Surgical Services
in Miami Florida

Total mastectomy is the removal of all of the breast tissue, including the nipple-areolar complex and some skin. It may be used in the treatment of breast cancer, but in other cases, it might be a preventative approach to prevent the development of the malignancy in high-risk patients.

Usually, to determine whether the mutated, malignant cells have spread beyond the area of the original tumor site to other bodily structures or lymph nodes, surgeons may also opt for performing other advanced techniques as well, such as sentinel node mapping and biopsy together with the total mastectomy.

Sentinel node mapping and biopsy can help gain crucial information about the state of the malignancy, which can help radiation and medical oncologists plan and carry out more effective treatments for the patient.

Also, a total mastectomy usually won’t involve lymph node removal from the armpit area. Axiliary node removal, or axillary lymph node dissection, is usually performed during another type of breast surgery called modified radical mastectomy.

In this variation of a mastectomy, a large portion of the skin is preserved, while the breast tissue and nipple-areolar complex are removed. This type of mastectomy is used in conjunction with immediate reconstruction, where a plastic surgeon reconstructs the breast. This allows for the maintenance of the

patient’s body image. This type of mastectomy can be used in the treatment of breast cancer and for risk reduction.

This type of breast surgery takes place under general anesthesia, meaning that the patient will be asleep during the procedure. The surgery will start with a small incision around the areola, and then, the surgeon will remove the necessary amount of breast tissue through the incision. In most cases, to enable effective tissue removal, the areola and nipple are also removed. Then, the sample is sent to a pathologist who will examine the breast tissue.

In some cases, the breast may be rebuilt, with the help of the patient’s own tissue, the use of temporary tissue expanders, or with the help of breast implants.

In some cases, if skin-sparing mastectomies, experts may also remove and check the nearby lymph nodes for cancer. In other cases, the areola and nipple may be saved.

As the name suggests, nipple-sparing mastectomy involves preserving the nipple-areolar complex while removing all breast tissue. Similarly to a skin-sparing mastectomy, nipple-sparing mastectomy is used in conjunction with reconstructive surgery performed by plastic surgeons. It can be used for risk reduction as well as for the treatment of breast cancer.

As you may know, the nipple and areola aren’t always spared during a mastectomy. When not opting for a total mastectomy, experts will first see whether they can perform a skin-sparing intervention, making the breast reconstruction process easier. If the surgeons can “save” the skin, they will also determine whether they can spare the areola and nipple as well. Generally, when safe, surgeons will leave both the nipple and areola intact. Remember, these breast surgeries aim to remove or reduce the risk of cancer, meaning that only experts aim to remove the least amount of tissue necessary.

Following the nipple-sparing procedure, surgeons may use the patient’s own breast tissue, temporary breast expanders, or breast implants to reconstruct the breast, restoring its cosmetic features as effectively as possible.

Patients who are undergoing mastectomy can also opt for immediate breast reconstruction surgery. Our breast surgeons work closely with plastic surgeons who perform breast reconstruction at the time of the mastectomy. Depending on the individual patient, this may be the only reconstructive procedure that is needed, or additional procedures may be required in the future.

There are two types of breast reconstruction- implant-based, where a breast implant is placed, and tissue-based reconstruction, where tissue from another part of the body is used to replace the breast. We partner with plastic surgeons who are adept in all forms of breast reconstruction.

Typically, reconstructive breast surgery is used after total mastectomies, skin-sparing, and nipple-sparing mastectomies. Regardless of which reconstructive route the patient and the plastic surgeon will want to take, our providers will focus on saving as many healthy structures and tissue as possible to make the reconstruction process faster, more effective, and less invasive.

The vital role of lymph nodes in our body is battling infections and tumors, which means that they are extremely reliable markers of the potential presence of harmful developments. In that battle, breast cancer cells may spread to the lymph nodes, most commonly to the axilla (armpit). The sentinel nodes

are the first lymph nodes that drain the breast. This is important because the tumor drains through them. If a sentinel lymph node is found to have cancer cells, it may change the way we approach your treatment plan.

A Sentinel node biopsy is a surgical procedure where a tracer material is injected into the breast (this may be done before the day of the procedure), the tracer is followed to the sentinel nodes, and these nodes are removed surgically for analysis.

