Minimal scarring and faster recovery
BENIGN lumps in the breasts are a frequent occurrence for many women. Although not a dangerous issue, many women are bothered by these noncancerous lesions and may wish to remove them.
Those who wish to go down this route may opt for an approach that is not only safe but will leave their breasts looking almost unharmed aesthetically.
Dr Tan Gie Hooi, consultant breast and oncoplastic surgeon at Park City Medical Centre, shares, “Many young girls have a common condition called fibroadenoma. They find a lump in their breasts and, upon seeing a doctor, are told that the lump is not cancerous.
“This condition usually affects girls and women between 15 and 40 years old. They do not need to worry, as the lumps are harmless and can be left alone.”
She explains that lumps generally shrink over time in 30% of all fibroadenoma cases, 30% remain the same size and 30% grow bigger over time.
Through a combination of clinical examination, imaging and either fine-needle aspiration or core-needle biopsy – a triple assessment is conducted. It has a 99% sensitivity rate where women can receive accurate diagnosis of their breast lumps that let them know if the growths are cancerous or not.
Although patients with fibroadenomas are not confronted with cancerous growths, doctors are usually faced with women who are anxious about their benign lumps.
“Some women are uncomfortable feeling the lump every day. They feel like they have a ticking time bomb in their breasts, even though the possibility of the lump turning cancerous is extremely small,” says Dr Tan.
For cosmetic reasons, doctors may offer to remove lumps that are getting bigger to avoid breast shape distortion.
Small cut, small scar
Vacuum-assisted excision biopsy is a minimally invasive surgical option for benign breast lumps. This technique involves making a tiny incision that leaves only the slightest scar.
“This type of minimally invasive surgery has been available for about 10 to 20 years overseas including in South Korea, Japan and Singapore. However, it is less common in Malaysia and does not seem to be a major trend,” shares Dr Tan.
The procedure is commonly advised for patients who have benign breast lumps smaller than 2.5cm and wish to have them removed without large incisions, which are the case with traditional open surgery.
A vacuum-assisted excisional biopsy makes use of a special needle (10 or 12 gauge) attached to a suction device. The surgeon makes an incision in the breast that is only a few millimetres in size and then inserts the needle through it, straight into the area where the lump is.
This is all performed under ultrasound guidance, which allows the surgeon to visualise the lump. Once the tumour location is identified, a vacuum needle starts cutting the lump into tiny pieces. After the cutting process, the shreds are sucked into an external container, removing it from the body.
The surgeon can observe if the lump has been completely removed through the ultrasound. Once complete extraction is confirmed, the needle is taken out and momentary pressure is applied to stop the bleeding.
This procedure is not recommended for excision of cancerous tumours because those tumours need to be kept intact to be measured. The size of the tumour will give the medical team a better understanding of the stage the cancer is at.
“It is easier to perform this type of minimally invasive surgery, especially on candidates whose lesions are not palpable.
This is because the doctor can visualise the lump through ultrasound while performing the procedure. This ensures the entire lesion is removed accordingly,” says Dr Tan.
The perks of technology
This procedure comes with a slew of benefits, including the highly desirable minimal scarring factor.
“The surgery only takes about five to 10 minutes if you have a small lump (about 1cm to 2cm) and can be done as a daycare procedure with no overnight stay at the hospital.
“The procedure can be done under general or local anaesthesia. Local anaesthesia involves injecting the patient with a local anaesthetic to numb the area where the lump will be removed. Of course, the suitability of local anaesthesia is dependent on the number and size of the lumps,” says Dr Tan.
Multiple lumps may be excised in a single procedure with minimal incisions, thus reducing the number of times a patient needs to undergo surgery. Furthermore, the recovery time for vacuum-assisted excision biopsy is brief. Dr Tan shares that most patients are back
Fibroadenoma usually affects girls and women between 15 and 40 years old. They do not need to worry, as the lumps are harmless and can be left alone. Dr Tan Gie Hooi
to normal within three to five days.
“Most patients experience mild to moderate pain after the procedure, which can be taken care of by oral painkillers.
“There is also a possibility of bruising or mild hematoma (bloodfilled swelling) forming at the site of the removed lump, but it usually resolves on its own,” she says.
Other uncommon risks of this surgery include infections and feeling faint when undergoing the procedure with local anaesthesia.
An open surgical procedure called an excisional biopsy remains an option for women who wish to remove their benign lumps, but this is only possible if the tumour is palpable – meaning that it can |be felt when the breast is examined.
If it is not palpable, the patient may opt for something known as the hook-wire guided surgery. This approach makes use of a wire hooked to the impalpable lump prior to making the incision, which the surgeon uses as a guide during the procedure.
The hook marks the location of the lump, allowing the surgeon to find it during open surgery. The entire lesion can be removed this way.
Know your options
If you find yourself or someone you love with benign breast lumps, simply know that there is a way to remove the lesions whilst still maintaining aesthetic appearances. There is nothing wrong with wanting to preserve visual attractiveness as long as it is not costing you your health.
Get an assessment and seek advice from a medical professional to decide on a treatment plan that is best suited to you.
For more information, call 03-5639 1212.