All in-office procedures are performed under local anesthesia. The risk of bleeding and infection is minimized by using adequate local anesthetic with hemostatic properties and by other means. The risk of infection is minimized by using sterile technique and sterile instruments.
Breast biopsy, Fine needle aspiration (FNA)
FNA is useful if evacuation of a fluid filled area is needed such as cysts. It can also be used for biopsy of tissue where cells form a suspicious area are aspirated into the instrument and then placed in a suspicion and sent off to pathology. For cyst aspirations rarely is that fluid sent for pathology examination.
Breast biopsy, Core needle
- A hollow tube (Core needle) of varying caliber can be used to obtain a small tissue sample form a suspicious lesion. This is a more accurate diagnostic modality because it allows more tissue to be removed and submitted for pathologic evaluation. This procedure is carried out with palpation guidance or with Ultrasound guidance in the office.
Breast biopsy, Skin Punch
- The best way to evaluate skin changes of a breast which are suspicious, and malignancy needs to be ruled out, is by performing a “punch” biopsy. The instrument used removes a small round piece of the skin. This is then sent for pathologic evaluation.
Breast biopsy, Incisional
- Rarely there is no other way of obtaining an adequate tissue sample but by removing a piece of it directly. In this instance a small piece of the lesion is excised and sent for pathologic evaluation.
Incision and drainage of abscess
- Infections in the breast can cause abscesses formation. These are pockets of purulent material that cannot be drained by using a needle to aspirate it out. In these cases, a small skin incision in the skin that opens up the abscess is needed to drain out the unwanted material and to allow the antibiotics to work. Once the cavity is empty packing is used to keep the pocket form closing and forming another abscess. The packing is removed and replaced at regular intervals until the cavity becomes to small to pack.
Excision of skin lesions
- The breast are covered with skin and like skin anywhere else on the body it can form different superficial lesions. These lesions are most often benign ones but sometimes malignancy needs to be ruled out. These lesions are removed and if needed can be sent to pathology for further evaluation.
Excision of sebaceous cysts
- The small oil glands found on our skin can occasionally become clogged and the resulting cyst be filled with undrained oils. These cysts can resolve on their own if the minute opening of this gland opens up but it can also get infected. Once a sebaceous cyst becomes infected and is treated the best option is to excise it. This prevents further infections.
Removal of Medi ports
- Once the chemotherapy is over and there is no further need for the medi-port placed for this purpose, the device can be removed. There is no set timeframe for the port removal. This can vary form person to person and the time to be removed is determined by the medical oncologist. The removal entails opening the skin incision that was used for its placement and cutting the sutures that are keeping the port in place. The port as well as the small catheter that is attached to it is removed and sent to pathology.
Insertion of partial radiation devices
- At Virtua Breast Care - Voorhees we are utilizing the newest technology to offer accelerated partial breast radiation. For this purpose, a catheter needs to be inserted into the tumor bed. This allows the cavity and the surrounding tissue to receive the needed radiation to decrease the likelihood of this cancer to grow back.
- The catheter placement is performed under local anesthesia in the office with Ultrasound guidance. In the end the catheter is deployed, and the small tail will be protruding thru the skin. This is dressed in gauze and soft pads. The dressing will be removed and replaced by the Radiation Oncology department for the duration of the radiation (one week).
- A Cat Scan of the chest is repeated to evaluate the location of the catheter by the medical Oncologist and the physicist who determine the radiation doses. If this is found to be adequate the radiation can commence. The treatments are a total of 10 delivered in 5 days, two treatments a day at least 6 hours apart.
- At the end of the radiation the catheter is pulled, and the small incision is dressed.
- While the catheter is in place it always needs to be kept dry and clean, this means that it should not be exposed to showers or submerged in baths.