solid mass in breast, best place to go?

[bostonmama]

I am 35 years old and pregnant with my 2nd child. I'm currently still in the first  trimester (7 weeks). The other day an ultrasound confirmed that a small lump I found in my left breast is a solid mass, not a cyst. I have been advised to schedule surgery for as soon as I'm in my 2nd trimester to have the lump removed and examined for breast cancer. Here are my current questions:

1. Is it safe to have a biopsy or the lump removed while I'm still in my first trimester, or should I definitely wait to have the procedure done until the 2nd trimester?

2. How do I go about finding the best place for me to have the biopsy done? I live in the Boston area. I'm interested in looking at rankings and reviews of local breast centers and surgeons' records, but have not been able to find that information. Given that I'm pregnant and, if all goes well, hope to breastfeed my 2nd baby, I want the best surgeon possible to avoid damage to the milk ducts. (The lump is very close to the skin's surface and to my areola.)

3. How will they tell whether I'm eligible for non-surgical removal of some of the lump's tissue?

Please advise. Thanks very much.

[Twocapes]

Before I moved out of the area, I used to use the breast center at Faulkner Hospital.  A few of the docs there were world renowned.  Good luck.

[platypus1]

Laura MB's description of a core biopsy is very accurate. However, I wouldn't worry about the procedure from the perspective of discomfort. It's pretty trivial. I did turn out to have cancer--though not during a pregnancy--and when I look back on the core biopsy compared with all that has followed, it was (relatively speaking) a mosquito bite. The important things is to go to a major cancer center (see my hospital recommendations above) and explain about your desire, if possible, not to mess with your ability to breastfeed. Given the location of your lump, you need a very good radiologist to make sure everything possible is done to spare your milk ducts. (Core biopsies are done by radiologists, not surgeons.) Ask whether an ultrasound-guided or stereotactic biopsy would be more appropriate for your case. The stereotactic one (another type of core biopsy, also done under local anesthetic) is a bit more complex and uncomfortable than the ultrasound-guided one, but still not a huge deal. Again, you need a breast expert to help figure out if one of the above biopsy methods (as compared with a surgical biopsy) would be possible, given the location of your lump, and to confer wtih your OB/gyn about the safety of doing any of this in the first trimester. Remember that the most important thing for your baby is to find out if you have cancer.

[platypus1]

I'm sorry about your stress-producing situation. Beth Israel Deaconess, Brigham and Women's, Dana Farber, and Mass General are all excellent. About the anesthesia issue: you may not require a surgical biopsy. Ask about the possibility of a core biopsy, which is an outpatient procedure done under injectable local anesthesia (sort of like getting a tooth filled). Perhaps that too would be contraindicated in your first trimester, but if it isn't, you might be able to do it and get results in 48 hrs, and then have surgery only if your lump turns out to be malignant. You might be able to get some idea of your chances of malignancy by seeing if the radiologist gave your previous scans a bi-rads score. (Higher scores mean a higher degree of suspicion.) Remember that even if you're unlucky, you've probably caught this early and you'll ultimately be fine. Good luck.  

[LauraMB]

I just went through the same thing. I live in Dallas, my OB/GYN recommended
a radiologist. I was terrified and read so many negative responses. The procedure was a little uncomfortable, but not painful. They inject Lidocaine which numbs your breast, I would insist on having a local anesthetic. They did 7 biopsies on one lump and six on a smaller one, with only one tiny incision in which they inserted the biopsy needle.
Of course the Xanax I took helped to relieve a lot of the stress I was feeling. lol
I had my results in 48 hours and had just a little discomfort afterward. I found it helped to leave the ace bandage on another day and to wear my bra when at all times, especially while sleeping. The worse part is waiting for the results. I was blessed that my biopsies were all benign. I wish you the best and will keep you in my prayers!

[boninclyde]

Where are you located? Find a good breast care center.

[Cleveland Clinic]

Dear Bostonmama:  The concern about doing a lumpectomy in the first trimester is about anesthesia risk.  Without reviewing the specifics of your situation, including the ultrasound and doing a clinical breast examination, it is not possible for us to speculate on the best way to proceed.  Certainly, risk must be weighed against benefit.  Our advice is to seek out a breast specialist.  These are likely found in the bigger academic medical centers.   You might try going to the website of the National Cancer Institute where you can find a list of NCI-designated comprehensive cancer centers in your area.   Although, you have not been diagnosed with breast cancer, these academic centers are likely to have breast centers with breast specialist s who should be able to evaluate the facts and make recommendations as to the type of and timing of a biopsy.