Breast Surgery

General surgeons are the specialists who are formally trained in the diagnosis and treatment of breast disorders, both benign and malignant. While many patients who see the surgeon do not require any surgical procedure at all, other patients may require intervention for diagnosis or treatment of their condition. Breast surgery, like many other fields of surgery, is constantly being refined and improved, especially with the development of newer, minimally-invasive techniques. Minor procedures such as cyst aspiration (often using ultrasound guidance), abscess drainage or removal of skin lesions are routinely done in the office using local anesthesia.

Most patients who traditionally required open surgical biopsy to establish a definitive diagnosis can now have an ambulatory procedure which is just as (if not more) accurate and much less traumatic. If an abnormal soft tissue density (shadow) is seen on mammography, needle aspiration or core needle biopsy can usually be done in the office with local anesthesia. At Montclair Surgical Associates, our surgeons utilize a brand new, state of the art Breast Ultrasound and can perform this at the time of your visit, obviating the need to make another trip to the hospital or outside lab.

For patients who are found to have suspicious microcalcifications on mammography, we most commonly perform stereotactic breast biopsy to establish the diagnosis. This is done by the surgeon as an ambulatory hospital procedure using local anesthesia. Just as our eyes provide us with a sense of depth perception, so do the stereotactic digital x-rays allow the surgeon to "target" a suspicious area seen on mammography. This area can then be sampled by removing small cores of tissue using a specialized biopsy instrument called a vacuum-assisted mammotome. The entire procedure is done through a ¼" nick in the skin which requires no stitches.

Some patients are not candidates for these minimally invasive techniques and require traditional, open surgical biopsy. This is routinely performed on a Same-Day-Surgery basis using either local or general anesthesia. After carefully reviewing your medical history, examining you and reviewing all of your imaging studies, the surgeon can decide which procedure is most appropriate in your particular case.

Patients diagnosed with breast cancer can avail themselves of many treatment options which were not available in years past. Most patients DO NOT require mastectomy (removal of the entire breast).

Lumpectomy (also referred to as partial mastectomy) in combination with radiation therapy (in most cases) is as effective a treatment as traditional mastectomy. Refinements in radiation therapy over the last 15-20 years have greatly diminished the incidence and severity of unwanted side effects. Exciting new methods of radiation delivery, such as breast brachytherapy, hope to offer effective treatment with even fewer side effects.

In certain cases, mastectomy is still indicated. Patients have the option of either simultaneous or delayed reconstruction. Our surgeons work as a team with Board-Certified Plastic Surgeons with extensive experience in breast reconstruction. The two most common forms of breast reconstruction currently in use are the TRAM (Transverse Rectus Abdominus Myocutaneous) Flap and the placement of a Prosthesis (usually Saline). TRAM Flap reconstruction is fairly extensive surgery involving the transfer of tissue (skin, fat and muscle) from the abdominal wall to the chest to rebuild the breast. A certain degree of "tummy-tuck" results from this operation as well. Placement of a Saline Prosthesis is also popular. For patients with larger breasts, an inflatable prosthesis is often used to expand the tissues gradually until the appropriate size is reached.

Accurate staging of breast cancer is essential for planning appropriate and effective treatment. One of the most important factors in staging the condition is the examination of the axillary (armpit) lymph nodes to determine whether or not the cancer has spread. The traditional approach involved removing a large number of these nodes at the time of either lumpectomy or mastectomy. This axillary dissection can give rise to certain complications including infection, local fluid accumulation (seroma) and edema (swelling) of the upper extremity, particularly when combined with radiation therapy. Many patients are candidates for a minimally-invasive procedure called Sentinel Lymph Node Biopsy which involves removal of only one or two nodes identified by injection of a dye or nuclear material around the area of the tumor. In this way, the same information is obtained for staging while the risk of complications is significantly reduced.

The surgeons at Montclair Surgical Associates are trained and experienced in all of the traditional and modern, minimally-invasive techniques utilized for the diagnosis and treatment of breast disease. We are proud to offer truly personal assistance to our patients at every step of their evaluation and treatment.

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123 Highland Avenue., Glen Ridge, NJ 07028
973-429-7600 - fax 973-429-7602

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