Changes To Scar Tissue Or Something More Worrying
I am hoping some of you ladies can advise me.
I had a WLE 3 and half years ago followed by rads. The WLE was quite big, taking a fair amount from the front of my breast including most of the nipple. I was left with what always seemed like a lot of really hard scar tissue, in fact it felt as if someone had shoved a misshapen lump of concrete in my boob. Most of the scar tissue went alongside the top and bottom of the scar line but there has always been an irregularly shaped bit which poked up from the rest of the scar tissue.
Over time Ive noticed that the scar tissue seems to have lessened, as if its taking up less of my breast than it used to. The irregular poking up bit is still there but even that seems smaller. It is still as hard as ever.
About a week ago I noticed a slight new dent just above the poking up bit. Is it possible for scar tissue to change/shift about 3 years down the line? My OH thinks it has just shrunk back a bit more but I dont know if scar tissue continues to change. I have to see my consultant next week for results of a bone scan, which is already stressing me out. I know Im going to have to front it up and ask him about the little dent at the same time and hope he can give me reassurance there is nothing sinister, but it is just adding to my worry. I did have a mammo 2 months ago which was clear.
Have any of you has anything similar? Do you know if scar tissue can continue to change a bit over time? Any advice would be welcome.
Cooper’s Ligament Fibrosis And Scars
Cooper’s ligaments are the supporting structures of the breast, and most people are familiar with these as the ligaments you wish to keep in shape as you age. Stretching of these ligaments over time are behind to slang “Coop’s droop” referring to the “descent” of breasts with age.
Fibrosis of Cooper’s ligaments can occur due to both benign and malignant breast changes.This is one way in which underlying tumors result in nipple retraction and changes in the surface of the appearance of the skin. But benign breast conditions, such as inflammation, fat necrosis, and biopsy scars can also damage these ligaments causing the surface appearance of breast cancer.
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What Happens After A Breast Mri
You should move slowly when getting up from the scanner table to avoid any dizziness or lightheadedness from lying prone for the length of the procedure.
If any sedatives were taken for the procedure, you may be required to rest until the sedatives have worn off. You will also need to avoid driving.
If contrast was used during your procedure, you may be monitored for a period of time for any side effects or reactions to the contrast, such as itching, swelling, rash, or difficulty breathing.
If you notice any pain, redness, and/or swelling at the IV site after you return home following your procedure, you should notify your health care provider, as this could indicate an infection or other type of reaction.
Nursing mothers may choose not to breastfeed for 12 to 24 hours after a breast MRI with contrast.
Generally, there is no special type of care required after a breast MRI scan. You may resume your usual diet and activities, unless your health care provider advises you differently.
Your health care provider may give you additional or alternate instructions after the procedure, depending on your particular situation.
What Are Breast Calcifications
Breast calcifications are small dots of calcium salts that can occur anywhere in the breast tissue. They are very small so you wont be able to feel them, and they dont cause any pain.
Breast calcifications are very common. They are usually due to benign changes that occur as part of aging.
Sometimes they form because of other benign changes in the breast, such as a fibroadenoma or breast cyst. They can also form if youve had an infection in your breast, if youve injured your breast, or if youve had surgery or a breast implant.
Breast calcifications can develop in the blood vessels of the breast. These may be age-related or caused by other medical conditions but dont usually require further assessment.
Breast calcifications are more common in women, but can also be found in men.
Occasionally, breast calcifications can be an early sign of cancer. Because of this, you may need further tests to check what sort of calcifications you have.
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More About Lactating Adenomas In Mammogram Images
Mammograms of lactating adenomas will tend to show an oval well-circumscribed mass with radiolucent central areas .
Ultrasounds of lactating adenomas tend to reveal the heterogeneous echotexture of the tumor, with central hyperechogenic areas. The radiolucent and hyperechogenic areas will indicate the fat content of the milk secretions in the tumor.
Since lactating adenomas occur in pregnant and breastfeeding women, this tends to simplify diagnosis. An abscess, for example, would be unlikely in the absence of:-
- skin edema
Lactating adenomas also tend to be only slightly painful, unlike an abscess. But, to exclude any possibility of malignancy a fine needle biopsy is usually performed anyways.
Fine needle biopsy is actually preferred over a core biopsy in suspected lactating adenomas because milk secretions can find their own paths through various tissues and confuse the issue.
In the cytologic image of lactating adenoma below, there are many more ducts than would normally occur . The ducts are dilated and contain milk secretions. The proliferation of new ducts distinguishes the lesion from a simple galactocele, which is just an accumulation of milk that cannot escape through normal channels.
Cytology of Lactating Adenoma
Lactating adenomas, like fibroadenomas, are somewhat prone to infarction , and this can lead to some strange and misleading features, possibly suggestive of malignant breast cancer.
