A Behind-the-Scenes Look at Breast Surgery - Excisional Biopsies
On Wednesday, I spent the day in the OR with Dr. K. She had a very busy day, with four breast biopsies and one mastectomy. I love being in the OR with Dr. K because I find her surgeries so fascinating --- I never tire of them! This blog post will focus on wire localized excisional biopsies, whilst my next post will talk about mastectomies.
Breast cancer is an important topic and it comes up in the media A LOT. Christina Applegate, Kylie Minogue, Sheryl Crow, and many more celebrities were diagnosed with breast cancer, and their cancer status really shined a spotlight on breast cancer. Perhaps it's because I am a woman, a feminist, and an aspiring breast surgeon, but I thought I'd share with you what it's like to be in the operating room and talk about what breast surgery entails. I remember, when I first started working with Dr. K, I was totally clueless, but I have learned so much and well, you know what they say...knowledge is power!
When a woman gets a mammogram, radiologists are looking for specific things in the breast --- mainly formations. If the radiologist see clumps or shapes in the breast that are alarming, but not obviously a tumor, they will recommend further imaging and biopsy. Why are shapes bad? If I recall correctly, and forgive me since it has been almost a year since I learned this, shapes indicate that your cells are doing something funny and that they are organizing themselves. This is bad. Such organization of cells in the breast could possibly lead to a tumor down the road. It is for this reason, that when radiologists see early signs of such possible formations, alarm bells go off and precautions are taken.
Radiologists may perform simple in house biopsies to establish a diagnosis, but they usually refer the patient to a specialist...in this case, Dr. K. She exams the radiologist's reports, the radiographic imaging, and discusses biopsy procedures with the patients.
For the breast biopsies, Dr. K's patients have a teeny tiny clip placed in the troublesome area of the breast. Since I have actually never seen this, I'm not 100% as to how this works. What I do know is that on the day of surgery, the patient checks in with the hospital and then goes to the breast center, where she (or sometimes he) is seen by the radiologist. In the breast center, the patient has another mammogram taken, but this time, an incredibly thin metal wire in placed into the breast under radiographic guidance. Blue dye is also injected into the breast. These are all designed to help Dr. K locate the troublesome area of breast that requires biopsy-ing. If you think about it, as cruel or awful as this sound, its kind of necessary. Unlike a bone fracture, the breast is just fat, so unless you mark your spot, you can't find it!
Once each patient finishes in the breast center, her wires are carefully taped down and she returns to the surgical holding area with her films and a round plastic container. The patient then waits to be brought to the operating room.
Once in the operating room, patients are made comfortable, anesthetized, and prepared for surgery. Whilst this is going on, Dr. K reads the mammograms, just to double check her game plan; she can confirm where the clip is and then finalize her surgical approach. Dr. K likes to make her incision in the areola margin, because it is a great place to hide a scar. After a few minutes, she locates the end of the wire and a huge clump of blue-stained breast fat. This fat is then removed and placed into the round plastic containers mentioned above.
In the operating, Dr. K has a special portable x-ray machine that she uses to determine whether she has excised the correct region in the breast. Essentially, when the plastic container, containing the specimen, in secured in the machine, she takes an x-ray and looks for the clip. If she finds the clip, she is good to go, but if there is no clip, this means she has to go back. I'd say 99.9% of the time, her specimen includes the clip. Once the radiologists, who are emailed the x-ray directly from the machine, call the OR to "ok" the x-ray, the specimen is preserved and sent to pathology.
Once this is done, Dr. K closes up the surgical site and finishes surgery. Dr. K employs a technique called "oncoplasty", which is basically surgical oncology mixed with plastic surgery. She is not a plastic surgeon and her main priority is to remove any cancerous tissue from the breast, however, this doesn't mean her patient's have to have nasty scares. For cosmetic reasons, Dr. K hides her incisions where she can, often making incisions at the areola margin or mammary fold. Similarly, rather than leave a defect in the breast, where the biopsy occured, Dr. K sews the surrounding regions of fat together, so that no defect is present. I commend her and I think this it is wonderful that she takes the time to ensure that her patients feel and look healthy!
Once surgery is over, the patient's breast(s) is cleaned, antibiotics are placed on the wound, and bandages are employed. Pathology reports take about 1 week, so the patients are usually seen for a follow up appointment the next week.
