Various procedures help diagnose and treat breast cancer. The specific procedures used can depend on the stage and extent of cancer, subsequent treatment decisions and patient preference and age. Talking with your health care team can help you make the right diagnostic and treatment decisions for your situation.
Fine Needle Aspiration (FNA)
The American Cancer Society describes a fine needle aspiration (FNA) as a procedure that uses a very thin needle and syringe to take a small piece of tissue from the area in question. This tissue is then examined microscopically for any changes in breast cells. While this is the easiest kind of breast biopsy to have, there are disadvantages. The needle may not reach the actual cancerous area, so no cancer may be seen under the microscope, and it is not diagnostic. If cancer is present, there is no way to tell if it is invasive cancer or not. The sample taken may also not be large enough to run other tests that the lab might want to run.
Core Needle Biopsy
In this type of biopsy, a larger needle is used to take a cylinder-shaped piece of tissue; typically, more than one tissue sample is taken. An advantage of this kind of biopsy is that with the larger tissue samples, it is more likely than fine needle aspiration to provide a definitive diagnosis of breast cancer.
Surgery
Surgery is one of the standard types of treatment for breast cancer, according to the National Cancer Institute (NCI). There are various kinds of surgery, including breast-conserving surgery and mastectomy. Breast-conserving surgery can either be a lumpectomy, where the lump is surgically removed, as well as a margin of normal tissue that surrounds the lump; or it can be a partial or segmental mastectomy, where the part of the breast that is cancerous is removed with some surrounding healthy tissue. Lymph nodes may also be removed with either of these surgeries, to see if cancer has spread to the lymph system. Simple mastectomy consists of removing the entire breast that has cancer in it, along with nearby lymph nodes. The NCI also describes a modified radical mastectomy, consisting of removal of the breast, underarm lymph nodes, the covering over the chest muscles and possibly some of the muscles in the chest wall. When all of the chest wall muscles are removed, this is a radical or Halstead mastectomy, and is rarely done.
Staged Breast Reconstruction
Staged reconstruction is the process of breast reconstruction that involves placing temporary expanders under the skin and muscle. A temporary expander is an implant that can be inflated to make room for a permanent implant by stretching skin and muscle. The Johns Hopkins Hospital describes this as a common technique of reconstruction; when the expanders are removed, a flap reconstruction takes place, or permanent breast implants are placed where the expanders were.
Deep Inferior Epigastric Artery Perforator Flap (DIEP flap)
While a TRAM flap (using tissues and muscles from the stomach) was often used years ago, newer trap reconstruction methods are being used, including the Deep Inferior Epigastric Artery Perforator flap (DIEP flap). This procedure is similar to the TRAM flap; tissue and fat are used from the abdominal area to form a new breast mound, but no muscle is taken from the stomach. The TRAM flap surgery would decrease muscle strength in the stomach, because muscle was removed; in this procedure, this is not a concern.