Some of these features may include:-
Breast Biopsy And Cancer
A breast biopsy is a definitive test if a cancer is suspected. This can be done as a fine needle aspiration biopsy , core needle biopsy, stereotactic breast biopsy, or open surgical biopsy. If the results of a core biopsy and imaging studies are discordant, a surgical breast biopsy usually follows.
A biopsy can also determine the type of cancer if one is present and the presence of estrogen, progesterone, and HER2 receptors. As noted above, even for women who have mammogram and ultrasound findings suggestive of cancer, it is still more likely that a biopsy will be benign.
Even with a biopsy, there is still a small chance of both false-positives and false-negatives .
So what are the breast conditions that mimic breast cancer on an exam or imaging reports that necessitate a biopsy? There are several we will look at here. Some of these are more common than others, and the conditions below are not listed in order of prevalence.
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Do Breast Calcifications Mean That I Have Breast Cancer
Many women experience a phone call from their breast imaging center. The call often concerns the patient coming back for additional imaging of tiny white spots called calcifications. Calcifications are frequently seen on mammograms they occur most often in women over 50. They may appear in any woman’s breasts and, occasionally, occur in a man’s breast tissue.
Most breast calcifications are benign . However, a few patterns of calcification are suggestive of some precancerous conditions or, even, breast cancer.
Lets Do Some Q& a About Mammography
How are mammograms done?
During a mammogram, your breasts are compressed between two firm surfaces to spread out the breast tissue. Then, an x-ray captures black and white images of your breasts that are displayed on a computer screen and examined by a doctor who looks for signs of cancer.
How can mammograms be used?
A mammogram can be used either for screening or for diagnostic purposes.
How often should you have a mammogram?
It all depends on your age and your risk of breast cancer.
How do I know when I should begin screening mammography?
Some general guidelines for when to begin screening mammography include women with an average risk of breast cancer and woman with a high risk of breast cancer.
What are the risks?
Some known risks and limitations of mammograms include the following: Mammograms:-
- expose you to low-dose radiation
- are not always accurate
- can be difficult to interpret in younger women
- may lead to additional testing
- can not detect all breast cancers
- may show cancer, but not all of the tumors can be cured
How do I prepare for my mammogram appointment?
- Choose a certified mammogram facility
- schedule the test for a time when your breasts are least likely to be tender
- bring your prior mammogram images
- do not use deodorant before your mammogram
- consider an over-the-counter pain medication if you find that having a mammogram is uncomfortable.
What can a radiologist possibly find on my mammogram imaging?
Well, possible findings can include:-
- calcium deposits
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What Are Some Common Uses Of The Procedure
An ultrasound-guided breast biopsy can be performed when a breast ultrasound shows an abnormality such as:
- a suspicious solid mass
- a distortion in the structure of the breast tissue
- an area of abnormal tissue change
There are times when your doctor may decide that ultrasound guidance for biopsy is appropriate even for a mass that can be felt.
Ultrasound guidance is used in four biopsy procedures:
- fine needle aspiration , which uses a very small needle to extract fluid or cells from the abnormal area.
- core needle , which uses a large hollow needle to remove one sample of breast tissue per insertion.
- vacuum-assisted device , which uses a vacuum powered instrument to collect multiple tissue samples during one needle insertion.
- wire localization, in which a guide wire is placed into the suspicious area to help the surgeon locate the lesion for surgical biopsy.
Re: Changes To Scar Tissue Or Something More Worrying
Hi again Ladies,
Just wanted to update you. Had appointment at breast clinic yesterday. Doc examined me pretty thoroughly and said nothing to worry about – all just scar tissue and nothing suspicious.
He said that as well as scar tissue forming after op and rads, the surgery site also fills up with a kind of fluid that also hardens and feels like scar tissue too. However over time this hardened fluid gradually dissipates and can leave you with a bit of a dented look. Thats what I’ve got. He said the scar tissue itself may also shrivel and feel less obvious eventually but will never completely go, there will always be some hard lumpiness there. He also confirmed – just as you said SGL – that when they check the mammos they will look very carefully at the surgery area.
The orginal reason for my appointment was to get results of bone scan and that was OK too! Just got normal wear and tear – big, big relief all round.
Thanks so much to all for posting. I really hope you are all doing as well as you can on this BC rollercoaster.
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What Do Breast Calcifications Mean
Breast calcifications may not be significant, but experts agree that the radiologist reading your mammogram should study the images to determine if your calcifications are a symptom of breast cancer.
Calcifications appear as small white dots. If the radiologist sees these dots, he looks at them to determine several characteristics:
- Size small or large.
