• Breast swelling and tenderness
• Breast pain
• Breast cysts
• Benign breast lumps
  • Fibroadenoma
  • Papilloma
  • Hamartoma
  • Pseudoangiomatous stromal hyperplasia
• Galactoceles
• Nipple discharge
• Breast infections
  • Mastitis
  • Abscess
  • Chronic recurrent subareolar abscess

Image guided Ablation of Benign Breast Tumors (cryoablation)

Navigating your way through your diagnosis and treatment:

• Lumpectomy = Partial Mastectomy
• Total Mastectomy
• Skin Sparing Mastectomy
• Nipple Sparing Mastectomy
• Modified Radical Mastectomy
• Sentinel Lymph Node Biopsy
• Complete Lymph Node Dissection
• Oncoplastic Surgery – advanced surgical techniques
• Breast Reconstruction following Mastectomy
• Breast Reconstruction following Lumpectomy or Partial Mastectomy
• Radiation Therapy including whole breast irradiation and partial breast irradiation
• Systemic Adjuvant Therapy for Breast Cancer
  • Endocrine Therapy
  • Chemotherapy
  • Immunotherapy 
  • Targeted Treatment Modalities
• Treatment of Locally Advanced Breast Cancer
• Treatment of Bilateral Breast Cancer
• Treatment of Male Breast Cancer
• Treatment of Breast Cancer in the Pregnant patient
• Treatment of Breast Cancer in the previously Augmented Breast: special considerations
• Treatment of Local Recurrence of Breast Cancer
• Treatment of the Unknown Primary Presenting with Axillary Lymphadenopathy

A Clinical Breast Exam (CBE) is a physical exam done by a health care provider. The exam will begin with a visual inspection of the breasts. A complete exam is then performed of the breast tissue as well as tissue under the arm (armpit). This exam is done with you sitting up as well as with you laying down. As indicated, the complete physical exam of the breast tissue will often be enhanced by the use of ultrasound, allowing a more accurate, real time evaluation of the breast tissue.

CBE is generally recommended as part of breast cancer screening for women. CBE continues to be a part of routine screening, even after you begin having mammograms.

At The Breast Health & Wellness Center, Dr. App and her team combine the clinical breast exam with all of your personal information, resulting in a comprehensive breast examination which includes the following:

• Complete physical exam
• Detailed History identifying any risk factors present that may put you at increased risk for the development of breast disease
  • Advancing age
  • Being younger when you had your first menstrual period
  • Starting menopause at a later stage
  • Being older at the birth of your first child
  • Never giving birth
  • Not breast feeding
  • Personal history of breast cancer or ovarian cancer
  • Personal history of benign proliferative disease of the breast (non-cancerous) which includes Atypical Ductal Hyperplasia, Atypical Lobular Hyperplasia, Flat Epithelial Atypia, Lobular Carcinoma Insitu
  • Personal History of previous breast biopsies
  • Family history of breast cancer (mother, sister, daughter)
  • Treatment with radiation therapy to the breast/ chest wall in the past; for example Mantle field radiation for the treatment of Hodgkin’s Lymphoma
  • Being overweight
  • Long term use of hormone replacement therapy (estrogen and progesterone combined)
  • Using birth control pills (oral contraceptives)
  • Drinking alcohol (more than one drink per day)
  • Not getting regular exercise

• Detailed Family History including three generations which identifies your level of risk
• Calculation of Gail Risk Model and Tyrer-Cuzick Risk Model
• Real time review of your mammogram and any other imaging you may have completed
• As indicated, breast ultrasound which allows a real-time “look” inside the breast tissue
• Calculation of whether you are a candidate for high risk screening breast MRI

This comprehensive breast examination is the first step in optimal breast health and breast cancer prevention.

Dr. App is proud to be one of a handful of surgeons in the country to offer cryoablation for the treatment of breast tumors. Cryoablation is safe and effective in treating breast fibroadenomas. It offers a nonsurgical, office-based treatment that completely eliminates the fibroadenoma and is well tolerated by patients. This advanced technology eliminates the fibroadenoma with no volume deficit to the breast, offers excellent cosmesis, earlier return to normal activities and highly satisfied patients. Ultrasound-guided cryoablation is the preferred option for treatment of breast fibroadenomas, avoiding the need for open surgery.

Dr. App has been performing this advanced technology for fibroadenomas of the breast since 2009. Dr. App is currently working with colleagues nationally on the future possibility of treating breast cancer with cryoablation.

