The information outlined below on common breast conditions and treatments is provided as a guide only and it is not intended to be comprehensive.

WHAT TO EXPECT

You will be seen initially by Miss Michelle Mullan who will review your medical history and perform a breast examination in the presence of a breast care nurse. She may then request any further tests as appropriate to obtain accurate diagnosis.

What other tests will I need?

If other tests are necessary they will be done during this visit and will usually include a Mammogram (an x- ray technique for taking pictures of the breast) and an ultrasound scan. Depending on your symptoms and the results of these tests additional tests may also be carried out during this visit including a Fine Needle Aspiration (FNA) or a Needle Core Biopsy.

What happens next?

After the necessary tests have been performed, Miss Mullan with her breast care nurse will see you again to explain the results and answer any questions you may have.

What if I need more treatment?

Happily, for the majority of patients no serious problems are identified and no further tests or follow up are necessary. In a small percentage of cases, further investigation and an operation may be needed to make a definite diagnosis. If this is the case you will be given all the options about continuing with your treatment privately.

With digital mammogram and MRI machines at the Priory and Spire, your treatment will be conducted in state-of-the-art facilities, ensuring the best care possible.


Common Breast Conditions

Breast pain

Breast pain (mastalgia) is a common symptom that affects up to two-thirds of women in the UK, mostly between the ages of 30 and 50.

Breast pain may be felt as a heaviness or soreness, and has also been described as a stabbing or burning pain. It's usually felt in the upper, outer area of your breasts and may extend from your breasts to your armpits, and sometimes down your arms.

Many women worry that breast pain may be a sign of a serious condition. However, breast pain by itself is not a symptom of breast cancer, and breast pain does not increase your risk of developing breast cancer.

In most cases, breast pain is relatively mild, although some women experience moderate or severe pain. Severe or chronic breast pain can interfere with daily activities and lead to stress, anxiety or depression.

Types of breast pain

There are two types of breast pain:

cyclical breast pain – the most common type of breast pain, linked to the menstrual cycle
non-cyclical breast pain – pain in the breasts unrelated to the menstrual cycle

Causes of breast pain

Cyclical breast pain

Although the exact cause of cyclical breast pain is unknown, it's thought to be linked to the changes in hormone levels before periods begin.

The menstrual cycle is controlled by your body releasing hormones such as oestrogen. Hormones are powerful chemicals that have a wide range of effects on the body.

The pain occurs around the same time every month, usually one to three days before the start of your period, and improves at the end of your period. The intensity of the pain will not always be the same. Although cyclical breast pain mainly affects women who are still having periods (before the menopause), some women can experience symptoms after the menopause if they undergo hormone replacement therapy (HRT).

Cyclical breast pain is not associated with any other breast-related conditions.

Non-cyclical breast pain

In many cases, the cause of non-cyclical breast pain can't be identified. However, breast pain is sometimes caused by other conditions, including:

mastitis – a condition that can be related to breastfeeding and causes the breast tissue to become painful and swollen

breast lumps – there are many non-cancerous (benign) causes of breast lumps, some of which may be painful

breast abscess – a painful collection of pus that forms in the breast

Non-cyclical breast pain may also be the result of an injury elsewhere in the body, such as pulling a muscle in the chest, which is felt in the breast.

In rare cases, non-cyclical breast pain may be caused by other medications and treatments – such as some types of antifungal medicines, antidepressants or antipsychotics – that are used to treat mental health conditions.

Breast cyst

What is a breast cyst?

Breast cysts are spaces filled with fluid that occur in the breast. They are most common in women in their forties and fifties, approaching the menopause.

How are breast cysts diagnosed?

The following tests may be performed:
• Clinical breast exam
• Mammogram
• Ultrasound
• Fine needle aspiration


What is the treatment for breast cysts?

Breast cysts may require treatment if they are large or causing pain. The treatment consists of draining the cyst using a needle and syringe. Miss Mullan can do this for you on your clinic visit in the Consulting Rooms.

Fat Necrosis

What is fat necrosis?

