Irregular Breast Lumps: Surgical Options and Concerns

There is an irregular lump in the breast?

Hello, doctor.
Today I went to the hospital for an examination regarding a movable lump in my breast, and I also had an ultrasound.
According to the doctor, the lump in my breast measures 3.1 centimeters, and its shape is somewhat irregular, being oval with a bulging end.
The doctor recommended that I undergo surgery to remove it and then have it tested, with the report expected in a week.

Question 1: I read about other people's examination procedures, and many had fine needle aspiration to check for tissue, but this doctor suggested surgery.
Is there something wrong with this procedure?
Question 2: The doctor recommended general anesthesia.
Is this normal? Will general anesthesia affect my health?
Question 3: Do I need to go to another hospital for a second opinion from another doctor?
Question 4: If I have surgery, can I request the doctor to use a cosmetic suturing technique to minimize scarring? Under what circumstances would a doctor agree to this? I'm really worried about having an unsightly scar.
Thank you.

Ms. Chen, 20~29 year old female. Ask Date: 2008/03/12

Dr. Zhuang Renbin reply Surgery

Dear Ms.
Chen,
I hope this message finds you well.
Currently, the diagnosis of breast tumors primarily relies on: 1.
Breast ultrasound, 2.
Mammography, and 3.
Fine needle aspiration cytology, which has a diagnostic accuracy for malignant tumors exceeding 90%.
For benign tumors larger than 2 centimeters, excision under local anesthesia is usually more challenging, as achieving a pain-free surgical outcome can be difficult.
However, I still recommend that patients undergo fine needle aspiration prior to surgery, because if the cytology indicates malignant changes, the entire surgical approach would differ, unless the ultrasound strongly suggests that the tumor is benign.
Therefore, I would advise you to visit our surgical department for a diagnosis and to arrange for subsequent management.
(Our hospital employs a subcutaneous cosmetic surgical technique for breast surgeries, so there is no need for suture removal.)
Wishing you good health and all the best!
Sincerely,
Director of Surgery, Tainan Hospital, Department of Health, Executive Yuan

Reply Date: 2008/03/12

More Info

When it comes to irregular breast lumps, particularly those that are mobile and have an irregular shape, it is essential to approach the situation with caution and thoroughness. Based on your description, the lump measures 3.1 cm and has an oval shape with a protruding end, which raises some concerns that warrant further investigation. Here are responses to your questions, along with additional information regarding the surgical options and considerations:
Question 1: Is it appropriate to recommend surgery instead of a fine needle aspiration (FNA)?
In many cases, a fine needle aspiration (FNA) or a core needle biopsy is performed to obtain tissue samples from a breast lump for diagnostic purposes. However, if the lump exhibits characteristics that are concerning for malignancy—such as irregular shape, size, and mobility—your physician may recommend surgical excision as a more definitive approach. This is particularly true if the imaging results (like ultrasound) suggest that the lump may not be benign. Surgical excision allows for both removal of the lump and comprehensive pathological examination, which can provide a clearer diagnosis. While FNA is less invasive, it may not always yield sufficient tissue for a conclusive diagnosis, especially in cases where the lump is suspicious.

Question 2: Is it normal to recommend general anesthesia for this procedure? Will it affect my health?
General anesthesia is commonly used for surgical procedures involving the breast, especially if the surgery is expected to be more extensive or if the surgeon needs to ensure complete control over the patient's comfort and safety during the operation. While general anesthesia does carry some risks, it is generally considered safe for healthy individuals. Your anesthesiologist will evaluate your medical history and current health status to minimize any potential risks. It’s important to discuss any concerns you have about anesthesia with your healthcare team, as they can provide reassurance and information tailored to your situation.

Question 3: Should I seek a second opinion?
Seeking a second opinion is always a reasonable approach, especially when it comes to surgical decisions regarding your health. If you feel uncertain about the recommended procedure or the urgency of the surgery, consulting another healthcare provider can provide you with additional perspectives and options. It can also help you feel more confident in your treatment plan.

Question 4: Can I request cosmetic suturing techniques to minimize scarring?
You can absolutely discuss your concerns about scarring with your surgeon. Many surgeons are skilled in cosmetic techniques that can minimize the appearance of scars. The decision to use such techniques often depends on the location and size of the incision, as well as the surgeon's expertise. Surgeons are typically open to accommodating patient requests for cosmetic considerations, especially if it can be done without compromising the surgical outcome. It’s best to have this conversation during your pre-operative consultation.

Additional Considerations:
1. Postoperative Care: After surgery, follow your surgeon's instructions regarding wound care, activity restrictions, and follow-up appointments. Proper care can help minimize scarring and promote healing.

2. Pathology Results: Once the lump is removed and sent for pathological examination, the results will guide further treatment, if necessary. Depending on the findings, additional interventions may be required.

3. Emotional Support: Dealing with breast lumps can be stressful and anxiety-inducing. Consider seeking support from friends, family, or professional counselors to help you navigate this experience.

In summary, while the recommendation for surgery may seem daunting, it is often the most effective way to ensure a thorough evaluation of suspicious breast lumps. Engaging in open communication with your healthcare team will help you make informed decisions about your health and treatment options.

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