Breast Care Unit

Our Breast Care Unit brings together the specialist staff needed to provide breast care services for the local Hillingdon Community. The majority of patients attending our clinics are assessed and investigated on the same day at ‘one-stop’ clinics. In the last year 2700 women were assessed and were evaluated at our unit, and around 200 women were diagnosed and treated by our dedicated multidisciplinary team of staff that specialise in breast disease and breast cancer management.

We provide a comprehensive service with assessment in breast clinics and same day imaging (if necessary). Patients who require operative management of breast disease can be discharged on the day of surgery from our specialist Day Care Unit. We also provide an Oncology Service (if required) and a full breast reconstruction service.

Referral to our service

Most of our patients are referred for assessment by their GP or less frequently after their screening mammogram recall.

If you are concerned about a breast lump or another breast symptom such as pain or nipple discharge, contact your GP and arrange an appointment with them. Once your GP has assessed you, they may feel it is appropriate to refer you for further assessment by our team. If they tell us there is any concerning features on initial assessment we aim to see you within two weeks. We will contact you with an appointment date to be seen on a weekday morning or afternoon.

At that appointment, you will be further reviewed by a doctor. Please bring details of any medication you take, information about previous medical or surgical problems and knowledge of any cancer in family members. If you have ever had breast implant surgery please bring as much information regarding the implants as is possible. From the doctor’s assessment they will make a decision as to whether you need further tests which might include mammograms, ultrasound scan and/or biopsies. We can usually do these tests on the same session as your appointment. Please allow for three to four hours for your appointment to allow for these additional tests.

If you have a mammogram or an ultrasound scan, you will most likely be told what this shows by the end of the assessment. If biopsies are taken, the results take longer as these have to be examined under the microscope in the pathology laboratory and so we will make an arrangement to tell you the results usually within two to three weeks either by a second appointment or a telephone conversation.

Call back following your routine screening mammograms

If your screening mammogram has shown something that requires further assessment you may have been recalled to the screening centre (i.e. Charing Cross Hospital). The screening centre will have reviewed your results and decided that you would benefit from attending the Breast Unit at Hillingdon Hospital. At this appointment, the surgeon will explain what the concern is and suggest further management based on the previous results and recommendations from the Screening Unit and Multi-Disciplinary Team meeting.

Understanding my scans

Your specialist will decide the appropriate scan to guide further assessment after taking a short history and performing a clinical examination.

Mammogram »

Mammogram is a breast X-ray and is the standard method of imaging for patients above the age of 40. Your breasts will be placed individually on the x-ray machine. The breast will be pressed down firmly on the surface by a clear plate. At least two pictures of each breast will be taken, one from top to bottom and then a second from side to side to include the part of your breast that extends into your armpit. You will need to stay in this position while the x-ray is taken.

You may find this process uncomfortable, but the compression does not harm your breast tissue and lasts only a few seconds. Please inform us if you had a mammogram within the last 12 months as you may not need a repeat mammogram if you had one in the last year. A mammogram is a useful tool for diagnosing breast disease is it can check the whole of both breasts and allow the radiologist to compare left with right as well as comparing with previous mammograms. It is therefore a key investigation for a number of women.

Ultrasound scan »

An Ultrasound scan is another type of scan your specialist might decide that you need. This is typically a targeted scan to check an area of concern in more detail. This will be performed by one of our experienced radiologists. To help gain a clear image of the breast, some gel will firstly be spread over a targeted area in the breast. The radiologist doing the scan will move a handheld scanning probe over the breast to look at the underlying tissue. The area under your arm (axilla) may also be scanned. The advantage of ultrasound is that it can be used in younger patients and in patients above the age of 40 it can be used as another mode of imaging with mammograms.

MRI »

Magnetic resonance imaging (MRI) is only used in certain circumstances, typically in the diagnosis of specific forms of breast cancer, when planning complex surgery and when breast cancer cannot be adequately visualised with other imaging types. The consultant radiologist will advise as to whether a MRI is required. MRI is a very sensitive test and frequently identifies areas of the breast that require further investigation such as "second-look ultrasound" or further biopsies.