Fat necrosis is a benign (not cancer) breast condition. It can occur anywhere in the breast and can affect women of any age. It does not increase your risk of getting breast cancer.

Breasts are made up of lobules (milk-producing glands) and ducts (tubes that carry milk to the nipple), which are surrounded by glandular, fibrous and fatty tissue.

Sometimes a lump can form if an area of the fatty breast tissue is damaged. This is called fat necrosis (necrosis is a medical term used to describe damaged or dead tissue).

The damage to the fatty tissue can occur following a needle biopsy, breast surgery (including breast reconstruction) or radiotherapy to the breast. The breast tissue may also be damaged by a bruise or injury to the breast, although many women don’t remember any specific injury.

What does it feel like?

Fat necrosis feels like a firm, round lump (or lumps) and is usually painless, but in some people it may feel tender or even painful.

The skin around the lump may look red, bruised or occasionally dimpled. Occasionally fat necrosis can cause the nipple to be pulled in (retracted). Sometimes within an area of fat necrosis cysts containing an oily fluid can occur. These are called oil cysts. If you develop an oil cyst, our breast cysts information may be useful.

How is it found?

Fat necrosis usually becomes noticeable as a lump in the breast. After a breast examination your GP is likely to refer you to Miss Mullan. Sometimes fat necrosis is found by chance following a mammogram (breast x-ray) during a routine breast screening appointment.

At the breast clinic you’ll probably have three different tests, known as triple assessment, so that a definite diagnosis can be made. These include a:

breast examination
mammogram (breast x-ray) or ultrasound scan (uses high-frequency sound waves to produce an image)
fine needle aspiration (FNA), core biopsy or vacuum assisted excision biopsy.

If the ultrasound or mammogram clearly shows fat necrosis, an FNA or core biopsy may not be needed.

Treatment and follow-up

If you’ve been told you have fat necrosis you won’t usually need any further treatment or follow-up.

If the fat necrosis contains fluid (an oil cyst), this may be drawn off with a needle and syringe (aspirated) to relieve any discomfort.

Fat necrosis often goes away by itself. If the lump or lumpy area doesn’t disappear or gets bigger, you may need to have a small operation to remove it. You may also need an operation if the biopsy hasn’t given enough information to confirm fat necrosis. This is called an excision biopsy and may be done using either a local or a general anaesthetic. The operation will leave a small scar but this will fade over time.

If you have fat necrosis that is diagnosed after having surgery or radiotherapy to the breast that causes you discomfort, it’s common for Miss Mullan or your GP to treat this with pain relief such as an anti-inflammatory drug like ibuprofen (if you are able to take non steroidal medicines).

What this means for you

Having fat necrosis does not increase your risk of developing breast cancer. However, it’s still important to be breast aware and go back to your GP if you notice any changes in your breasts, regardless of how soon these occur after you were told you had fat necrosis.

Duct Ectasia

Duct ectasia is a benign (not cancer) breast condition. It’s caused by normal breast changes that happen with age, and it’s nothing to worry about.

Breasts are made up of lobules (milk-producing glands) and ducts (tubes that carry milk to the nipple), which are surrounded by glandular, fibrous and fatty tissue.

As women get nearer to the menopause and the breasts age (from 35 years onwards) the ducts behind the nipple shorten and widen. This is called duct ectasia.

Sometimes a secretion is produced and can collect in the widened ducts. This can irritate the lining of the ducts. Some people also experience pain, although this is not common.

There can also be a discharge of these secretions through the nipple, which is usually thick but can also be watery. It can vary in colour, and can occasionally be bloodstained.

Sometimes a lump can also be felt behind the nipple. This can be because the tissue behind the nipple has become infected or scarred.

The nipple may become inverted (pulled inwards) as the ducts shorten.

How is it diagnosed?

After your GP has examined your breasts you’re likely to be referred to a breast clinic. At the breast clinic you’ll have a breast examination and probably a mammogram (breast x-ray) and/or ultrasound scan (which creates a picture of the breast using high-frequency sound waves).

If you have nipple discharge that’s bloodstained, this may be tested to help confirm the diagnosis.