The tracer material may be a blue dye or a radioactive substance (or both). Once removed, the experts check the sentinel node for malignant cells. If they are found, surgeons may remove additional lymph noodles during a follow-up procedure or during the initial biopsy. These procedures may be performed on an outpatient basis as they don’t require an extensive hospital stay.

Some patients who are found to have tumor cells in the axillary lymph nodes may require an axillary dissection. This surgical procedure is performed using the incision to the armpit to remove the axillary lymph nodes.

Opting for this method helps to determine the current prognosis and better understand what treatment options should be available.

In cases where tumors have been detected in later stages, patients may also have to count for cancer spread or metastasis. Tumors that have spread from the area of origin are typically more challenging to treat, often requiring more invasive treatment methods, which are usually combined. As mentioned above, axillary node dissection may help experts get a better understanding of the extent of the spread, which can help them create more effective treatment plans in even more advanced cases.

While not a type of breast surgery, axillary node dissection can play a crucial role in determining both the course of surgical and other treatments patients may receive.

A port is a device that is surgically implanted into the upper chest and is used for the delivery of chemotherapy. The port allows for easy access to the venous system without the need to start an IV.

Just as in the case of sentinel node biopsy and axillary node dissection, port placement isn’t a type of breast surgery but another intervention that might be used later in the treatment process.

On that end, port placement may yield the following benefits in the fight against cancer:

• Port placement will reduce the number of needle sticks needed to deliver the necessary chemotherapy.
• Port placement can enable experts to give treatments that last longer than a day, as the needle can safely stay in the port for several days.
• A port can enable providers to administer more than a single medication at a time.
• Enables experts to perform blood tests and provide chemotherapy the same day with a single needle stick.

An excisional breast biopsy is a surgical procedure used to diagnose abnormal tissue in the breast. An incision is made in the breast, and the abnormal tissue is removed and sent for analysis. This type of biopsy may be indicated with some types of breast lesions and in the case when an image-guided biopsy is not possible. This can be performed using a variety of localization techniques.

Usually, this type of breast surgery is performed due to the following reasons:

• You or your healthcare provider want the troubling lump removed. Even in cases when we’re talking about a benign lump or lesion, patients may want to remove them because it’s causing them pain or due to cosmetic reasons.
• There might be other concerns regarding the lump. Your provider might want to remove it and examine it under a microscope to see whether it’s malignant or not.

Typically the biopsy is performed under general anesthesia, but patients can opt for various other methods. The breast surgery typically takes around half an hour.

In most cases, surgeons will start the intervention by making a cut on the areola’s line, and they will remove the lump as they go through the breast gland.

The mammary gland producing milk is composed of alveoli or hollow cavities, which are padded with milk-secreting cells. Conjoint alveoli form lobules, and each of these lobules has its duct, which leads to the nipple.

Typically, nipple discharge that happens to occur in an affected patient might call for mammary duct excision. In this procedure, the affected milk ducts are removed for examination in the laboratory.

The main benefit of this type of breast surgery is that surgeons can remove the tissue, examine it up close, and find out what’s causing the discharge. In most cases, the underlying condition will be something benign, like milk duct widening (duct ectasia) or a warth-like growth developing in the milk duct (intraductal papilloma). In more than ten percent of cases, experts may find cancerous cells in their early stages, which usually means that further treatment will be necessary.

Also, healthcare providers may recommend mammary duct incisions in cases when the patient experiences recurrent abscesses in the breast. The surgery can help reduce the risk of further infections.

Male patients affected by gynecomastia or enlargement of breast gland tissue are not dealing with cancerous changes. Nevertheless, physical transformation is both aesthetically devastating and can be accompanied by feelings of tenderness and pain. Pseudo-gynecomastia or accumulation of fat in obese patients does not qualify for surgical treatment.

Subcutaneous mastectomy is the preferred surgical procedure for patients with gynecomastia. There are a few variations, and the principle is the same: making the smallest possible cut and extracting all of the breast tissue through an incision. With this method, the skin, the nipple, and the areola are left intact.

This breast surgery type is also performed under general anesthesia and takes somewhere between one and two hours to finish. The surgeon incisions around the areola and cuts out the excess glandular tissue from the breasts.

In some cases, the breast surgery is accompanied by liposuction if there’s also fatty tissue around the excess breast tissue. Lastly, often in the case of excess skin left over, surgeons may also remove the skin and recontour the breast.