GEORGE S. FERZLI, M.D., F.A.C.S.

Until Always: Freedom, passion, integrity and the constant quest for innovation.
This web site is dedicated to the memory of my father Salem.

Dr. Ferzli's Procedures

Specializing in Minimally-Invasive Surgery

Breast Disease

Anatomy of the Breast

To understand the process of detecting breast cancer, it’s important to visualize some of the anatomy of the breast and surrounding areas. On the illustrations to the right, you can see ducts radiating from the nipple. They drain the lobules which constitute the functional breast tissue which produces milk. Also notice the extensive network of 30 or more lymph nodes.

Breast Cancer Symptoms

First, it is important to know that the breast does not have a uniform texture and there are some normal structures, such as a rib, that might feel like a lump. Also, chances are that if you find a lump, it probably is benign.

When you go to your physician, depending upon the results of a clinical examination, he or she may order a mammogram and/or sonogram.

After evaluating these results, your doctor might order a biopsy so that a pathologist can examine cells or tissue from the lump directly.

You often hear the statistic that one of every eight women will be diagnosed with breast cancer. But this is the cumulative risk for the woman who lives to the age 85. The actual risk is dependent on age as shown in the chart to the left.

Both age and sex are the strongest risk factors for breast cancer. Other risk factors such as a family history of breast cancer, a menarche (start of menses) before age 12, menopause after age 50 are pertinent for only a minority of cases. In fact, in 80% of cases, women don’t have these risk factors, and likewise, many women with one or more of these factors don’t get breast cancer. Strong risk factors such as inheriting a mutated gene (BRCA1 or BRCA2) again apply to a small minority of cases. There is currently no definite way to prevent breast cancer, so the best strategy is early detection.

Breast tissue

Breast Self Examination

CIRCULAR PATTERN

CIRCULAR PATTERN

01. Put one hand behind your head.

02. With finger pads of the 3 middle fingers, move your hand over the entire breast area in a circular motion.

UP & DOWN PATTERN

UP & DOWN PATTERN

01. Put one hand behind your head.

02. With finger pads of the 3 middle fingers, move your hand over the entire breast area in up and down motion.

WEDGING PATTERN

WEDGING PATTERN

01. Put one hand behind your head.

02. With finger pads of the 3 middle fingers, move your hand over the entire breast area in wedging motion.

Breast Biopsies

These are types of biopsies that are available:

Aspiration Of A Suspected Cyst

This effectively treats the cyst by reducing it in size. If the fluid looks suspicious, the doctor will send it to a pathologist for examination.

Fine Needle Aspiration

This sounds similar to the first procedure but is somewhat different. Here, the surgeon uses a fine needle to probe the lump and then aspirate or suck up the free floating cells into the syringe. These cells are examined by a pathologist who is specially trained in cytology to look for cancer.

Breast biopsy

Core Biopsy

Here, a larger needle is used to remove several cores of tissue. The advantage here is that the arrangement of cells remains intact and helps with the diagnosis of cancer.

Incisional Biopsy

This is where the doctor uses a local anesthetic to make an incision and removes part of the lump.

Excisional Biopsy

This involves removing the entire suspicious lump with some surrounding normal tissue.

Stereotactic Biopsy Systems

The latest technology available allows the surgeon to locate the breast lesion with 3D imaging and then remove multiple cores of tissue with minimal loss of normal breast tissue.

Breast Cancer: Stereotactic Biopsy Systems

These are types of biopsies that are available:

Aspiration Of A Suspected Cyst

This effectively treats the cyst by reducing it in size. If the fluid looks suspicious, the doctor will send it to a pathologist for examination.

Fine Needle Aspiration

This sounds similar to the first procedure but is somewhat different. Here, the surgeon uses a fine needle to probe the lump and then aspirate or suck up the free floating cells into the syringe. These cells are examined by a pathologist who is specially trained in cytology to look for cancer.

Core Biopsy

Here, a larger needle is used to remove several cores of tissue. The advantage here is that the arrangement of cells remains intact and helps with the diagnosis of cancer.

Incisional Biopsy

This is where the doctor uses a local anesthetic to make an incision and removes part of the lump.

Excisional Biopsy

This involves removing the entire suspicious lump with some surrounding normal tissue.

Stereotactic Biopsy Systems

The latest technology available allows the surgeon to locate the breast lesion with 3D imaging and then remove multiple cores of tissue with minimal loss of normal breast tissue.

Breast Cancer: Lumpectomy

Lumpectomy is the term used to describe the excision of a breast mass (or lump) while leaving most of the breast tissue in tact. This procedure is performed for women with smaller tumors and for very early cancer. Depending on the size and type of breast mass, a lumpectomy can be performed in combination with hormone treatment, chemotherapy and / or radiation to cure many breast cancers. In most cases there is little change in the shape or size of the breast after surgery.

Breast Cancer: Mastectomy

Mastectomy is a procedure that is performed for breast cancer. A simple mastectomy is removal of all the breast tissue. It is indicted for certain types of early cancer (ductal carcinoma in situ or DCIS) when there are several areas of DCIS or a very large area of DCIS. It is usually combined with post surgery hormonal treatment and radiation.

A Modified Radical Mastectomy combines mastectomy with removal of some or all of the lymph nodes that drain the breast (axillary lymph node dissection). This surgery is indicated for invasive cancer with the intention of cure. Modified radical mastectomy is usually supplemented with radiation and chemotherapy or hormone treatment.

Sometimes a woman who has not developed breast cancer may decide to undergo prophylactic bilateral mastectomy because she is at very high risk of developing the disease. These are women with very strong family histories of breast cancers or who have genetic markers for the development of the disease.

Certain smaller invasive cancers can be treated with lumpectomy (removal of only part of the breast) and axillary node dissection. This treatment has about the same rate of cure for smaller cancer as modified radical mastectomy.

Breast reconstruction

A mastectomy can be followed by reconstruction of the breast either at the time of the mastectomy or later. There are a number of options in breast reconstruction which include implants or reconstruction with the patients own tissue.

Breast Disease: Further Information

For more information on Breast Disease, click here to download a PDF.

"Pink Bra" - An App for Breast Disease!

Pink Bra

Check out our app on Breast Disease!

Breast Cancer: Resources On The Web

The American Cancer Society recommends:

  • • That your breast be examined by a nurse or doctor at least once a year starting at age twenty.
  • • That you receive regular mammograms starting at age 40.
  • • That you keep track of the areas of the breast that have been in question, and that you check them regularly for any changes.

You can find the other details including the Breast Self Examination (BSE) at their website: www.cancer.org

The Cancer Information Service (www.nci.nih.gov) is sponsored by the National Cancer Institute.

The Susan G. Komen Breast Cancer Foundation has an award-winning website (www.komen.org/bci) with a variety of resources.

Another resource for breast cancer information is the National Breast Cancer Coalition – NBCC (www.nbcc.org).

Yet another resource for breast cancer information is the Y-ME National Breast Cancer Organization (www.y-me.org)

For further information, you can ask Dr. Ferzli.