Treatment

Most cases of duct ectasia don’t need any treatment as it’s a normal part of ageing and any symptoms will usually clear up by themselves.

Try not to squeeze the nipple as this may encourage further discharge. In the meantime, if you have any pain you may want to take pain relief such as paracetamol.

If you continue to have discharge from the nipple (without squeezing) which doesn’t settle, you may be offered an operation to remove the affected duct or ducts. You may be offered removal of just the affected duct (a microdochectomy) or removal of all the major ducts (a total duct excision). The operation is usually done under a general anaesthetic, and you’ll be in hospital for the day, but sometimes you might have to stay overnight. You’ll have a small wound near the areola (darker area of skin around the nipple) with dissolving stitches in.

You’ll be advised about which pain relief to take after the operation as your breast may be sore and bruised. The operation will leave a small scar but this will fade in time.

After the operation your nipple may be less sensitive than before, and for a few people it may become inverted.

The operation should solve the problem but if your symptoms may return and you may need further surgery to remove more ducts. It’s important to go back to your GP if you have any new symptoms.

What this means for you

Having duct ectasia doesn’t increase your risk of developing breast cancer in the future.

However, it’s still important to be breast aware and go back to your GP if you notice any other changes in your breasts, regardless of how soon these occur after your diagnosis of duct ectasia.

Fibroadenoma

Fibroadenomas are solid benign (noncancerous) breast lumps that are common in young women. They can increase in size during pregnancy and breastfeeding.

How are fibroadenomas diagnosed?

If you find a lump in your breast, you should consult with a doctor. The following tests may be performed:

• Clinical breast exam
• Mammogram (in women over 40 years old)
• Ultrasound
• Fine needle aspiration or Core needle biopsy


Miss Mullan and her team of specialists are incredibly sensitive to the anxiety a breast lump creates for her patients. Therefore, we follow strict guidelines for evaluation, biopsies and pathology reports. On the day of your breast biopsy, you will be given an idea of the most likely diagnosis and the biopsy report will follow within a few days.

What is the treatment for fibroadenomas?

If fibroadenomas are large or are causing the patient concern, they may require surgical removal (excisional biopsy), but this is rare. Many fibroadenomas stop growing or shrink over time.

Intraductal Papilloma

An intraductal papilloma is a benign (not cancer) breast condition. Intraductal papillomas are most common in women over 40 and usually develop naturally as the breast ages and changes. 

Breasts are made up of lobules (milk-producing glands) and ducts (tubes that carry milk to the nipple), which are surrounded by glandular, fibrous and fatty tissue. Sometimes a wart-like lump develops in one or more of the ducts. It’s usually close to the nipple, but can sometimes be found elsewhere in the breast.

You may feel a small lump or notice a discharge of clear or bloodstained fluid from the nipple. Generally intraductal papillomas aren’t painful but some women can have discomfort or pain around the area.

Intraductal papillomas can occur in both breasts at the same time. Intraductal papillomas generally don’t increase the risk of developing breast cancer. However, when an intraductal papilloma contains atypical cells (cells which are abnormal but not cancer), this has been shown to slightly increase the risk of developing breast cancer in the future. Some people who have multiple intraductal papillomas may also have a slightly higher risk of developing breast cancer.

How are they found and treated?

Intraductal papillomas can be found by chance following routine breast screening (a mammogram or breast x-ray), after breast surgery or if you go to your GP (local doctor) with symptoms. You will then be referred to a breast clinic where you’ll be seen by specialist doctors or nurses.

Triple assessment

At the breast clinic you’ll probably have three different tests, known as triple assessment, to help make a diagnosis. These are:
• a breast examination
• a mammogram (breast x-ray) and/or an ultrasound scan (which uses high-frequency sound waves to produce an image)
• a fine needle aspiration (FNA) or core biopsy

Occasionally you may be offered a vacuum assisted biopsy as an alternative to a core biopsy. After an injection of local anaesthetic, a small cut is made in the skin. A hollow probe connected to a vacuum device is placed through this. Using an ultrasound or mammogram as a guide, a larger volume of breast tissue is sucked through the probe by the vacuum into a collecting chamber. This means that several samples of breast tissue can be collected without removing the probe. The samples are sent to the laboratory where they are examined under a microscope. This can occasionally be therapeutic as well as diagnostic. This procedure can cause some bruising for a few days afterwards.

