If a breast mass is found by patient or the patient’s primary care physician a careful evaluation will be carried out. A comprehensive history and physical exam is obtained. Ordering and interpreting the results of the most appropriate breast imaging and tissue sampling if that is necessary.
Is when there is fluid discharged from the nipple when the person is not breast feeding. The evaluation and the discussion of the reasons for the discharge as well as the options in the treatment are discussed at the time of the consultation. Performing the necessary imaging and testing and finally if found necessary performing surgery.
Enlarged cysts (pockets of fluid) in the breast that are symptomatic would be worked up with imaging and conservative treatment in most cases. However, if the cyst is very large, painful and distress causing aspiration of the cyst is offered in the clinic with the appropriate numbing of the area.
High risk for breast cancer
After a thorough history and physical the risk will be calculated for developing breast cancer as well as the likelihood of having the breast cancer gene mutation. These numbers will be discussed and the appropriate follow up, treatment and testing will be determined. The genetic testing is discussed and administered in the office. A referral to genetic councilor is also available if desired.
In the case of a previous biopsy that showed high risk lesion or there is other reasons to be high risk for developing breast cancer chemo prevention can be considered. This modality of decreasing the risk is not taken lightly and the pros and cons of such a treatment are discussed and considered on an individual
Breast cancer gene mutation carrier
The risks of developing breast and ovarian cancer are discussed. The patient preferences are considered when we discuss risk reduction and follow up. There are risk reduction surgeries and chemo prevention that can be evaluated and discussed depending on what the persons preferences. There is Onco-fertility referral available if child baring is in the future and gyne/oncology referral for close follow up for ovarian health.