The Breast Care Clinic at WWH is designed to offer a customized experience for each unique patient. After a breast cancer diagnosis, the team will work together to formulate a comprehensive treatment plan. Our new Breast/Oncology Nurse Navigator will assist with education, scheduling appointments, and will ensure each patient receives the services and support they need.

Patients should visit Western Wisconsin Health Breast Care Clinic:

  • Women and Men at High Risk for developing Breast Cancer; or those wanting to understand their risk of developing breast cancer
  • Breast concerns – Lumps, pain, nipple discharge, skin dimpling, mammogram callbacks
  • Breast Cancer diagnosis
  • Survivor Care

Services available:

  • Breast cancer screening – 3D Mammography, Breast MRI and Ultrasound
  • Patient navigation to assist in scheduling, education and support
  • Breast biopsies
  • Breast cancer treatment
  • Genetic testing
  • Follow up care

The goal of the WWH Breast Care Clinic is to offer professional, compassionate expert care close to home.  To schedule an appointment for services offered in the WWH Breast Care Clinic please call 715-684-1111.  Western Wisconsin Health, Building a Healthier Tomorrow, Together

Phone: 715.684.1478

Mammogram is an x-ray image of the breast. It is the best screening tool used today to find breast cancer early. A mammogram can detect cancer before a lump can be felt.

Current recommendations are to have a mammogram every year starting at age 40. If you are younger than 40 with a family history of breast cancer or other concerns, talk with a health care provider in our breast clinic about what screening tests are right for you. Have a clinical breast exam every year starting at age 20 and learn about how to perform a careful self-examination.

Mammography is a safe and effective screening tool for women who have breast implants. It is important to tell the technologist before your mammogram as the 3D machine must be specially adjusted to obtain the best image of the breast tissue.

3D Mammography (Digital Breast Tomosynthesis) used here at Western Wisconsin Health reduces the chance of false positive results that would mean a patient had to come back for additional imaging. 3D is also recommended for women with dense breast tissue.

Following your mammogram, radiologist will send you a letter describing findings and listing your breast density. If the radiologist would like you to return – “a call back” – for additional imaging our RN navigator will contact you.

An MRI is a noninvasive and painless procedure in which radio waves and powerful magnets linked to a computer are used to create remarkably clear and detailed pictures from side-to-side, top-to-bottom, and front-to-back. The pictures show the difference between normal and abnormal tissue and enable doctors to determine what the inside of a particular structure looks like. This makes it very useful in diagnosing abnormalities.

In women with a strong family history of breast cancer, clinical trials have shown that MRI is more sensitive than mammography in the early detection of breast cancers. A breast MRI can also be used to study lumps in the breast found during a clinical breast exam that were not seen on mammography or ultrasound, as well as to plan surgery for patients who have already been diagnosed with breast cancer.

During an MRI test the patient must remain still in a confined space. If necessary, a relaxant can be taken prior to the test.

Your technologist will help you get positioned, face down, on the MRI table, a special coil will be placed under the area being imaged to improve the quality of the images. Headphones will be provided so that you can listen to music during your exam. The length of your exam will be about 60 minutes. A contrast agent is frequently used to enhance the visibility of certain tissues or blood vessels.

Test results are available in 24 hours and patient will typically come back to clinic to discuss results.

If your lifetime risk of developing breast cancer is greater than 20%, you are high risk.

Risk factors that may put you at high risk are:

  • 1 or 2 first degree relatives with breast cancer
  • Breast cancer diagnosis of a relative before age 50
  • Known BRCA mutation in family
  • Personal history of breast cancer
  • Family member with ovarian cancer
  • Ashkenazi (European) Jewish ancestry
  • Previous benign but “high risk” biopsy

Once you have been identified as having high risk factors, you will be scheduled to see one of our providers in the Breast Care Clinic. The provider will gather additional information about your personal and family history to more specifically calculate your personal lifetime risk of developing breast cancer. The provider will discuss what this means and through shared decision making the two of you will create an individualized risk management strategy.

Patients with an estimated risk of > 20% for developing breast cancer in their lifetime have yearly mammograms, as well as yearly Breast MRI’s. Tests are scheduled 6 months apart and are timed so that you have a semiannual clinical breast exam every 6 months.

