Surgical Associates / Birmingham Alabama / Specialist in Surgery

Breast health continues to be one area of focus by our practice. Our physicians and staff understand that prompt care and answers ease anxiety. Our approach is to facilitate an appropriate evaluation, prompt results and coordinated treatment and follow-up. We share your desire for care, convenience and compassion.

Diagnosis of Breast Masses and Abnormal Mammograms
The role of a biopsy first and foremost should be to accurately establish a diagnosis. This most often can be done with a needle biopsy. On occasion, an area of abnormality needs to be removed with a surgical biopsy. Minimally invasive biopsies are usually needle biopsies and usually are our method of choice to establish a diagnosis. We prefer needle core biopsies as opposed to needle aspirations as they provide more tissue and thus a more accurate diagnosis. Most often, a needle biopsy is done with either ultrasound or mammographic guidance under local anesthesia.

Ultrasound Guided Biopsies
Ultrasound guided biopsies are performed in the office. These require only a small puncture site.

Stereotactic Biopsy
Stereotactic biopsy requires mammographic guidance and thus is not an office-based procedure. However, this can often be done the same day you are seen in our office.

Mammotome Core Biopsy - A mammotome core biopsy utilizes computer imaging to localize and biopsy an area of abnormality with multiple small pieces of tissue removed for pathologic examination.
En Bloc Biopsy - In an En Bloc biopsy, a larger, single tissue sample is removed, which lessens the time required for the biopsy and improves the pathologic evaluation. Our group was again the first to use this technique in Alabama.

At times, a breast mass or abnormality may be present and not seen by ultrasound or mammogram. In these situations, a surgical biopsy is required. Also, some patients prefer for a mass to be completely removed rather than a needle biopsy. A surgical biopsy is an outpatient surgical procedure, most often done with local anesthesia.

Treatment of Breast Cancer
There are two issues to be considered with the treatment of breast cancer. First, how should the breast be treated. Secondly, should the whole body be treated, i.e. is there a need for chemotherapy. Breast cancer often can be effectively treated with less than a total mastectomy (removal of the breast), using lumpectomy and radiation therapy. Many factors are involved in deciding between breast conservation therapy and mastectomy. However, over 80% of patients are good candidates for breast conservation therapy.

Sentinel Lymph Node Biopsy
The most important predictor of prognosis for breast cancer is the status of the lymph nodes beneath the arm (axilla). The presence of cancer cells in these nodes indicates a much higher risk of recurrence. Fortunately, most patients do not have cancer cells in these lymph nodes. Previously to determine if these nodes contained cancer, a surgical procedure was performed to remove up to two-thirds of the axillary lymph nodes. Long-term side effects such as numbness and swelling of the arm, known as lymphedema, can occur with surgical removal of these nodes. Now a method is available that will identify the lymph node to which cancer cells would most likely spread. This node is excised and if it is without cancer cells, the patient is spared the more extensive removal of lymph nodes. Recently, a large multi-center study has confirmed the accuracy of the Sentinel Node Biopsy and its low complication rate. This is something we have known first-hand since 1999 when we started performing this procedure. Since then, we have performed over 400 sentinel node biopsies.

Partial Breast Radiation
Breast conversation therapy traditionally has required the use of radiation therapy to the entire breast. This usually requires six to seven weeks of treatment. Recently, new technology (Mammosite catheter placement) has been made available so that only a portion of the breast tissue around the cancer site is radiated. Thus far, studies have shown this method to be just as effective as whole breast radiation therapy in controlling cancer. Aside from less tissue being radiated, the time commitment is much less with partial breast radiation therapy. The therapy is now completed in five days with this new technique. Our group has experienced few, if any, complications with the Mammosite catheter.

Mastectomy with Reconstruction
For most patients, mastectomy is not a necessary form of treatment. For most patients who require mastectomy, reconstruction is an option. Most who need reconstruction can have it done at the same time as the mastectomy. One of the main advantages of this approach is the mastectomy can be done in a way that facilitates the cosmetic result by saving most of the skin of the breast. We have a number of plastic surgeons that work with us closely on this procedure so that we can maximize your cancer treatment as well as the cosmetic result of the reconstruction.

Breast care continues to be an ever changing and improving area in medicine and Surgical Associates strives to stay on the forefront of new, proven and effective technology. It is our sincere desire to provide the appropriate medical expertise for breast health in a comfortable and supportive setting to you and your family.