Breast Conditions

There are many different types of breast conditions that may require a surgical consult and/or surgical intervention. You and your primary care physician may have noticed changes that require further evaluation. Frequently, mammograms reveal breast abnormalities. Most of the time, these changes or abnormalities will be benign and easily treated.

Benign Breast Conditions

• Mastalgia is a general term used to describe painful breasts. This is most likely caused by the breast tissue reacting to the hormone changes that occur during your cycle.
• Cysts are fluid-filled lumps that may grow large and be painful, especially near your cycle or with increased caffeine intake.
• Fibroadenomas are firm, rubbery lumps that may or may not be painful.
• Fat necrosis can occur after any type of trauma to the breast, surgical or accidental. The area feels firm and is usually nontender.
• Intra-ductal papilloma: A wart-like growth in a milk duct of the breast, which may lead to a bloody discharge.

Other breast abnormalities are more serious. They can increase your chances of developing cancer or actually indicate the presence of cacner. These conditions include:

• Atypical lobular hyperplasia (ALH): Abnormal cells in the breast lobules.
• Atypical ductal hyperplasia (ADH): Abnormal cells in the breast ducts.
• Lobular carcinoma in situ (LCIS): A significant number of abnormal cells in the breast lobules (more than with ALH).
• Ductal carcinoma in situ (DCIS): Abnormal cells in the lining of a breast duct. Called "in situ" because the cells have not spread outside the duct to the breast tissue.

Diagnosis

A biopsy is often recommended to determine whether you have breast cancer and to determine a proper course of treatment. Dr. Castillo makes every effort to use the most minimally invasive procedure. Depending on the situation and your expressed wishes, the lump or abnormality may be completely removed during the biopsy procedure.

Depending upon the size and location of your mass, Dr. Castillo may recommend the following biopsies:

• Ultrasound-Guided Core Biopsy: In this procedure, Dr. Castillo uses an ultrasound machine and spring-loaded device to withdraw tissue samples for examination. This is a minimally invasive procedure, done in the office with local anesthetic.
• Stereotactic Needle Core Biopsy (mammotome): During this type of biopsy, a mammography machine is used to project mammographic images onto a computer screen. Dr. Castillo then precisely guides a needle into the mass to take tissue samples. This is a minimally invasive procedure, done in a special radiology facility with local anesthetic.
• Open Breast Biopsy (Surgical Biopsy): During this kind of biopsy, Dr. Castillo makes an incision in the breast and removes tissue from the suspicious area. It is then sent to a pathologist for a diagnosis. This procedure is performed in the operating room under general anesthesia.

Breast Cancer

There are two main types of breast cancer. Most breast cancers are of the type called ductal carcinoma, which starts in the breast milk ducts. The other type, lobular carcinoma, starts in the lobules of the breast. Breast cancer can be invasive, meaning it has spread from the lobule or duct where it originated to other breast tissue. Ductal carcinoma in situ refers to breast cancer that remains confined within the ducts.

Treatment

Dr. Castillo works closely with each patient to determine the best surgical procedures to treat their breast conditions. His goal in all aspects of surgical care is to provide patients with evidence-based medicine in a way that is compassionate and comprehensive. Dr. Castillo believes that good communication with the patient and all those involved in his or her care is essential to optimal outcomes. In this regard, to lessen patients' stress and anxiety, his office will help coordinate any additional specialist consultations as indicated, including plastic surgery, medical oncology, and radiation oncology prior to surgical intervention. He is committed to his patients' long-term well being and he continues to care for his breast cancer patients for years after surgery, including follow-up visits, imaging studies, and scheduling appointments with specialists when needed.

Surgical procedures he performs for breast cancer treatment include:

Oncoplastic Breast Conservation Therapy: In this surgical procedure, only the cancerous tumor and some surrounding tissue are removed. A lumpectomy is a form of "breast-conserving" surgery that has the advantage of preserving the breast. Oncoplastic surgery allows Dr. Castillo to remove the cancer and optimize the post-operative cosmetic results. However, in certain situations, such as large or multiple tumors, a lumpectomy is not a good option. On rare occasions, additional cancerous tissue is discovered during the procedure, which may result in the need for a repeat lumpectomy or a mastectomy. The amount of tissue that is removed in a lumpectomy can vary greatly and will affect the size of breast deformity that results. This procedure is performed in a surgical facility under general anesthesia.

Mastectomy: This is surgery to remove the whole breast, usually including the nipple. The procedure is performed in a surgical facility under general anesthesia. Most patients are able to go home the same day. If desired, a plastic surgeon can work with Dr. Castillo to perform reconstructive surgery at the same time as your mastectomy. Some women choose not to have reconstructive surgery done at all or choose to have this done at a later time.

Sentinel-Node Biopsy: Dr. Castillo was one of the first physicians in Phoenix to perform minimally invasive sentinel node biopsy for breast cancer. For 20 years, he has achieved nearly 100% success in identifying the sentinel node in this type of cancer. Sentinel nodes are the first node(s) the tumor drains to. Knowing whether cancer is in the underarm lymph nodes can help Dr. Castillo decide if you need chemotherapy or other treatment in addition to surgery.

To perform a sentinel node biopsy, he injects a small amount of radioactive material and blue dye around the tumor. The radioactive material and blue dye travel to the sentinel node(s) and help Dr. Castillo identify them. The nodes are then removed and examined to see if they have cancer. If they do not contain cancer, it is unlikely that the other nodes under the arm have cancer. Usually this means there is no need to remove more lymph nodes. Having fewer lymph nodes removed results in a less painful recovery and lowers the likelihood that you will develop lymphedema and other problems caused by damage to lymph vessels and lymph nodes.

Axillary Dissection: During a mastectomy, and sometimes during or after a lumpectomy, Dr. Castillo will remove axillary (underarm) lymph nodes that show evidence of cancer. Typically between five and thirty nodes are removed during an axillary dissection. Once removed, the nodes are examined by a pathologist to determine if they are cancerous.

Partial and Whole Breast Radiation: Breast radiation is often employed after breast-conserving surgery or in some cases after a mastectomy. To receive partial breast radiation, a device is placed in the breast. Dr. Castillo places this device in the office with local anesthetic. Then radiation (usually in the form of seeds or pellets) is delivered through the tube directly to the breast. Radiation is administered by a radiation oncologist.

Chemotherapy: A course of drug treatment designed to stop the growth of cancer cells. There are a variety of chemotherapy drugs used to treat breast cancer, and they may be administered intravenously or orally. In some cases, chemotherapy may be required after breast conservation therapy or mastectomy. Occasionally, chemotherapy is given before surgery in order to shrink the tumor so it can be removed more easily. Chemotherapy is administered by a medical oncologist.