Breast lump excision

Before you agree to have your breast lump removed it is important to know all you can about it. The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your breast lump treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

There may be one of two problems:

• There is something in part of your breast, such as a solid lump or a cyst. We need to take it out to prevent it getting bigger or troublesome. This is called a lumpectomy or breast lump excision.
• There is something in the breast, which is not quite normal. We need to take it out for examination under the microscope. This is called an excision biopsy.

What has gone wrong?

The breast is made up of millions of tiny glands, called lobules, which make milk and tiny tubes, called ducts that carry the milk to the nipple. There are other tissues, such as fat, blood vessels, fibrous tissue and lymph glands.

There are a number of things that can form a lump:

• Fibroadenomas - The ducts are often the cause of problems like yours. Fibrous tissue can form around the ducts causing clearly felt lumps, called fibroadenomas. These are benign or non-malignant.
• Cysts - A cyst is a round lump, made from a duct swollen with liquid. Cysts are also benign.
• Fibrocystic disease - Often, there is a less clear thickening in the breast, made up of fibrous tissue and many tiny cysts, with some benign changes in the cells lining the ducts. Fibrocystic disease is one of many names for this condition.

• Malignancy - Sometimes, the changes in the cells lining the ducts suggest that the condition may start turning malignant at some stage. Rarely, the cells already look malignant, but have not moved out of the ducts. This is called in-situ. More rarely still, the cells have already passed through the duct wall to form an invasive malignancy, a form of breast cancer or carcinoma.
• Lipomas - The fat cells in the breast can grow to form slightly soft, non-malignant lumps called lipomas.
• Fat necrosis - Sometimes an injury, such as from a seat belt, can damage the fat cells. Scar tissue forms thickenings around the damaged cells, called fat necrosis.

There are many other breast conditions that could be the reason for an operation of this type. Your surgeon or breast specialist will be able to give you more details of the reason in your case.

The aims

The aim of the operation is to take out the tissue with a narrow rim of normal breast. We do this through a cut in the skin over or near the affected part of the breast. We choose a place that will heal neatly. We send the tissue to the laboratory for examination under a microscope.

You may have a general anaesthetic during the operation, but you should be able to come into hospital and go home on the same day. Sometimes the operation is done with the breast skin numbed with local anaesthetic. You would be awake during the operation but feel no pain.

The benefits

If the lump or cyst is removed, it should not cause you any more trouble. Any doubts about the breast lump should be made clear by the operation and the examination of the tissue.

Are there any alternatives?

Most swelling and cysts can be safely left in the breast if they pass three tests:

• The swelling should feel all right to the specialist.
• The x-rays and scans should not have revealed any concerns.
• Microscopic examinations of the tissue should not raise any concerns.

If your particular swelling is getting bigger, or causing you discomfort and anxiety, you should have it removed.

X-rays and scans will not tell us any more about the tissues in the breast. Taking tissue samples with a needle has not given the answer. Treatment such as antibiotics or hormones is not a good idea, if we do not know what the cause of the problem is.

What if you do nothing?

If there is any doubt about your breast problem, and you do nothing, the problem will remain. We will not be clear what is going on. You may miss out on important treatment.

Author: Mr Michael Edwards FRCSEng FRCSEd. Consultant general surgeon.

© Dumas Ltd 2006

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