Due to insurance denials this program is currently on hold.

Genetic testing for cancer susceptibility is an important area of medicine. We are committed to cancer prevention, early detection and improved disease management. Our Center is equipped with the tools to facilitate proper patient identification and risk assessment.

Our Center provides education on genetic testing, performs the testing as well as provides resources and personnel that assist with family testing.

All breast cancer patients should consider genetic testing at the time of their initial breast cancer diagnosis. This information may change our recommendations for you and may decrease the risk of you developing additional disease in the future.

FACTS:

Young patients with germline mutations in BRCA1 or BRCA2, PALB2, ATM, CHEK2, CDH1, TP53 and PTEN and the many other newly discovered breast cancer genes, have a higher risk of developing ipsilateral and contralateral second primary tumors than women with sporadic breast cancer. Therefore, knowing the mutation status of women diagnosed with breast cancer is essential to providing mutation-positive women with appropriate medical management options that may significantly reduce the risk of future breast cancer diagnosis.

Consider testing if you meet any of the following criteria:

Identification of a genetic alteration provides awareness of a patient’s risk for other cancers. For example, in the BRCA1, 2 population these patients are at increased risk for ovarian cancer.   CHEK 2 patients are at increased risk for colon cancer.  Knowing that you are at increased risk for the development of certain cancers allows the patient to obtain increased surveillance in the areas of risk and prevent the cancers.

The Breast Health & Wellness Center is committed to cancer prevention, early detection and improved disease management. It is our goal to identify patients at high risk and empower these Ladies with the knowledge to seek proper screening and necessary surveillance in an effort to find the disease at the earliest possible stage or prevent the disease.

The Breast Health & Wellness Center offers:

• Risk Assessment including Gail Risk Model and Tyrer-Cuzick Risk Model and Claus Risk Model
• Up to date large panel genetic testing which analyzes 84 genes associated with major cancers including breast, colorectal, ovarian, endometrial, pancreatic, prostate, gastric and melanoma.
• Individualized management strategies for women who test positive for the BRCA 1 or BRCA 2 mutation. This management includes consideration of the following risk- reduction measures:
  • Prophylactic oophorectomy
  • Prophylactic mastectomy
  • Anti-hormonal therapy
  • Increased surveillance, including breast MRI Digital Breast Tomosynthesis and breast Ultrasound
• Educational programs, town meetings, and classes that focus on educating the general community about screening guidelines, accessing care and early detection and treatment for breast cancer
• Alternative therapies and wellness programs, including weight management and dietary guidelines for cancer prevention

According to the CDC (Center for Disease Control and Prevention) Breast Cancer Risk Factors can be found at the CDC website, click HERE for more information.

Having a risk factor does not mean you will get the disease. Most women have some risk factors and most women do not get breast cancer. If you have cancer risk factors, talk with our dedicated Providers about screening for breast cancer.

The preoperative diagnosis of breast cancer by minimally invasive methods is now the standard of care. The advantages include the following:

• Small scar
• Excellent cosmesis
• Efficient
• Minimal pain
• Results in greater likelihood of achieving negative margins at surgery
• Allows better planning for the definitive breast cancer surgery and reduces the number of operations required to treat breast cancer.

This biopsy procedure is a quick outpatient procedure performed in the comfort of our office under the guidance of ultrasound. The procedure requires a tiny 4 mm skin nick, requires no suturing and leaves little to no surface scarring. Patients are able to resume normal activity hours after the procedure.

Dr. App is a leader in minimally invasive biopsy and has been performing this procedure since 2006.   We are proud to offer you the most advanced and least invasive techniques to conserve breast tissue, reduce pain and minimize scarring.

A well- balanced diet rich in calcium and vitamin D is important. Good sources of calcium include low-fat dairy products; dark green, leafy vegetables; and calcium-fortified foods and beverages. Supplements can help ensure that the calcium requirement is met each day, especially in people with a proven milk allergy. The Institute of Medicine recommends a daily calcium intake of 1,000 mg (milligrams) for men and women up to age 50. Women over age 50 and men over age 70 should increase their intake to 1,200 mg daily.

Vitamin D plays an important role in calcium absorption and bone health. Food sources of vitamin D include egg yolks, saltwater fish, and liver. Many people, especially those who are older or housebound, may need vitamin D supplements to achieve the recommended intake of 600 to 800 IU (International Units) each day.

