Cryoablation and its role in the treatment of breast diseases

Breast Care Services

Breast lumps can be quite common in women, especially young women. While most lumps will turn out not to be cancerous, it is important not to ignore them. See a doctor to confirm the presence of the breast lump. You will usually need to have an ultrasound and possibly also a mammogram done, depending on your age and what the doctor thinks the lump is. Have it checked out for early detection and peace of mind.

Common causes of breast lumps are cysts and fibroadenomas, which are benign and related to hormone effects on the breast tissue. Other causes include fibrocystic change, abscesses, papillomas, Phyllodes tumours and cancer. One in ten breast lumps will be cancer, so do not ignore it if you have a breast lump. Sometimes the mammogram and ultrasound may not be conclusive with regards to the nature of the lump, so your doctor may discuss about performing a breast biopsy.

It is considered normal to have some persistent milky discharge sometimes months after stopping breastfeeding, especially if you have breastfed for several months. However, any blood or clear/transparent discharge from the breast is not normal especially if it leaks out on its own. This is usually an indication of some form of disease in the milk ducts behind the nipple. Your doctor will need to perform a mammogram and ultrasound to determine the cause. Even if the mammogram and ultrasound is normal, you may need further tests as the disease is often very early and in a very localized area. Discuss with your doctor if you need more tests.

It is normal to experience some form of breast pain intermittently especially about a week before your menstrual period. This cyclical form of breast pain is related to hormone fluctuations during the menstrual cycle and will usually subside when your period starts. If the pain is persistent or if the pain is associated with a lump you can feel, see your doctor to have it checked out.
A mammogram is a special Xray of the breasts. This allows your doctor to look at what is happening to the breast tissue. Mammograms are recommended for routine health screening in women 40 years and above. The purpose of screening mammograms is to look for early changes in the breast tissue that may indicate early cancer change, such as pre-invasive cancer. If cancer is detected and treated at this stage, the cure rates are excellent. It may be slightly uncomfortable to undergo a mammogram because of the compression of the breasts during the Xray. Arrange to have your mammogram done after your period so that the breasts will be less full and sore and you will experience less discomfort. While the mammogram is the gold standard for breast screening, it is not 100% accurate. If you have abnormal symptoms such as a lump or nipple discharge despite your mammogram being normal, see a specialist for further tests.
Ultrasound is not routinely recommended for health screening but it can be useful for young women and/or women with dense breasts. Ultrasound tends to pick up many benign (non-cancerous) changes in the breasts like tiny cysts and nodules, but occasionally it may also pick up important changes like cancer that the mammogram might miss.
Magnetic resonance imaging (MRI) of the breasts is used very selectively to further evaluate changes that have been detected clinically by your doctor, or on mammogram and ultrasound. Most women will not need to have an MRI. The MRI does not have all the answers and has lower specificity compared to mammogram. It cannot replace a pathological diagnosis from a biopsy. A selected group of women at high risk for breast cancer or with breast implants will benefit from MRI screening.
A breast biopsy is sometimes necessary to determine the nature of findings seen on mammogram, ultrasound or during examination. Various types of breast biopsies are available. They include fine needle aspiration, core needle biopsy, vacuum assisted biopsy (mammotomy) or surgical open biopsy. Some are performed under image guidance for accuracy. If you need a biopsy, discuss with your doctor which method is most suitable for you. Most biopsies can be performed under local anaesthesia with or without sedation, except for surgical open biopsy which is usually done under general anaesthesia.

Breast cancer can be a devastating diagnosis. However bear in mind that with advances in treatment, breast cancer can be very curable if detected in the early stages.

The diagnosis of breast cancer is usually first confirmed with a needle biopsy. For the majority of cancers, surgery to remove the tumour is the first step in treatment. Following surgery, depending on type/stage of cancer and type of surgery performed, further treatment such as chemotherapy and radiotherapy may also be needed. Treatment is tailored to each patient and your doctor will look at the pathological report to determine which type of treatment is best for you.

It is important to remain positive when you are undergoing treatment as this will help in your recuperation. Support from family and friends is important and you can also join a breast cancer support group (eg Breast Cancer Foundation) to meet other survivors who can share with you their experience and encouragement and offer strength and support.