CT scan »

Computerised tomography (CT) scans are rarely used in the initial diagnosis of breast cancer. However, sometimes a patient has a CT scan for another reason, which detects an abnormality in the breast incidentally. In these cases, the doctor who organised the first scan may refer the patient to the Breast Unit for clinical examination and mammograms or ultrasound scan as necessary.

A CT scan is sometimes useful after breast cancer has been diagnosed to look for any breast cancer deposits (metastases) elsewhere in the body. This is usually requested on the advice of the oncologists.

Bone scan »

A bone scan is occasionally performed to rule out any bony metastasis if there is suspicion of a bony finding on CT scan.

Understanding my biopsy

A biopsy is when a sample of cells or tissue is taken so that they can be examined under the microscope. The majority of breast lumps are benign (non-cancerous) however it is sometimes necessary to take a biopsy to confirm the diagnosis of what has been seen on scans.

If a biopsy is required, this will be explained to you. The biopsy results, typically, takes a couple of weeks and you may need a follow-up appointment to discuss them.

There are four sorts of biopsies that are carried out in Breast Care:
  • fine needle aspiration cytology
  • core biopsy
  • skin punch biopsy and vacuum biopsy
  • .

These procedures carry a small risk of complications and we take steps to minimise the risks. Most people will get some bruising after their biopsy. The commonest complication after a biopsy is bleeding, which may result in a haematoma (small collection of blood), so if you have a clotting disorder (such as haemophilia) or take any medications that may increase your risk of bleeding you should tell us. This may include rivoroxiban, apixiban, warfarin, aspirin, ticagrelor or clopidogrel.

Fine needle aspiration cytology »

Fine needle aspiration cytology is where a needle and syringe are inserted into the area of concern and a cell sample is taken. These are then sent to the pathologist to be examined under the microscope.

Core biopsy »

This method is designed to take cells from the center of a lump. Core biopsy is a procedure where an injection of local anaesthetic is used to numb the skin before a needle is introduced through a small cut in the skin. Once the needle is in the appropriate targeted area, the biopsy is taken - there is a loud click as this is being done, as the biopsy needle is spring-loaded. Several core biopsies may need to be taken to get a representative sample. These are then sent to the pathologist to be examined under the microscope.

Skin punch biopsy »

Skin punch biopsy is used when a concerning area is on the skin of the breast rather than the underlying breast tissue. This biopsy is done after an injection of local anaesthetic to numb the skin. A small circle of skin is then removed and is sent to the pathologist to be examined under the microscope.

Vacuum biopsy »

This type of biopsy is rarely done on the first visit and it will be explained if it is needed. It is usually done when an initial biopsy has not produced enough tissue for the pathologist to make the diagnosis. Sometimes vacuum biopsy can be used to remove small abnormalities completely. In each case, all the tissue removed is then sent to the pathologist to be examined under the microscope.

Vacuum excision »

This is performed by our Consultant Radiologist as per the guidelines for atypical lesions.

Understanding breast cancer management

The majority of patients who come to the breast clinic have a benign diagnosis (non-cancerous) and do not need ongoing care as they have been reassured at the one-stop clinic. However, if a diagnosis of cancer has been made for you or your relative, a number of the following options will be discussed following our multi-disciplinary team meeting.

Breast cancer treatment

Once you have been diagnosed with breast cancer, you will be offered treatment. There are several different ways of treating breast cancer and most people will be offered a combination of treatments. For example, you may be offered surgery only, or surgery followed by radiotherapy and/or chemotherapy. Alternatively, you may be offered chemotherapy before surgery or you may not require any chemotherapy at all. Your treatment plan will depend on a number of different factors including; the features of your cancer (such as size of the cancer, appearances on biopsy, lymph node involvement in the armpit), whether you are fit to undergo a particular treatment and your preferences (such as whether you want to have a mastectomy with breast reconstruction).

