Expert Breast Care

Barry G. Landry., M.D, F.A.C.S.

"The doctors and staff have always treated myself and my family with great compassion and has always answered any of my questions to where I could make wise choices about my care."

—From Patient Survey

Like many of you, several people on our staff have been personally touched by breast cancer in a close family member. Our physicians have developed a particular interest in this area of medicine, along with a strong belief in the importance of innovative treatment. As a result, our patients have access to one of the area's only in-office ultrasound machines for breast cancer detection as well as ultrasound and mammogram guided breast biopsy techniques. Additionally, our doctors attend frequent seminars to learn the most advanced techniques.

Our physicians are experienced in the most advanced surgical techniques in breast cancer treatment, including breast-saving lumpectomy and Sentinel Lymph Node Biopsy. All procedures are performed locally allowing our patients and their families the reassurance and comfort of treatment close to home in the expert care of a surgeon they know and trust.

Complete Breast Care

Worldwide, there are approximately 1 million new cases of breast cancer annually. Breast cancer is the most frequently diagnosed cancer in women in the United States accounting for an estimated 215,990 new cases and 40,110 deaths in 2004 according to the American Cancer Society. Breast cancer accounts for approximately 30 percent of all cancer diagnosed and approximately 16 percent of all cancer deaths in American women. In the USA, the incidence of breast cancer increases with age, and a woman's lifetime risk of developing breast cancer is estimated at 1 in 8.

Breast cancer surgery at the beginning of the twentieth century was one procedure, Radical Mastectomy (removal of the entire breast, underlying chest muscle and lymph nodes in the axilla). In the 1970's, it became apparent that the same results could be obtained with Modified Radical Mastectomy (entire breast and axillary lymph nodes removed). In the 1980's, breast conservation surgery evolved when it became apparent that the same results or better could be obtained with lumpectomy (limited breast removal), axillary dissection and radiation to remainder of the breast. Today, sentinel lymph node biopsy is being carried out on breast cancer patients to determine when axillary dissection is necessary, avoiding potential arm swelling in many patients.

The physicians of Thibodaux Surgical Specialists evaluate patients from the moment any abnormality of the breasts (including abnormalities of mammogram or breast ultrasound) is found. Careful evaluation is then performed to determine need for biopsy or close follow up evaluation. With a diagnosis of breast cancer, patients are monitored throughout completion of surgical therapy, as well as throughout a lifetime for the possible development of recurrent or new breast cancer.

Non-cancerous conditions such as fibroadenomas, cysts, nipple discharge, fibrocystic change, infections, and pain are also evaluated and treated. The Gail Model Risk Assessment is performed on all patients presenting for breast evaluation. This can identify patients at high risk for breast cancer. These patients may be offered prophylactic medical therapy and long term monitoring.

Procedures For Breast Surgery

Minimally invasive breast biopsy techniques

Fine Needle Aspiration (FNA) is an office procedure in which a small needle is used to sample cells from an area of abnormality in a breast without anesthetic. This technique is also used to drain cysts of the breast.

Needle Core Biopsy is an office procedure in which a large needle is used to take pieces or “cores” of tissue with anesthetic from an abnormal area of a breast.

Vacuum-assisted Needle Core Biopsy uses a vacuum devise attached to a large needle to sample breast tissue with anesthetic, allowing for larger sampling. With this technique, abnormalities identified by both mammogram and ultrasound may be completely removed. This procedure may be performed in the office or hospital. A very small incision is usually closed with glue or “butterfly” strips.

Office-based ultrasonography

Digital Ultrasonography can be performed in the office to evaluate abnormal areas of the breast and also to assist with needle biopsy techniques.

Open surgical biopsy may be necessary in the rare instance that needle biopsy does not offer a definitive diagnosis. Removal of abnormal areas of the breast with a small incision in the operating room would then be performed. This may require placement of a wire in the breast to guide tissue removal.

Lumpectomy or Breast conservation is the complete removal of a breast cancer with a rim of normal breast tissue around the cancerous tissue. This allows for surgical treatment of the cancer with preservation of the breast. Typically, small cancers are treatable with this technique and radiation therapy usually is added to further treat the breast tissue.

Mastectomy is the complete removal of a breast for the treatment of a breast cancer. This may be accompanied by reconstructive techniques by a plastic surgeon at the same setting.

Sentinel Lymph Node Biopsy (SLNB) is a widely accepted technique of evaluating the axillary (area of the arm pit) lymph nodes for the spread of breast cancer. A radioactive material and a blue dye are injected in the breast. Using a hand held radioactive counter the small number of lymph nodes (usually 1-2) that drain fluid from the breast are identified. The blue dye serves as a second aid in order to identify these lymph nodes. The lymph nodes are then immediately evaluated for the presence of cancer cells. In 70% of cases, this is all that is required to test the axilla for cancer spread. SLNB has a very low incidence of arm swelling (1-2%).

Axillary lymphadenectomy is the removal of all of the lymph nodes lying in the axilla or arm pit. This may be necessary if sentinel lymph node biopsy, x-ray studies or physical exam reveals cancer spread in the axillary lymph nodes. Axillary lymphadenectomy has a higher incidence of arm swelling and under arm numbness (10-20%).