In the past two decades, oncoplastic breast surgery has gained widespread acceptance within the United States. Oncoplastic breast surgery is a term used to describe techniques that combine the principles of surgical oncology with those of plastic surgery in order to control cancer while producing a desirable cosmetic result. There are many advantages to this advanced technique including the ability to remove a larger area of breast tissue around the tumor as well as the ability to immediately reshape the breast, resulting in a superior cosmetic outcome to lumpectomy alone.

Dr. App is proud to offer this option to patients and the technique often involves her Plastic Surgeon Colleagues. Dr. App believes in this technique because it allows more effective cancer removal, allows for a wider safety margin, and lowers the risk of recurrence. This technique also preserves the shape and appearance of the affected breast.

In appropriately selected patients, the overall goal of oncoplastic surgery is to remove the cancer with a large margin of normal tissue and leave the patient’s breast with a more cosmetically pleasing result than prior to the cancer removal. In general, patients are thrilled with the results.

Intraoperative ultrasound guidance (IOUSG) was developed in 1988. It is an ultrasound probe that is used to localize the breast tumor in the operating theatre. IOUSG improves the surgical accuracy of breast cancer excision. IOUS enables the surgeon to optimally position the incision on the breast and to operate under direct vision. This technique facilitates the surgeon to achieve optimum resection volumes, reducing the unnecessary resection of healthy breast tissue and contributing to improved cosmetic results and quality of life. Ultrasound-guided surgery can significantly reduce the need for a second surgery. This technique is non-invasive, simple, safe and comfortable for patients. The use of intraoperative ultrasound is also cost efficient.

Dr. App has been utilizing intraoperative ultrasound since 2007, and has performed thousands of ultrasound directed surgeries.

The Breast Health & Wellness Center is committed to breast cancer prevention. We believe, the first step in breast cancer prevention is to identify women who may be at higher risk than a general population woman to develop breast cancer.

A routine part of your visit at the Breast Health & Wellness Center will include an Individual Risk Assessment. Our nurses will enter your personal data and comprehensive family history into the Mastery of Breast Surgery Program through the American Society of Breast Surgeons.   This will allow immediate calculation of three risk models : Gail Risk Model, Tyrer-Cuzick Risk Model and Claus Risk Model.

This information identifies your lifetime risk for the development of breast cancer. This information, as well as the comprehensive breast exam that will be performed during this consultation as well as review of your imaging studies, will allow Dr. App to determine your level of risk to develop breast cancer. You will then be catergorized into the following:

Low Risk

Intermediate Risk

High Risk

A Tailored Screening Program will then be provided to you based on your individual risk.

Example of Low Risk:

For example, a woman with fatty breast tissue (non-dense) and no family history of breast cancer has a low risk and will be recommended:

Annual screening digital mammography

Monthly self breast exams

Annual breast exam by Physician

Example of Intermediate Risk Woman:

This may be a woman who had her first baby after age 35 or has never had children, her breast tissue is mildly dense, she may have had a previous biopsy revealing atypical cells and she has a some family history of breast cancer.

Her tailored screening program may include:

Annual screening digital mammography, may consider 3-D mammogram (Tomosynthesis)

Monthly self breast exams

Annual breast exam by Physician

Screening breast US may be considered

These patients do not typically meet insurance criteria for standard high risk screening breast MRI, however may be a candidate for and an abbreviated form of screening breast MRI (cash pay)

Example of High Risk Woman:

• This may be a woman who has a strong family history of breast cancer, has dense breast tissue, has required previous breast biopsies showing atypical cells.
• Woman who has had previous mantle radiation for childhood Hodgkin’s Lymphoma
• Woman with Neurofibromatosis
• Woman with any of the following genetic mutations:

BRCA 1 , BRCA 2                      ATM                                     PALB2

MMR                                         CHEK2

APC                                            BARD 1

PTEN                                         BRIP1

SMAD4                                     RAD51C, RAD51D

STK11                                        NBN

Example of High Risk Tailored Screening Program

Monthly self breast exams

Annual breast exam by Physician

Annual screening 3-D mammogram (Tomosynthesis)

Annual High Risk Screening Breast MRI

Breast Ultrasound as indicated

• The message is, all women do not have the same risk for the development of breast cancer and The Breast Health & Wellness Center can assist in identification of your personal risk for the development of breast cancer and provide you with the Tailored Screening Program you deserve!

For more information please follow this link to the breast360.org/en/topics/2015/10/23/breast-cancer-screening-101/