Excision biopsy

After a triple assessment, Miss Mullan may want you to have an operation called an excision biopsy. This is surgery to remove more breast tissue, which will be examined under a microscope.

An excision biopsy can be carried out under a local or general anaesthetic. Your surgeon may use dissolvable stitches placed under the skin which won’t need to be removed. However, if non-dissolvable stitches are used, they’ll need to be taken out a few days after surgery. You’ll be given information about this and about looking after the wound before you leave the hospital. The operation will leave a scar but this will fade over time.

Follow-up

You will be seen to check the wound and get the results of your laboratory analysis about a week after surgery.

What this means for you

For most people, having an intraductal papilloma doesn’t increase their risk of breast cancer.

If your intraductal papilloma contains atypical cells, or if you have multiple intraductal papillomas, you may be worried or anxious that your risk of breast cancer is slightly increased. However, this doesn’t necessarily mean you’ll develop breast cancer in the future.

Even though your intraductal papilloma has been removed, it’s still important to be breast aware and go back to your GP if you notice any other changes in your breasts.

Nipple discharge

What is nipple discharge?

Nipple discharge may be common for premenopausal women—especially milky discharge. This is usually due to normal hormonal changes within a woman’s body. It often occurs in both breasts.

There are some specific types of nipple discharge that warrant closer evaluation:

Bloody nipple discharge – If the discharge is bloody, a papilloma is suspected. This wart-like group inside the duct irritates the tissue, producing the reddish discharge. This can also be a symptom of breast cancer, so proper evaluation is recommended.
Greenish nipple discharge – If the discharge is army green in color, it can be a sign that there is a breast cyst underneath the nipple and areola area that is spontaneously draining. This can be further evaluated with breast imaging studies, such as ultrasound.
Clear nipple discharge – Clear discharge can be a sign of abnormal cells (including cancer cells) within the breast. The risk of cancer is lower when there is discharge from both breasts.

How do I know when to see a breast specialist?

It is always important to have nipple discharge evaluated, as it may signal other worrisome health problems. If you have discharge coming from one or both of your breasts, and if the discharge is new and has not been thoroughly investigated, we strongly recommend that you make an appointment with us as soon as possible.

How will I be evaluated for nipple discharge?

Miss Mullan will give you a clinical breast exam, ask about your personal medical history, and probably order a mammogram and/orultrasound to rule out any possible masses. Ultrasound is very useful at evaluating causes of nipple discharge. In some cases, a biopsy will be performed.

She may take a sample of the nipple discharge to be analysed by the laboratory. The results of this will guide her as to whether a surgical excision biopsy is necessary.

Periductal Mastitis

What is periductal mastitis?

Periductal mastitis occurs when the ducts under the nipple become inflamed and infected. It’s a benign condition (not cancer), which can affect women of all ages but is more common in younger women.

Symptoms include:

• the breast becoming tender and hot to the touch
• the skin may appear reddened
• discharge from the nipple, which can be bloody or non-bloody
• a pulled-in (inverted) nipple.

Occasionally, an abscess (collection of pus) or fistula (a tract that develops between a duct and the skin) may develop.

People who smoke have an increased risk of being affected by periductal mastitis, because substances in cigarette smoke can damage the ducts behind the nipple. Nipple rings (piercings) can increase the chances of infection and make periductal mastitis more difficult to treat.

How is it diagnosed?

Your GP will refer you to Miss Mullan who can make a definite diagnosis. To do this you will probably have a breast examination, mammogram and/or ultrasound scan.

If you have discharge from the nipple a sample may be looked at under a microscope, especially if it’s bloody, to help confirm the diagnosis.