DISCLAIMER: I cannot claim that this is the standard for all breast surgeons, since I am basing this all on what I have seen with Dr. K, but I would expect that most breast surgerons follow the same, if not a similar protocol.
Breast cancer is an important topic and it comes up in the media A LOT. Christina Applegate, Kylie Minogue, Sheryl Crow, and many more celebrities were diagnosed with breast cancer, and their cancer status really shined a spotlight on breast cancer. Perhaps it's because I am a woman, a feminist, and an aspiring breast surgeon, but I thought I'd share with you what it's like to be in the operating room and talk about what breast surgery entails. I remember, when I first started working with Dr. K, I was totally clueless, but I have learned so much and well, you know what they say...knowledge is power!
When a woman gets a mammogram, radiologists are looking for specific things in the breast --- mainly formations. If the radiologist see clumps or shapes in the breast that are alarming, but not obviously a tumor, they will recommend further imaging and biopsy. Why are shapes bad? If I recall correctly, and forgive me since it has been almost a year since I learned this, shapes indicate that your cells are doing something funny and that they are organizing themselves. This is bad. Such organization of cells in the breast could possibly lead to a tumor down the road. It is for this reason, that when radiologists see early signs of such possible formations, alarm bells go off and precautions are taken.
Radiologists may perform simple in house biopsies to establish a diagnosis, but they usually refer the patient to a specialist...in this case, Dr. K. She exams the radiologist's reports, the radiographic imaging, and discusses biopsy procedures with the patients.
For the breast biopsies, Dr. K's patients have a teeny tiny clip placed in the troublesome area of the breast. Since I have actually never seen this, I'm not 100% as to how this works. What I do know is that on the day of surgery, the patient checks in with the hospital and then goes to the breast center, where she (or sometimes he) is seen by the radiologist. In the breast center, the patient has another mammogram taken, but this time, an incredibly thin metal wire in placed into the breast under radiographic guidance. Blue dye is also injected into the breast. These are all designed to help Dr. K locate the troublesome area of breast that requires biopsy-ing. If you think about it, as cruel or awful as this sound, its kind of necessary. Unlike a bone fracture, the breast is just fat, so unless you mark your spot, you can't find it!
Once each patient finishes in the breast center, her wires are carefully taped down and she returns to the surgical holding area with her films and a round plastic container. The patient then waits to be brought to the operating room.
Once in the operating room, patients are made comfortable, anesthetized, and prepared for surgery. Whilst this is going on, Dr. K reads the mammograms, just to double check her game plan; she can confirm where the clip is and then finalize her surgical approach. Dr. K likes to make her incision in the areola margin, because it is a great place to hide a scar. After a few minutes, she locates the end of the wire and a huge clump of blue-stained breast fat. This fat is then removed and placed into the round plastic containers mentioned above.
In the operating, Dr. K has a special portable x-ray machine that she uses to determine whether she has excised the correct region in the breast. Essentially, when the plastic container, containing the specimen, in secured in the machine, she takes an x-ray and looks for the clip. If she finds the clip, she is good to go, but if there is no clip, this means she has to go back. I'd say 99.9% of the time, her specimen includes the clip. Once the radiologists, who are emailed the x-ray directly from the machine, call the OR to "ok" the x-ray, the specimen is preserved and sent to pathology.
Once this is done, Dr. K closes up the surgical site and finishes surgery. Dr. K employs a technique called "oncoplasty", which is basically surgical oncology mixed with plastic surgery. She is not a plastic surgeon and her main priority is to remove any cancerous tissue from the breast, however, this doesn't mean her patient's have to have nasty scares. For cosmetic reasons, Dr. K hides her incisions where she can, often making incisions at the areola margin or mammary fold. Similarly, rather than leave a defect in the breast, where the biopsy occured, Dr. K sews the surrounding regions of fat together, so that no defect is present. I commend her and I think this it is wonderful that she takes the time to ensure that her patients feel and look healthy!
Once surgery is over, the patient's breast(s) is cleaned, antibiotics are placed on the wound, and bandages are employed. Pathology reports take about 1 week, so the patients are usually seen for a follow up appointment the next week.
DISCLAIMER: I cannot claim that this is the standard for all breast surgeons, since I am basing this all on what I have seen with Dr. K, but I would expect that most breast surgerons follow the same, if not a similar protocol.
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