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SURGICAL SPECIALISTS, P.C.

BREAST CANCER

Pink Cancer Rose

Understanding and knowing more about breast cancer will assist you in choosing the best choices for your surgeon, type of breast surgery and your treatment plan. The outlook for treatment today is hopeful since there are more advanced and better treatment options available.

Our expert breast surgeons in our practice in Connecticut are eminently qualified to assist you in making the right decisions and care for you in a compassionate and comprehensive way.

Cancer cells are different from normal cells. They can divide and spread uncontrollably. Within time, some of these cells can spread beyond the breast to other areas of the body.

The two main types of breast cancer are:

  • Ductal carcinoma starts in the ducts (tubes) that move milk from
    the breast to the nipple.
  • Lobular carcinoma starts in the parts of the breasts that produce
    milk (lobules).

Rarely will cancer develop in other areas of the breast.

Men can develop breast cancer with symptoms that include a breast lump, breast pain and tenderness.

Breast cancer can be invasive or noninvasive:

  • Noninvasive - Early breast cancer (in situ) is restricted to the ducts
    located within the breasts. If left untreated it may become invasive.
  • Invasive - Invasive breast cancer occurs when cancer cells spread
    beyond the ducts or lobules in the breasts. The cells will first spread to nearby breast tissue.
  • Over a period of time cancer cells may metastasize (travel)
    to other parts of the body if they move in the lymph nodes
    or bloodstream
SYMPTOMS

EARLY BREAST CANCER - Symptoms are not always present when early
breast cancer develops. Breast exams are very important for early detection
of the disease. As the cancer develops and the symptoms do begin
to appear, they can include:

  • A palpable breast lump which may have uneven edges,
    is hard and generally does not hurt.
  • Change in the shape, size or feel of the breast or nipple.
    Patients may experience redness, dimpling or puckering.
  • Discharge coming from the nipple that may appear bloody,
    green, clear to yellow and may look like pus.

ADVANCED BREAST CANCER – Symptoms of advance breast
cancer can include:

  • Breast pain or discomfort
  • Bone pain
  • Skin ulcers over the breast
  • Swelling of the arm (underarm) near the breast with cancer
  • Weight loss

Although less common, men can develop breats cancer with symptoms that
may include a breast lump, breast pain and tenderness.

MEDICAL EVALUATION

Should you notice a change or lump
in your breast
, it should be examined
without delay. A physical exam and
diagnostic tests will be performed to
determine the cause.

  • HISTORY AND PHYSICAL EXAMINATION – We will ask you for
    a complete medical history that will include questions regarding the time you discovered the lump and if there were any changes to the lump, questions concerning your period, pregnancies, prior breast problems, if any, and if you're using birth control pills or HRT. Our surgeon will perform a clinical breast exam, using gentle pressure to feel your breast tissue for lumps and other changes as well as a comprehensive evaluation and physical to check your overall health.
  • DIAGNOSTIC TESTS will provide additional information about the
    change in your breasts. You may have one or more of the following
    tests.
    • MAMMOGRAM
      MAMMOGRAMThis is an x-ray of your breasts
      using a low dose of radiation.
      Mammograms are also regularly
      used to check women who have
      no problems. It is a screening
      process that should be used on a regularly scheduled basis.
      Women age 40 usually go annually, and sooner if there is a family history of breast cancer
    • BREAST ULTRASOUNDBREAST ULTRASOUND
      Painless sound waves are used
      to produce a picture of the
      breast. This helps determine if
      a lump is solid or filled with fluid.
    • MRI
      Magnetic resonance imagingMagnetic resonance imaging
      (MRI) is a noninvasive medical
      test that uses a powerful
      magnetic field, radio frequency
      pulses and a computer to
      produce detailed pictures of organs, soft tissues, bone and
      all other internal body structures. The images are then examined
      on a computer monitor, transmitted electronically printed or
      copied to a CD. An MRI of the breast offers valuable information
      about many breast conditions that cannot be obtained by other
      imaging modalities like mammography or ultrasound.
 
