My breast care

What should I do if I have concerns about a lump in my breast?

Throughout our lives our breasts change, particularly during adolescence, the menstrual cycle, pregnancy and breast feeding and as a consequence of the menopause. Most breast changes are not due to cancer.

Everyone’s breasts look and feel different. When you check your breasts try to be aware of any changes that are different for you

  • Changes in size and shape
  • Redness or a rash of the skin +/- around the nipple
  • Changes in skin texture such as dimpling or puckering (like an orange skin)
  • A lump or thickening that feels different from the rest of the breast tissue
  • Discharge from one or both of your nipples
  • If your nipple becomes pulled in (inverted) or changes its shape or position
  • Constant pain in your breast or armpit
  • Swelling in your armpit or around your collar bone

If you notice or feel a change in your breast always go and see your GP. He / she will be able to examine you and reassure you that there is nothing to worry about or may refer you for a more detailed examination and assessment of your breast at a specialist breast care unit.

All breast symptoms, even if not suspected of cancer, are seen with 2 weeks of GP referral in the Surgical Outpatients area at the NNUH (Guidelines from Department of Health).

What can I expect when I attend the Breast Assessment Clinic?

You will be asked to attend the Breast Assessment Clinic at the NNUH, in Surgical Outpatients Department, West Block, Level 3.

Your visit to breast clinic may take a few hours which will hopefully enable any tests required to be carried out. We would encourage you to bring a relative or friend for company or support.

Initially you will be asked to book in at the clinic using the self-check in scanner, but if you have any concerns the reception staff are happy to speak to you at the reception desk

You will be asked to fill in a health questionnaire which asks some relevant questions about you which are part of your over all assessment. A clinic nurse will introduce herself and call you into clinic when the doctor is ready to see you.   The clinic nurses understand the level of anxiety caused by coming to the clinic and will try to keep you informed with clear and concise information at all times. Do feel free to ask any questions that you may have and we will do our best to answer them.

You will be seen by a doctor from the breast care team who will take a history of your symptoms and perform a breast examination. The doctor will check both breasts and usually examine the lymph glands in your arm pit and neck area. The doctor may then discuss with you about any further tests that need to be undertaken. These usually include a mammogram, an ultra sound scan which may be followed by a biopsy and / or fine needle aspiration (FNA) and these procedures are performed in Breast Imaging Department (BID).

It is standard practice that any woman with a breast lump is offered a ‘triple assessment’.

Triple Assessment means:

  • Examination – the breast will be examined by a Doctor/Practitioner trained in breast disease
  • Imaging – the breast will be imaged by x rays (mammogram) and / or by ultrasound.

The choice between mammography and ultrasound for imaging depends largely on the patient’s age, although some patients have both tests.

  • Some fluid or cells may be removed from the lump or gland under your arm by means of a small needle through the skin – a fine needle aspiration (FNA). More often a core biopsy may be performed, which removes a small piece of tissue from the lump using a slightly larger needle. Local anaesthetic is usually used for this test

MRI scan (Magnetic Resonance / Imaging) may be used in addition to triple assessment. It has a useful role in selected cases as a problem solving tool to help diagnose breast cancer or to give further information. This scan if necessary would be performed at separate appointment in the X-ray Department.

Mammogram – a mammogram is a breast x-ray

The breast is compressed and flattened between 2 special plates in order to keep breast still and ensure a clear picture. Some women / men find this uncomfortable or even painful but it only lasts a few seconds. Mammograms are part of the assessment process which is considered to be best practice for diagnosis of breast disease.

Ultrasound – This is using high frequency sound waves to produce an image of the breast

The scan is painless and only takes a few minutes.

You may be offered one or both of the following tests (occasionally some patients are offered both tests)

It is done while you are lying on a couch, sometimes with your arm above your head. Gel is applied to the skin and a probe will be moved around the breast.

Core biopsy – This test is performed to obtain a sample of tissue

If this test is performed, you will receive a local anaesthetic prior to a biopsy needle being inserted into the skin which takes a small piece of breast tissue for close examination.

The results from this particular test are not available at this visit as they take several days to process.

FNA – fine needle aspiration

The doctor may take some cells from the problem area with a needle. These cells will be sent for analysis.

The core biopsy procedure and FNA are carried out to help medical staff with their diagnosis. Following either of these procedures you may experience some bruising and swelling, with the lump sometimes feeling bigger. You may find that your breast aches and becomes tender or painful; it would therefore be advisable to bring some painkillers with you to your appointment. The staff in Breast Imaging Department where these procedures are performed, will give you an aftercare information sheet, to inform you when to remove the small dressing which has been applied.

Your results

Sometimes results of the tests are available the same day and would be discussed with you by the doctor prior to you leaving the department. However, this is not always possible, particularly for biopsy and FNA results, as they take several days to process and you may be asked to return to the clinic the following week to discuss your results and any further treatments that may be recommended for you by the MDT.

What treatment might I need?

Surgical treatments

Wide Local excision  – or Breast Conserving Surgery – this is where the cancer is removed with a margin of normal breast tissue

Mastectomy  – removal of all the breast tissue including the nipple area, the muscles underneath the breast are not usually affected.

Sentinal Lymph Node biopsy  – sentinel node biopsy aims to identify the lymph gland that receives lymph fluid first from the breast and therefore the first place to which a cancer may have spread to.

The procedure involves injecting a tiny amount of radioactive liquid into the area around the nipple before surgery (this is carried out on the day of your surgery in the Department of Nuclear Medicine or Breast Imaging Dept. Occasionally blue dye may be injected into the same area at the time of surgery. The radioactive liquid or dye will travel to the sentinel node. Once identified the node or nodes are removed and sent to laboratory for testing.

If the sentinel node(s) doesn’t contain any cancer cells this usually means that the other nodes are clear and so no further surgery is performed to the armpit. If the nodes are involved by cancer then the remaining lymph nodes are removed known as Axillary Node Clearance and would involve a second operation.

Axillary Node Clearance  – A ‘tail’ of breast tissue extends into the armpit (also called axilla)

The armpit also contains a collection of lymph nodes (glands). The operation will remove most or all of the lymph nodes in your armpit. This operation is necessary to remove any cancer that maybe within the lymph nodes in the armpit. It also gives further information to the breast team looking after you

about any potential spread of your disease. This allows the MDT team to plan any additional treatment that may be required.

Breast Reconstruction

For patients who require a Mastectomy, Breast Reconstruction may be an option.

Reconstruction is performed by our Oncoplastic surgeons Mr M Hussien or Mr M Youssef and also in conjunction with the Plastics Surgeons in Plastics Department, NNUH, Level 2, West Block.

Hannah Newstead – Breast Reconstruction Specialist Nurse

They offer immediate and delayed reconstruction depending on their assessment and discussion with you.

  • DIEP
  • IGAP
  • LD Flap
  • Reduction / Augmentation
  • Insertion of implants and tissue expanders
  • Nipple and areola reconstruction
  • Nipple areola tattoo

Non-Surgical Treatments for Breast Cancer

Anti-breast cancer treatments include hormonal therapies, different types of Chemotherapy, and targeted therapies such as Herceptin and Radiotherapy.