Dr. Dwight De Risi, M.D.

Thank you for your question
A Surgical Oncologist is a physician who has gone beyond the routine five year general surgical training program and now concentrates on understanding the biology and behavior of malignancies. This advanced fellowship program is usually two years where one learns about all tumor types and how to care for them from diagnosis to surgery to follow up recommendations including systemic therapy and radiation. I took my fellowship at Roswell Park in Buffalo and became proficient in Head and Neck, Soft Tissue tumors, Gastrointestinal malignancies, skin cancer, and of course breast cancer which is my specialty. There are other specialists who are expert in the fields of gynecology and urology.
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The axilla (armpit) is a very interesting anatomical part of the body. It contains many structures from skin, hair follicles, nerves, blood vessels, and lymph nodes to name a few. Any one of these structures can create a tumor. When I decide if a tumor is benign or not, I take several factors into consideration. If there is any doubt, I always do a needle biopsy to decide if the tumor needs to be removed. Usually tumors that are small and benign do not always have to be removed. We never wait for something to become malignant before we take it out. Benign tumors should be surgically considered if they continue to grow or cause symptoms like pain or become chronically infected or if they are cosmetically unsightly. If you have any concerns regarding your doctor's recommendations, go for another opinion.
Thanks for your question.
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Depends on your pain threshold. I send all my patients home after mastectomy in one and at most two days without reconstruction or with implant reconstruction.
-Single-sided or bilateral
-Flap reconstruction is usually three days before discharge
-There will be drains needed to be emptied that remain @ 2 sometimes 3 weeks
-The healing time for all surgery is about six weeks
-You will probably feel better many days before that
-The most common complaint I get is the sensation loss
-Your surgeon will have a timeline for you as to when you can return to normal activity
-I tell my patients @ 4 weeks let your body talk to you
-If you try to do something and it hurts a lot, back off a bit
-Use your better judgment
-If your not allergic, Extra strength Tylenol is great 2 pills every 6 hrs

Best off luck!!!

My rule is simple but requires each benign tumor a thoughtful approach. If a new tumor has been identified on a physical exam, mammogram, sonogram or breast MRI it is imperative we know what the pathology is If it’s a new finding in a young person and less than 2 cm, having benign characteristics:
-Homogeneous
-Smooth margins
-Wider than taller
-No acoustic shadowing
-To name a few
-It can be followed with a repeat study in 3 to 4 months
-If it enlarges or changes its characteristics, have a specialist do a needle biopsy
-If benign with no premalignant findings, it can be followed without surgical intervention
-If on follow up it continues to enlarge, remove the tumor
-If the tumor is greater than 2 cm no matter what the age or how it looks, I would recommend an excisional biopsy following a needle biopsy
-There are tumors that look benign and are not
-This is why a needle biopsy is my preferred initial approach to all breast tumors
-This way there are minimal surprises at the time of surgery when indicated

Best of luck !!!

Your question is a good one. Although simple, the answer is quite complex. Each modality of treatment you mention works differently and should not be interchanged with each other. Surgery and radiation therapy are local treatments while chemotherapy, immunotherapy and anti-estrogen treatments are systemic. Before initiating therapy, each patient’s tumor type should be detailed and understood as with this information a protocol will be set up sequencing each treatment needed. Surgery today is usual conservative, preserving the breast contour. Lymph nodes are usually sampled to stage the cancer if it is invasive. Chemotherapy if needed is very well tolerated. Each patient can request a cold cap to minimize hair loss. Radiation is usually associated with fatigue, but well-tolerated if needed. Having a good support team and a positive attitude makes the difference.
Thanks for the question. Best of luck!!!

Depending on the type you are having and who is going it. Generally the procedure should be done within a half hour.

The first evaluation I recommend is to see your gynecologist. Let them evaluate you and send you for appropriate testing mammogram and sonogram and needle biopsy if indicated. Most breast tumors are benign, however, you need to get this checked by your doctor now.

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I am adamant about the first breast biopsy being closed IE. A needle biopsy to find out what the abnormality is. Many of these findings do not require surgery.
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If the opinions are differing I would say yes. Treating breast cancer systemically is not a black and white issue.

If they are completely removed no. Could you get another of the same type in the same breast? Yes/

Hopefully the lump has been needle biopsied before it is removed to help the surgeon plan the correct surgery. Stop smoking for two weeks prior. Stop potential bleeding products 4 days before and after making sure you check with your medical doctor. Wash the breast the day before with an antibacterial soap that you are not allergic to. Usually the pain post op is tolerable and can be controlled with extra strength Tylenol.

Best of luck!!!

Usually one month, sometimes a bit longer. The healing and pain element is lessened once the drains are removed. With implant expanders the process is longer.

Best of luck!!!