Treatment

Some people may not need any treatment for periductal mastitis as it can clear up by itself. However go back to your GP if your symptoms return or if you have any new symptoms. Smoking can slow down the healing process, so if you smoke it’s a good idea to try to cut down or to stop.

If you need treatment, this will usually be with antibiotics. You may also want to take pain relief, such as paracetamol, if your breast is painful.

If you have developed an abscess and/or a fistula, your specialist will decide the best way to treat it. This may involve using a fine needle and syringe to draw off (aspirate) the pus, or sometimes an opening is made in the skin to allow the pus to be drained. This can be done under either local or general anaesthetic.

If periductal mastitis doesn’t get better after taking antibiotics or if it comes back, you may need to have an operation to remove the affected duct or ducts.

After the operation your nipple may be less sensitive than before.

The operation should solve the problem but, if it comes back, more ducts may need to be removed, as finding all the ducts can sometimes be difficult.

What this means for you

Having periductal mastitis does not increase your risk of breast cancer. However, it’s still important to be breast aware and go back to your GP if you notice any further changes in your breasts regardless how soon these occur after having periductal mastitis.

Phyllodes Tumor

Phyllodes tumours are rare tumours that can be found in the breast. Most Phyllodes tumours are benign (non-cancerous). Only 1 in 10 Phyllodes will turn out to be malignant, and this makes up less than 1% of all breast cancers seen in the UK.

What are the symptoms of Phyllodes tumours?


Phyllodes usually present as a smooth lump beneath the skin. They are often fast growing so should be investigated promptly. They tend to occur in women in their 30s and 40s, but women of any age can have a Phyllodes. The breast may become red or warm to the touch. Symptoms can also mimic those of other types of breast cancer, but they can also be mistaken for fibroadenomas.

How is a Phyllodes diagnosed?

When you are seen by Miss Mullan, she will take a history from you, examine your breasts and obtain a mammogram and breast ultrasound. A needle core biopsy will be performed either by Miss Mullan in the Consulting Suites or by the Consultant Radiologist using ultrasound guidance. The biopsy results are usually ready within a week.

What is the treatment for Phyllodes tumours?


While the tumours are most often benign, it is still critical to remove the entire breast lump with a healthy margin of around 1cm of normal breast tissue. Even if one cell is left behind, it will grow back. Miss Mullan will perform a “lumpectomy” to remove the Phyllodes, usually as a day case operation under a general anaesthetic. You will not need any surgery to your armpit as Phyllodes tumours do not tend to spread anywhere else in the body.

What is the prognosis for Phyllodes tumours?


For women with a benign Phyllodes tumour, the outlook is excellent.

Women with malignant Phyllodes tumours, the prognosis depends on size, prognostic factors and other information obtained from the pathology results. Malignant Phyllodes tumours are different from the more common types of breast cancer. They do not respond to hormone therapy and are less likely than most breast cancers to respond to radiation therapy or the chemotherapy drugs normally used for breast cancer.

Miss Mullan will review your pathology report with you, following the Multidisciplinary Meeting, and advise you if you need any additional treatment. .

How do Phyllodes tumours affect your risk for breast cancer?

Having a benign Phyllodes tumour that’s not cancer does not affect your breast cancer risk, but you will be followed up by Miss Mullan in the outpatient clinic on an annual basis for a few years, as these tumours can come back after surgery. Miss Mullan may choose to also get some extra surveillance mammograms or ultrasound scans during this time, to keep an eye on your breast health.

Radial Scars/Sclerosing Adenosis

Sclerosis of the breast is an area of hardening of the breast tissue that can occur as the breast ages.

Sclerosis is found in these benign (not cancer) breast conditions:

sclerosing adenosis
radial scar/complex sclerosing lesions.

What is sclerosing adenosis?

Breasts are made up of lobules (milk-producing glands) and ducts (tubes that carry milk to the nipple), which are surrounded by glandular, fibrous and fatty tissue. Sclerosing adenosis is extra growth of tissue within the breast lobules. It can sometimes cause pain or result in a small lump in the breast.