BIOPSY

Following the examination and diagnostic tests, a biopsy may be recommended. The biopsy procedure removes a sample of tissue from the breast lump. The cells in this tissue are studied for the presence of cancer. The type of biopsy you may have is contingent upon the size and location of the lump.

  • PERCUTANEOUS BIOPSY
    Needles or special probes are used to remove samples through the skin. This is usually performed in our office or in an outpatient setting. If on examination the lump is not palpable an image-guided biopsy is performed.
  • FINE NEEDLE ASPIRATION
    This is the simplest form of biopsy requiring no anesthesia,
    and is used to sample cells of lumps that can be felt. They can
    be fluid-filled cysts or solid masses.
    • BEFORE – Our surgeon will discuss the risks of the
      procedure prior to performing it in our office. This is
      considered a minor procedure and you may haver a
      little bleeding, pain or bruising in the area where
      the needle is inserted. solid.
    • DURING – This procedure is performed in a few
      minutes. A very thin needle is placed in the lump and
      fluid is sampled or cells are removed if the lump is
    • AFTER – If any pain or bruising occurs, it will disappear
      quickly, leaving you without a scar. Results will be
      available a few days after the biopsy.
  • CORE NEEDLE BIOPOSY
    A core needle biopsy will provide a larger sample than a
    fine needle biopsy.
    This can be used for solid masses that
    can be felt as well as breast changes that can't be felt.
    All biopsy samples are sent to a lab for study.
    • BEFORE – Our surgeon will discuss the procedure with
      you and tell you what you can expect to happen before,
      during and after the biopsy. You can anticipate some
      swelling and possible bruising as well as a slight chance
      of an infection in the area where the needle was
      inserted. You will have to tell us what prescription and
      over the counter medications you are taking as well as
      any vitamins and herbal supplements.
    • DURING – A local anesthesia will be administered
      so that you will be pain free; but alert. A hollow
      needle is used to remove a section of the mass or
      breast change. More than one biopsy sample may
      be taken requiring the needle to be inserted several
      times.
    • AFTER – Within a short time after the biopsy you
      will be able to go home. Stitches are normally not
      necessary and you will probably require a small
      bandage. There is a possibility of a small scar
      appearing that looks like a freckle forming at
      the site where the biopsy was performed.
  • IMAGE-GUIDED BIOPSY
    An image guided biopsy is performed if a lump or breast
    change is unable to be felt.
    This procedure is performed in the
    Radiology Department of the hospital. Computer mapping guided
    by mammograms is used to pinpoint the breast changes. Ultra
    sounds can also be used to locate breast changes. A core needle
    is used to take tissue samples once the change is located. A
    vacuum-assisted probe may sometimes be used. This procedure
    is similar to a core needle biopsy but the probe is only inserted once.
  • SENTINEL LYMPH NODE BIOPSY This procedure is
    performed to see if the breast cancer has spread to the
    lymph nodes.
    The first node that the fluid passes through in a
    group of lymph nodes is called the sentinel lymph node. The
    sentinel nodes are the first lymph nodes to which the cancer cells
    in the breast tumor are most likely to spread. Lymph node tissue
    is removed to search for the presence of cancer. If cancer is
    found in the sentinel lymph node at the time the biopsy procedure
    is being performed, additional surgery will be required to remove
    additional lymph nodes. A dye or tracer is injected in the area
    with the breast tumor. A camera (lymphoscintigraphy) is used
    to take pictures of the lymph nodes. The first lymph node or
    nodes that will absorb the dye or tracer are called the sentinel
    nodes. Once found, the sentinel node(s) are removed to look for
    the presence of cancer cells.


    WHEN TO CALL THE DOCTOR

    We ask that you call us in the event the following should occur
    following any of the procedures:

    • A fever over 101 degrees
    • Severe pain
    • Bloody drainage lasting for several days
  • SURGICAL BIOPSY
    A larger sample of tissue can be removed with a surgical
    breast biopsy.
    Most often, the entire lump will be removed.
    Should thE breast change be a result of tiny deposits of calcium
    (microcalcifications), then tissue containing the calcifications will
    be removed. Most surgical biopsies are done on an outpatient
    basis.