- Shape round, irregularly-shaped like popcorn, or rod-like.
- Pattern randomly scattered or clustered.
Your doctor and the radiologist, based on their experience, determine if follow-up is necessary. The radiologist will compare your new mammogram to the previous one for comparison, if possible. Patients may be called back for a second mammogram, called a diagnostic mammogram. The second mammogram provides additional views of the suspicious areas. The radiologist then classifies the calcifications:
- Clearly benign
- Likely benign
- Suspicious or suggestive of cancer
If your doctor detects breast calcifications during a mammogram, an oncologist can help determine if additional testing is needed. Consult with one of our breast cancer specialists in the Portland, OR and Vancouver, WA areas.
Scar Tissue After Breast Biopsy
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Lactating Adenomas In Mammogram Images
Breast cancer is very uncommon in younger women. So, if a young woman who is pregnant came in for a screening of a palpable breast lump it is far more likely that the lesion is a fibroadenoma of some kind.
One common variation of fibroadenoma in pregnant women is a lactating adenoma, which is essentially a tubular adenoma that occurs in pregnant women. Lactating adenoma features the accumulation of milk secretions in addition to hyperplasia.
Breast X-rays are not normally given to pregnant women. Given that breast cancer is very unlikely and lactating adenoma is quite likely, ultrasound and possibly a fine needle aspiration biopsy would typically be utilized for diagnostic investigations.
The main concern with a lactating adenoma from the perspective of breast cancer is that the condition can occur simultaneously with breast cancer. However, on their own, they indicate no increase in the risk for subsequent breast cancer development.
In the ultrasound image of lactating adenoma below, one notes a hypoechoic, non-cystic mass in an ovoid shape. It has a long axis running parallel to the skin, posterior acoustic enhancement, and well-defined margins.
Breast Ultrasonography And Magnetic Resonance Imaging
Breast ultrasonography can be used to distinguish between solid and cystic masses in the breast. It can be used to evaluate a focal mass identified on a mammogram or a palpable mass. It is also used as an adjuvant for biopsy. Because of its low specificity, it is not thought to be a good modality for screening. It cannot replace mammography because it has no ability to detect microcalcifications. Ultrasonography can complement mammography in young women with dense breasts because dense breasts limit the accuracy of the mammogram.
Magnetic resonance imaging has a high sensitivity for the detection of breast cancer, and it is not affected by breast density. Screening studies to date have been done in high-risk patients, primarily those at risk because of known or suspected BRCA mutations or a family history of breast cancer. A systematic review by Warner and colleagues in 2008 identified 11 prospective studies of MRI screening. In the systematic review, MRI’s sensitivity was 75%. Combining mammography and MRI increased the sensitivity to 84%. The specificity of MRI was comparable but marginally lower than the specificity of mammography . These studies on the use of MRI for surveillance of women at high risk for hereditary breast cancer have demonstrated a substantial benefit for breast cancer detection.
The optimal point in time to perform the MRI in relation to mammography has not currently been determined.
Mary L. Gemignani MD, in, 2012
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Inserting A Metal Marker
Sometimes a small metal clip may be placed in the breast where the biopsy has been taken. This is so the area can easily be found again if a further biopsy or surgery is necessary. If another procedure isnt needed, the clip can be safely left in the breast.
The marker clip is usually made of titanium . It will not set off alarms at airports. Most clips are now suitable for having an MRI, but if the marker clip is left in and you need to have an MRI scan in the future, let your doctor or radiographer know.
Infectious Mastitis And Breast Abscess
Breast abscess is a complication of infectious mastitis. Abscesses can be associated with lactation, in the case of puerperal abscesses, or independent of pregnancy, in the case of nonpuerperal abscesses . Puerperal abscesses tend to be peripheral in location and are often easily recognized clinically. Nonpuerperal abscesses can pose a diagnostic challenge and are more commonly seen in younger women. They are usually periareolar and typically have worse outcomes and a higher rate of recurrence than puerperal abscesses. The risk factors for nonpuerperal breast abscesses are thought to include smoking and diabetes .
Mammographically, mastitis and breast abscess present with skin thickening, asymmetry, a mass, or architectural distortion . Sonographic features of breast abscesses include one or more hypoechoic collections of variable shapes and sizes that are often continuous and multiloculated . Breast abscesses typically demonstrate a thick echogenic rim and increased vascularity, suggesting malignancy . Associated mastitis presents as an area of increased parenchymal echogenicity, representing inflamed glandular parenchyma. Skin thickening, distended lymphatic vessels, and inflammatory axillary adenopathy can also be seen. On MRI, breast abscesses will typically be T2-hyperintense, have progressive enhancement kinetics, and sometimes have the characteristic thin rim of peripheral enhancement .
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