It’s more common as the breast ages, most often in women in their 30s and 40s, but it can occur at any age. Most women will not notice any symptoms and it’s often only diagnosed during a routine mammogram (breast x-ray) or following investigation of an unrelated breast condition.

Diagnosis

Sclerosing adenosis can be difficult to diagnose as it can occasionally look like breast cancer on a mammogram. Because of this, a biopsy may be needed to make a firm diagnosis. This may be done in several ways:

a core biopsy
a stereotactic biopsy
a vacuum-assisted biopsy.

Occasionally a small operation (excision biopsy) may be needed to remove the affected area and confirm that it’s not breast cancer.

Follow up

Once a diagnosis has been confirmed as sclerosing adenosis, no further treatment is needed, even if the area of concern has not been removed.

What are radial scars and complex sclerosing lesions?

Radial scars and complex sclerosing lesions are benign (not cancer) conditions. They are the same thing but are identified by size, with radial scars usually being smaller than 1cm and complex sclerosing lesions being more than 1cm.

A radial scar or complex sclerosing lesion is not actually a scar. It is an area of hardened breast tissue. Most women will not notice any symptoms and these conditions are often only found on a routine mammogram or during investigation of an unrelated breast condition.

It may not be possible to clearly identify radial scars and complex sclerosing lesions from a breast cancer on a mammogram. Therefore your doctor may suggest you have a core biopsy, which removes small samples of breast tissue, to confirm the diagnosis. Sometimes they may suggest a vacuum-assisted biopsy be done instead. Find out more about these procedures.

Follow up

Even though the diagnosis can usually be made on a core biopsy, your doctor may suggest a small operation (excision biopsy) or a vacuum-assisted technique to remove the radial scar or complex sclerosing lesion completely. Once this has been done and confirmed as a radial scar, or a complex sclerosing lesion, no further tests or treatments will be needed.

Experts disagree as to whether having a radial scar or complex sclerosing lesion might mean a slightly increased risk of developing breast cancer in the future. Some doctors believe that any increase in risk is determined by what else is found (if anything) in the tissue removed, for example, an area of atypical hyperplasia.

What this means for you

Sclerosing adenosis

You may feel anxious about having sclerosing adenosis, even after it is removed. Even though it’s a benign condition, you may still worry about breast cancer.

Sclerosing adenosis doesn’t increase your risk of developing breast cancer.

Radial scar or complex sclerosing lesion

If you have a radial scar or a complex sclerosing lesion, you might be worried or anxious that your risk of developing breast cancer in the future may be slightly increased.



Common Treatments and Investigations

Breast Screening

Breast screening is carried out by the NHS Breast Screening Programme either at special clinics or mobile breast screening units. The procedure is carried out by female members of staff who take mammograms. You will get a letter within 14 days of your mammogram to say if your mammograms are ok, or if you need further assessment. If breast screening say you need to see a surgeon, Miss Mullan can see you as a priority.

About one in eight women in the UK are diagnosed with breast cancer during their lifetime. There's a good chance of recovery if it's detected in its early stages. Breast screening aims to find breast cancers early. It uses an X-ray test called a mammogram that can spot cancers when they are too small to see or feel.

Breast screening starts at 47 and goes up to 73. As the likelihood of getting breast cancer increases with age, all women who are aged 47-73 and registered with a GP are automatically invited for breast cancer screening every three years.

What happens during breast screening?

Breast screening is carried out at special clinics or mobile breast screening units. The procedure is carried out by female members of staff who take mammograms.

During screening, your breasts will be X-rayed one at a time. The breast is placed on the X-ray machine and gently but firmly compressed with a clear plate. Two X-rays are taken of each breast at different angles.

Miss Mullan operates on over 50 NHS breast screening patients per year and is fully breast screening trained.

Read more on the NHS pages here.

Mammography

What is a mammography?
A mammogram is a specialist X-ray of the breast. It uses low amounts of radiation and the risk to your health is small.

Benefits
The mammogram can detect small changes in breast tissue, which may indicate cancers that are too small to be felt either you or your doctor. It is able to show up areas of calcium which are not able to be felt.