    It is difficult to locate a breast change that cannot be felt. In
    such a situation one or more guide wires might be placed in the
    breasts prior to the biopsy procedure. These are thin wires that
    are used to mark the tissue that has to be removed. A
    mammogram or ultrasound is used to direct the placement of the
    wires. Before the wire is inserted, the area is numbed. During
    the biopsy procedure the wire is removed.


    • BEFORE – We must know what prescription and over
      the counter medications, vitamins and herbal
      supplements you are taking. Some medications may
      adversely affect the body's response during surgery
      and healing after surgery. You will need to make
      arrangements for someone to take you home.
    • DURING – This procedure is performed at the
      hospital. Intravenous sedation is given to produce a
      light sleep or"twilight state" and prevent you from
      feeling pain. An incision is then made in the breast,
      and whenever possible, in a way to hide the scar.
      Then, in most cases, the lump is completely removed
      and the incision is closed with stitches. Some stitches
      will have a tendency to dissolve on their own, while
      others will need to be removed at a later date.
    • AFTER – You will be able to go home the day of the
      biopsy. You can expect not to be too uncomfortable,
      but pain medication will be prescribed if the need to
      take it arises. Ice packs will be used to help decrease
      the soreness and swelling. We will advise when to
      remove the dressing and when to bathe and exercise.
    • RISKS AND COMPLICATIONS – The possible risks
      that can occur with a surgical biopsy include:
      • Excessive bleeding or bruising
      • Infection
      • Difficult wound healing
      • Problems resulting from the general anesthesia
      • Slight change in the contour of the breast
      • Swelling due to the accumulation of fluid

WHEN TO CALL THE DOCTOR

We ask that you call us in the event the following should occur:

  • A fever over 101 degrees
  • Pus draining from the incision site
  • Pain increasing at the incision site
  • Increasing warmth or redness at the incision site
  • Severe swelling or bloody drainage that lasts for
    several days
  • Coughing, chest pains or shortness of breath
  • Bleeding that soaks through the dressing
THE TREATMENT OF BREAST CANCER

Breast cancer can be treated in several ways. Factors affecting the
decision making process include the extent of the cancer and your feelings
as well as your needs. Some of the factors determining the treatment include:

  • Type and stage of the cancer
  • Whether the cancer has a sensitivity to certain hormones
  • Whether the cancer overproduces a gene called HER2/neu

TREATMENTS
Cancer treatment can be either local (only the area of the disease)
or systemic (the entire body).
Examples of local treatments are surgery
and radiation. Chemotherapy is a form of systemic treatment.

  • SURGERYUsed to remove the cancer. Surgical options
    include only removing the lump (lumpectomy) or removing the
    breast (mastectomy - partial or complete).
  • CHEMOTHERAPYMedications are used to destroy
    cancer cells.
    These drugs travel in the bloodstream and move
    throughout the body. Chemotherapy may be given before
    surgery, after surgery or on its own without surgery.
  • RADIATION THERAPYX-rays are focused on the breast
    and possibly the lymph nodes and used to destroy
    cancerous cells.
    This type of therapy is almost always used
    after a lumpectomy is performed since it helps destroy cancer
    cells that might remain after the surgery.
  • HORMONAL THERAPYA method used to fight cancers
    that respond to the female hormones estrogen and
    progesterone.
    Hormonal therapy can be taken in pill form
    for approximately five years and may help prevent the
    cancer from returning.

    Tamoxifen is the drug taken to block the effect of estrogen
    which helps cancer cells grow and survive. Most women will
    benefit from this drug when they have estrogen sensitive
    breast cancer.

    Aromatase inhibitors are another class of hormonal therapy
    medication. Medicines like Aromasin have been known to
    work as well or better than Tamoxifen when taken by
    postmenopausal women with breast cancer. These inhibitors
    block estrogen from being made.
  • TARGETED THERAPYA newer form of cancer
    treatment that is also referred to as biologic therapy.

