A mammogram is carried out by a female radiographer who has specialised training in this form of X-ray. The whole procedure takes less than 20 minutes. The X-ray images are viewed and reported by a Consultant Breast Radiologist.
Old Broad Street and London Bridge Hospital have the newer digital technology as opposed to the analogue film screen combination. Instead of an image being processed onto film, digital mammography takes an electronic image and stores it onto a computer. This has the advantage that it can manipulated later on a screen for optimal diagnosis and allows the images to be easily archived and stored on CD for future follow-ups. Clinical trials have also shown that there is a reduced radiation dose with digital mammography.
If you have had previous mammograms, these will be compared with your current mammograms. Please be sure to bring your old mammograms along if they are in your possession.
Stereotactic core needle biopsy
We do not perform this type of biopsy at 31 Old Broad Street or London Bridge Hospital however, we can assist in referring to a Clinic/Hospital outside of London Bridge.
Axillary node clearance
In cases of breast cancer, affected lymph glands under the arm are best removed by surgical operation. This is an important part of the treatment to reduce the risk of breast cancer returning in this area, also to provide information essential to decide on the need for drug treatment. The surgery is carried out through a small incision in the affected armpit (axilla). The fat containing the glands is removed. A tube (drain) is inserted to drain any fluid or blood caused by the surgery. The tube is usually removed after three days.
Some patients may request to have the breast reconstructed at the time or after mastectomy immediate or delayed reconstruction. There are several techniques in use. Some involve insertion of a silicone implant under the chest wall muscle (submascular implant), others are done by raising the skin and the muscle of the back to provide adequate cover for the implant (LD flap). It is also possible to use the skin and the fat of the tummy (TRAM flap) or buttock (S-Gap) to reconstruct a breast. These are complicated procedures and discussing them with your surgeon is very important before you decide which might be best for you.
Correction of inverted nipple
Inverted nipples can present cosmetically unacceptable problem for some women. It occurs as a result of shortening of the milk ducts for variety of benign conditions for instance chronic infection. Surgery is the only way to correct it. The operation is carried out under general anaesthesia. A short cut is made at the base of the nipple and the milk ducts are divided releasing the nipple. A couple of fine stitches are placed to close the wound.
This is a small procedure that is carried out to ascertain the nature of a breast lump. The procedure can be done under local or general anaesthesia. A small cut of the skin is made over the site of the lump. The lump is then removed and bleeding is arrested. The skin is closed with a single dissolvable stitch that is invisibly and run under the skin and does not require to be removed. The tissue removed always get sent for histological examination (examination under microscope)
Excision of a benign (non-cancerous) lump
It is often that a breast lump is found to be benign. However patient or her specialist may decide that it is best to be removed. The procedure can be done under local or general anaesthesia. This is a small operation that involves a cut which is often as long as or a bit longer than the size of the lump. The lump is removed and bleeding is arrested. The skin is closed with a single dissolvable stitch that is invisibly and run under the skin and does not require to be removed. The lump removed is sent for examination under the microscope as a matter of routine. Fistulectomy and saucerisation. This is the surgical removal of infected tissue underneath the nipple. The small opening (sinus) at the edge of the nipple through which the infection drains is also removed (fistulectomy). The presence of infection means that the wound often does not heal well and may become re-infected. In some cases the wound is left open and not stitched to heal together by itself.(saucerisation). This minimises immediate wound healing problems.
This is an operation that involves removing the whole of the breast tissue. There are different types of mastectomy which could result in removing all the skin over the breast or part of it. Only in exceptional circumstances does the nipple need to be removed. The shape of the scar therefore varies. The operation is done under general anaesthesia. Drains are routinely inserted to assist drainage of the fluid and blood from the operation. The skin is closed in the usual way or staples can be used but they do require removal once the wound healed (usually in 10 days time). The drains stay in place for about 3-5 days.
Modified radical mastectomy
This is a mastectomy that includes not only the removal of the breast but also the removal of all the lymph nodes in the armpit. This is only necessary when there is invasive breast cancer that has spread to the lymph nodes.
Nipple discharge, particularly if blood stained, can be a manifestation of breast cancer, albeit rare. Removing the duct from which the discharge is emerging may be sometimes the only way to exclude a serious problem. The operation can be done either under local or general anaesthesia. The operation involves making a short cut at the edge of the brown part surrounding the nipple, called the areola. The duct is then identified and removed along with a small amount of surrounding breast tissue. The tissue is sent for microscopic examination.
Needle localisation and excision
The use of mammography (Breast x-ray), under the right circumstances, sometimes lead to detection of abnormality that can not be felt. If this abnormality needed to be removed then to be able to locate such an abnormality and remove it, patient must have a fine wire inserted in the breast as close as possible to the abnormality under local anaesthesia in x-ray department. The patient is taken to theatre at a later date, and under general anaesthesia the whole abnormality is removed in a similar was as described for the above operation of excision biopsy.
Sentinel node biopsy
In case of breast cancer it is crucial to know if the cancer has travelled to lymph glands under the arm. Removing unaffected glands is of no value to the patient and leaves a small but lifetime risk of arm swelling and skin infection. Information can be obtained by carrying out a smaller operation to sample the lymph glands. To know which gland to remove the surgeon injects a blue dye in the skin of the breast about 10minutes before operation. Through a small incision under the arm the surgeon can identify the right lymph glands by the blue colour. The removed glands will be examined under the microscope to determine if a second operation is needed to clear the rest of the glands.
Total duct excision
Discharge from the nipple or nipples can sometime occur without an underlying serious problem. However it can be socially embarrassing as it may stain the woman's clothes. Removing the milk ducts is the only way of stopping this problem. The operation is most commonly done under general anaesthesia. A cut is made at the edge of the areola and all the milk ducts are detached from the under surface of the nipple and surrounding tissue.
Tumourectomy/ Wide excision
When a lump is diagnosed as being cancerous it will certainly need to be removed. This procedure is the same as an excision of non-cancerous lump however the surgeon aims at removing the cancer with a clear tissue margins, that is to say complete excision of the cancerous tissue. This procedure is preferably done under general anaesthesia.