The procedure
A mammogram is carried out by a radiographer who will position your breasts on the specially designed digital mammography machine. In order to obtain a good, clear picture the breast must be held tightly between two pieces of plastic. You may find the scan uncomfortable or painful as the breast tissue needs to be held firmly to ensure a good image is obtained, but this will only last a few seconds. Both front and side images of the breast are taken. Please do not use spray deodorant or talcum powder on the day of the mammogram, as this may affect the quality of the X-ray.

Results
Miss Mullan will usually be able to give you the results of your mammogram on the day of the One Stop Breast Clinic

Ultrasound

What is an ultrasound scan?
Ultrasound uses high frequency sound waves to create pictures of the inside of your breast. It can usually tell if a lump is liquid (a cyst) or solid. Ultrasound is our first investigation of choice for women under the age of 40 and is often also used in older women, along with mammograms.

Having an ultrasound
Having a breast ultrasound is not painful and you are not exposed to radiation. When you have a breast ultrasound scan you will be asked to lie on the bed. A clear gel will be applied to the breast, which helps the machine to make secure contact with the body. The consultant radiologist will then scan your breast to get a picture. Sometimes biopsies of an abnormal area in the breast are performed using the ultrasound machine to pinpoint the site of interest.

Biopsies

Core Needle Biopsy
This biopsy is undertaken either by Miss Mullan in the Consulting Suites or by one of the Consultant Radiologists in the XR Department once an abnormal area is identified within the breast. The breast is frozen with local anaesthetic and a sample of the breast tissue is taken using a small biopsy gun. The procedure is pain-free and does not leave any scars, although you may be a little bruised for a few days afterwards.

The results of the core biopsy are ready within one week. Miss Mullan is mindful of the fact that her patients want results as quickly as possible. However, strict protocols are in place for all breast specimens. Michelle makes sure all of her patients are discussed in the Multidisciplinary Team Meeting (of which she is Chair), where Consultant Radiologists and Pathologists are also present. She will give you an indication at the time of your initial consultation if she suspects breast cancer.

Breast Excision Diagnostic Biopsy

Occasionally, even after a core needle biopsy, a firm diagnosis of what is going on in the breast cannot be made by the Multidisciplinary Team. If this is the case, an excision biopsy (under general anaesthetic) is recommended to obtain more tissue for the Pathologists to analyse.

During this operation, an area of abnormal breast tissue or a lump is removed (excised) through the smallest and most appropriate incision. This is a day case procedure. The sample of breast tissue (usually less than 30g) is sent to the laboratory to be analysed. The results will be back within 2 weeks, and Miss Mullan will see you in the Consulting Suites following your operation.

Stereotactic or Guidewire Excision Biopsy

This type of excision biopsy is indicated when patients have an abnormality that is visible on a mammogram or ultrasound but cannot be felt in clinical examination.  To assist Miss Mullan, the site of the abnormality to be biopsied is marked by a Consultant Radiologist, with a guide-wire or skin marking (localisation), using either mammography or ultrasound. 


At the time of surgery, the wire is removed along with the abnormal area and a margin of normal breast tissue. The results will be back within 2 weeks, and Miss Mullan will see you in the Consulting Suites following your operation. 


Sentinel Node Biopsy

If you are having a breast cancer operation, you will have had your armpit (“axilla”) scanned on your initial visit. If this scan is clear of cancer, Miss Mullan will recommend a sentinel node biopsy of the axillary lymph nodes at the time of your breast cancer operation. This is a targeted operation to remove one or two sentinel lymph nodes. The sentinel node is found by injecting a radioactive isotope and blue dye into the breast .  If the sentinel node is clear, it usually means that the other nodes are free of cancer and removal of further lymph nodes under the arm is not be necessary.
 


Axillary Node Clearance

If your armpit scan shows that the breast cancer has moved up into the armpit, Miss Mullan will remove all your lymph nodes at the time of your breast surgery. This is called an axillary node clearance, and gives the Multidisciplinary team extra information about whether or not to recommend chemotherapy or radiotherapy to the armpit.





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