In common with most breast cancer units in the UK, any significant treatment recommendations for you will have been discussed in a meeting of the multi-disciplinary team (MDT) which includes different specialist in the treatment of breast cancer. Usually, this team consists of a specialist breast oncologist, surgeon, radiologist and pathologist. In practice, the MDT meeting usually includes several representatives from each discipline, along with a coordinator, unit manager, breast care nurses as well as doctors in training and medical students. In your next clinic appointment after this meeting, your treatment plan or potential options will be discussed with you. Many people find it helpful to bring a friend or family member to these clinic appointments.

As sometimes there is a lot of information to take on board, one of the breast care nurses will usually be present in the consultation to support you and afterwards will make sure you have any written information you need to take away.

Breast cancer surgery

Most people who are diagnosed with breast cancer will be offered surgery as part of their treatment. If you are offered surgery, there are two main considerations: what surgery you wish to undergo to remove the cancer from the breast and what surgery is needed to the lymph nodes in your armpit (the armpit is also called the 'axilla', and hence surgeons talk about 'axillary surgery').

Breast surgery

Breast surgery to remove the cancer falls into two main groups: mastectomy which involves removing the whole breast and breast conserving surgery (BCS, wide local excision (WLE), therapeutic mammoplasty, ''lumpectomy') in which the cancer is removed from the breast but the shape of the breast is preserved. If you have a mastectomy, breast reconstruction may be an option for you. Your surgeon and breast care nurse will be able to discuss all your surgical options with you.

Reconstructive surgery

For some patients it is necessary to remove all the breast (mastectomy). For these patients, we can offer breast reconstructive surgery. Our surgeons and breast care nurses provide counselling and information on the options available for reconstruction, with the aid of photographs of patients who have had reconstructions at Hillingdon Hospital and the Royal Free Hospital.

We can offer implant-based breast reconstructions and incorporate new techniques to carry these out. This could involve using biological meshes through a pre-pectoral approach (in front of the pectoralis major muscle) which differs from the previous traditional approach of sub-pectoral implant reconstruction (behind the pectoralis major muscle).

Patients can also undergo reconstructions using purely the patient’s own tissue (autologous) such as the DIEP flap. For these we work in conjunction with the plastic surgeons at the Royal Free Hospital. We work closely with our plastic surgeons and there is a weekly clinic with them to facilitate our reconstructive practice. We can offer immediate reconstructions during the same mastectomy operation or as a delayed procedure for patients who have had previous simple mastectomy operations.

We also schedule procedures on the opposite breast, if this becomes necessary to achieve better symmetry. This may involve reducing its size or lifting the breast by tightening the skin, with or without an additional implant.

Axillary surgery

Axillary surgery has changed in recent years and therefore the procedure and outcomes may be different from how you’ve previously heard it described. The surgery involves removing the lymph nodes into which any tumour may drain. The commonest axillary surgery is sentinel lymph node biopsy (SLNB) in which more than one lymph node is removed from your armpit and sent to the pathologist to look at under the microscope.

By removing the first few lymph nodes adjacent to the cancer a pathologist can look at them under the microscope and find out whether any cells from your breast cancer have spread to the lymph nodes in your armpit. This is important to know as it can affect what treatments you need after your surgery (eg chemotherapy).

If you are found to have significant deposits of breast cancer cells in those nodes, you may be advised to come back for further surgery, which would be axillary node clearance (ANC). If you are already known to have cancer deposits in your armpit before your surgery (through a needle biopsy), you may be advised to have axillary node clearance (rather than sentinel lymph node biopsy) at the same time as your breast surgery.

Oncology treatment

This is provided by our team of medical and clinical oncologists with the support of our breast care nursing team and acute oncology nurse specialist. Oncology treatment is usually offered after surgery however occasionally chemotherapy is given at the beginning of treatment depending on the tumour biology.

We participate in research as well as national trials, and occasionally patients are asked to participate in these trials if eligible. Opting out of such trials does not impact on your breast cancer management

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