    Special anticancer drugs are used to target changes in a cell
    that can lead to cancer. Trastuzumab is a drug in that category
    and it may be used for women with HER2-positive breast cancer.

TREATING DIFFERENT STAGES OF BREAST CANCER
Most women will receive a combination of treatments.

  • STAGE 0 and DCIS – The standard treatment consists of a
    lumpectomy with radiation or a mastectomy. There is
    controversy over how to treat DCIS.
  • STAGE 1 and 2 – The goal is to treat the cancer and prevent
    it from returning. Standard treatment includes a lumpectomy
    plus radiation or a mastectomy with some kind of lymph node
    removal. Following surgery hormone therapy, chemotherapy
    and/or biologic therapy may also be recommended.
  • STAGE 3 - The goal is to treat the cancer and prevent it from
    returning. Treatment includes surgery possibly followed with
    chemotherapy, hormone therapy and biologic therapy.
  • STAGE 4 – The goal is to improve the symptoms and help
    the patient live longer. Treatment may include surgery,
    chemotherapy, radiation, hormonal therapy or a combination
    of all four.

Some women will continue to have treatment after the initial plan is completed. Blood tests, mammograms and other tests are standard means of continued future treatment and follow up.

Reconstructive breast surgery for women who have mastectomies can be performed at the same time as the mastectomy or at a later date. In many cases the restorative procedure is covered by insurance.

SUPPORT GROUPS

Breast CancerIt can be extremely overwhelming
to learn that you have breast
cancer. Other women can be a
tremendous source of support
and information when you share
common experiences and problems.

Joining a support group for women with
breast cancer can help ease the situation
and help you cope. The following
organizations can help you learn more
about the disease:

  • American Cancer Society:
    800-227-2345, www.cancer.org
  • National Cancer Institute:
    800-422-6237, cis.nci.nih.gov
  • National Women's Health Information Center:
    800-994-9662, www.4woman.gov
PROGNOSIS

People with breast cancer are living longer than before with the
advent of new and improved treatments.
How well you do after
treatment is contingent upon several factors. Our team will review the factors
of your case and discuss the potential risk of possible recurrence with you.

Additional information regarding the treatment for breast cancer is
available by clicking on the following link:
http://www.norwalkhospital.org/smilow.aspx

LOCATIONS


148 EAST AVENUE, SUITE 3A
NORWALK, CT 06851
203-899-0744

2 TRAP FALLS ROAD, SUITE 100
SHELTON, CT 06484
203-256-9707

778 LONG RIDGE ROAD, SUITE 101
STAMFORD, CT 06902
203-348-0589

52 WASHINGTON AVENUE, SUITE 3
NORTH HAVEN, CT 06473
203-285-2861

831 BOSTON POST ROAD, SUITE 202
MILFORD, CT 06460
203-647-0140

Dr. Craig Floch

the founder and senior partner of Fairfield County Bariatrics & Surgical Specialists, P.C. His commitment has enabled us to become one of the most prominent, dedicated, personal and highly respected practices serving Connecticut, New England and New York.

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Dr. Neil Floch

the Director of Minimally Invasive Surgery at Norwalk Hospital as well as the Bariatric Director of the Hospital. He is the first fellowship trained advanced Laparoscopic Surgeon in Fairfield County.

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Dr. Peter Ingraldi

is a partner of Fairfield County Bariatrics & Surgical Specialists, P.C. He joined our practice in 2007. Dr. Ingraldi specializes in general surgery and surgical critical care and is Board Certififed in both fields.

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Abe Fridman

joined our practice September 1, 2012. Dr. Fridman specializes in general and bariatric surgery.

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Dr. Marko Lujic

is the newest member of Fairfield County Bariatrics & Surgical Specialists, P.C., having joined our practice in October 2017. Dr. Lujic will lead our initiative in Milford and will provide comprehensive general surgical services, including breast surgery, thyroid surgery and melanoma in addition to managing traditional general surgery consultations.

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