CLINICAL SERVICES

Screening for Breast Cancer: Our Center performs a statistical risk evaluation on every patient. We perform yearly clinical breast exams for patients and personally review every mammogram. We perform specialized screening procedures such as ductal lavage and genetic testing which are described below.

Cancer Risk Reduction: Some patients who are found to be at high risk for developing cancer can be placed on a medication which can cut that risk by as much as 44%. We prescribe these medicines for appropriate patients and follow them on a yearly basis. On rare occasions, removal of the functioning breast tissue may be performed (see prophylactic mastectomy below).

Ductal Lavage: Dr. Walker is one of 200 surgeons nationwide to be credentialed to perform the technique of nipple aspiration and ductal lavage. Through this painless technique, high-risk women can have a cytologic examination of the cells residing within the milk ducts of the breast, characteristically finding a cancer three years before it appears on a mammogram. Currently, this technique is only covered by a few insurance carriers.

Genetic Testing: Dr. Walker is a certified cancer risk educator and performs risk evaluations and genetic testing for mutations which increase your risk of developing breast and ovarian cancer. Since genetic counseling is not covered by most insurances, we have developed a three-phase evaluation process which saves you money as the first (and expensive) phase can often rule out the need to do additional counseling and testing.

Breast Biopsy: Traditional incisional and excisional breast biopsies are performed as needed. This includes the surgical removal of a palpable (able to be felt) abnormality or the excision of a imaged-only lesion through a wire-localization approach in conjunction with our radiologists. Our open biopsy rate is less than 50%, in conjunction with nationally prescribed standards.

Stereotactic Breast Biopsy: One of the two image-guided techniques has the patient lying face down on a biopsy table. A specialized x-ray machine and a computer assist us in determining the exact location and depth of the tissue which we desire to examine. Through a small (1/8 inch) incision multiple small pieces of breast tissue can be obtained to painlessly reach a diagnosis. No sutures are required for this technique which is performed under local anesthesia.

US-Guided Biopsy: If the lesion is visible on ultrasound, we can frequently perform an incisional biopsy (through a 1/16 inch incision) in our Center, sometimes on the first visit. Dr. Walker has performed over 100 ultrasound-guided biopsies of imaged abnormalities.

Cryoablation: If the lesion has been biopsied to show that it is a fibroadenoma, one of the three options is to "freeze" the tumor, after which the body simply "digests" it. This procedure is performed right in our Center, under local anesthesia, through a 1/8 inch incision. We are one of only a few Centers to be able to offer this new procedure.

Prophylactic Mastectomy: Patients who are found to be at extremely high risk of developing breast cancer (often as high as 90%), may choose prophylactic mastectomy which is performed in conjunction with one of the leading plastic surgeons in our area. When a less-drastic procedure can provide the same degree of risk reduction, Dr. Walker always chooses this treatment plan.

Nipple-sparing Mastectomy: We are one of the few Centers in the area to be able to provide nipple-sparing mastectomy which allows a woman to save the nipple-areolar complex while removing the remaining glandular breast tissue. This is done in conjunction with pathologists specifically trained to evaluate the subareolar ductal structure under the microscope. This is utilized most frequently with prophylactic mastectomy.

Lumpectomy (partial mastectomy): The majority of our patients are able to be treated with breast conservation surgery which is commonly called a "lumpectomy". Our cosmetic results are excellent and frequently one is hard-pressed to determine at a glance on which side the operation took place.

Oncoplastic reconstruction: Cosmetic results are important. We are able to utilize plastic and reconstructive techniques to enhance the cosmesis while being true to the principles of oncologic surgery. These include "bat-wing" and periareolar incisions, fibroglandular flap mobilization, and balanced tissue reductions.

Sentinel Lymph Node Biopsy: This technique removes only those lymph nodes which are most likely to be effected with the spread of cancer. This saves our patients from the risk of arm swelling (lymphedema) which can be troublesome in women who have undergone a total axillary dissection.

Total Mastectomy (modified radical mastectomy): Some women are still more safely treated with the total removal of the breast which, up until 1980, was the standard of treatment for carcinoma of the breast.

Chemotherapy "Port" Insertion: Many women who are undergoing chemotherapy prefer to receive these IV medications through an implanted reservoir and catheter (port). We have extensive experience in the safe placement and removal of these vascular access devices.

Partial Breast Irradiation Catheter (MammoSiteŽ) Insertion: Women who can safely undergo partial breast radiation received this treatment modality through a small balloon-catheter which is placed surgically into the tumor cavity. While most surgeons are now capable of placing this catheter, we were among the first to do so.