In general, surgery for breast cancer can be divided into breast conservation surgery (BCS) or mastectomy. BCS essentially means removing the cancerous tissue with a margin of normal tissue, hence preserving the breast. The aim is to achieve an aesthetically acceptable appearance of the breast after tumour removal. This is ideal for women who have relatively small tumours. Radiotherapy to the remaining breast tissue is almost always necessary after BCS.

Mastectomy is the surgical removal of the entire breast. This is necessary when the tumour is large or extensive and involves a large area of the breast, where it is not possible to remove the tumour with clear margins and yet achieve a cosmetically acceptable outcome. If mastectomy is required, you may choose to have immediate breast reconstruction at the same time. Reconstruction involves using your own body muscle or fat tissue and/or a silicone breast implant to re-create a ???new??? breast after mastectomy. Reconstruction helps women to preserve their body image and continue the same lifestyle as before surgery.

A) Minimal-scar mastectomy and immediate reconstruction

 

In minimal-scar mastectomy, as the name implies, the breast is removed via a much smaller-sized incision.  Types of minimal scar mastectomy include:

 

-nipple-sparing mastectomy:  the breast tissue is removed while the native skin envelope and the nipple-areola complex are preserved.  

 

-skin-sparing mastectomy:  here, the breast tissue is removed, along with the nipple and areola but the skin envelope is maximally preserved. 

 

When is mastectomy preferred?  

Usually, mastectomy is advised if a) the tumour is large, b) the tumour involves more than 1 area of the breast, c) when radiation therapy is contraindicated or undesired by the patient, or d) patient’s preference. 

 

B) Breast Conserving Surgery and oncoplastic technique for reshaping.

 

Breast-conserving surgery (BCS) is surgery to remove the part of the breast that has cancer, along with a rim of healthy tissue that surrounds it.  The volume of tissue removed depends on various factors.  A change in size and shape of the treated breast is expected.  Nonetheless, oncoplastic technique can be used to reshape and maximize the outlook of the breast after BCS.  After BCS is done, radiation therapy is given to the rest of the breast to lower the risk of recurrence.  

 

When is BCS suitable? 

Generally, BCS is an option for some women if her breast cancer is small, is located in 1 area of the breast, and the patient has no contraindication—and agrees—for post mastectomy radiation therapy.

Breast cancer treatment usually involves a combination of surgery, radiation therapy, chemotherapy and/or other targeted/drug therapy.  The type of surgery (mastectomy vs breast-conserving surgery) depends on several patient-related and tumour-related factors, including the stage, tumour distribution, size and biology, as well as age, general health, and patient’s preference. 

Hear from Our Patients

"I went for a colonoscopy, gastroscopy, and hemorrhoidectomy procedure with Dr Melvin Look. It was nerve wrecking for me to go under general anesthesia (GA) but Dr Look eased my fears with his calm and confident demeanour along with his funny disposition. Had a smooth and successful procedure with attentive pre- and post-op care from Dr Look who has been very patient with all my questions before and after the surgery!"

Melody Chong, 45 Patient

I met Dr Sam Peh in 2018 when I was admitted to parkway east hospital for acute unrinary retention . Subsequently in the same year I had TURP procedure .Some tissues from TURP was found to be cancerous . We just monitor the situation on 6 monthly psa reading In 2020 the psa reading spiked and am MRI scan shows 2 lesions in the prostate Dr. Peh give me the option to burn the 2 lesions using the HIFU technology. I’m glad to use HIFU as the downtime was like only a day. Dr Peh always explain the procedures to me using simple layman’s language and with drawings as illustrations. I feel safe and confident with Dr Peh as my urologist.

Philip Whang Patient

I was worried about my constant bloatedness , nauseous & poor appetite in eating . I was not eating well at all for 4 months. I decided to seek help from Dr Melvin Look and was scheduled very quickly for a scope - to give me a peace of mind. Nursing team was also assuring and patient with me when I had questions on insurance & costing . I was very well advised at every step of the way! Thank you Dr Look and to the nurses who attended to me at pan asia!

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