Some higher risk patients may choose to pursue additional risk-reducing treatment options including lifestyle changes, medications, or surgery.

Breast wire localization is a diagnostic procedure in which a special needle and x-rays are used to identify the precise location of abnormal breast tissue or a previously placed clip for the purpose of performing a breast biopsy or lumpectomy. Combined with a mammogram of the specimen the procedure helps ensure correct specimen is retrieved.

Breast wire localization will be performed by a radiologist and a radiologic technologist or a registered sonographer. The radiologist will numb the skin and insert a small localization needle and a tiny wire. An x-ray or ultrasound will be taken to confirm the precise location of the needle to pinpoint the area of concern for your surgeon.

Typically, a mammogram is taken with wire in place to convey exact position to surgeon. The wire will then be taped to your skin and you will go to the operating room for surgery. The wire and any previously placed clip(s) are removed during the biopsy/surgery.

The breast needle localization procedure usually takes 30 to 60 minutes.

Ultrasound is a painless, safe procedure that produces images of the inside of the body using sound waves. Ultrasound imaging involves the use of a small transducer (probe) and ultrasound gel placed directly on the skin. High-frequency sound waves are transmitted form the probe through the gel into the body. The transducer collects the waves that bounce back and a computer then uses those sound waves to create an image. There is no radiation exposure to the
patient.

Ultrasound imaging is very useful in visualizing breast lumps and areas that are abnormal on a screening mammogram or MRI. Breast cancers are generally easy to recognize on ultrasound.

Mastectomy is a surgical procedure that removes all of the breast tissue and may or may not remove the nipple. The procedure is used either to treat breast cancer or to prevent breast cancer from developing in people at high risk for the disease. A few lymph nodes from under the arm on the side of the tumor are also typically removed to determine if the cancer has spread beyond the breast. Most patients having a mastectomy will stay overnight in the hospital and will go home with a drain that stays for about one week.

Many people choose to have breast reconstruction surgery to restore the shape and appearance of breast(s). Other patients choose not to have reconstruction, and opt for an aesthetic flat closure. Prosthetic breast forms are available for women who have mastectomy without breast reconstruction but desire to maintain the outward appearance of the breasts.

Mastectomy may be recommended for you if:

  • The tumor is larger than 5 centimeters.
  • There are two or more tumors in different parts of your breast
  • You have an inherited gene mutation (BRCA1 or BRCA2) that increases your risk of developing a second breast cancer
  • You have inflammatory breast cancer.
  • You have multiple or very large areas of ductal carcinoma in situ (DCIS)
  • Your breast is small and a lumpectomy would leave you with an altered appearance of the breast
  • Your surgeon has already made multiple attempts to remove the tumor with lumpectomy, but has not been able to completely remove the cancer
  • You are not a candidate for post-op radiation therapy
  • You had breast cancer before in the same breast.
  • Although many patients believe that mastectomy would have a better outcome than a “less aggressive” lumpectomy procedure, this has not proven to be the case for most patients. In fact, complications are at least twice as high for mastectomy vs lumpectomy.

Risks and Complications of Mastectomy:

  • Infection
  • Bleeding
  • Fluid collection (hematoma or seroma)
  • Nerve pain
  • Loss of sensation or numbness
  • Stiffness of the shoulder
  • Scarring
  • Lymphedema (long-term swelling of the arm)
  • Breast skin necrosis

Breast cancer cells can spread along lymphatic channels to the axillary (arm pit) lymph nodes. A sentinel node is the first lymph node to which the lymph channels pass through. If sentinel node is not invaded by cancer cells then it is very unlikely that other nodes will be involved. Therefore, it is quite important to determine if sentinel node is positive or negative.

Sentinel lymph node removal (SLNB) is done at the same time the primary tumor is removed from the breast. SLNB status determines stage of the cancer (extent of the disease within the body) and helps your MD develop an appropriate treatment plan.

A sentinel lymph node biopsy is a procedure where the sentinel lymph node is first identified, then removed and examined by the pathologist. The surgeon locates the sentinel node (or nodes) by injecting and tracing some blue dye and a radioactive marker to the sentinel node.

A negative SLNB result means no further lymph node surgery. A positive SLNB result indicates that cancer is present in the sentinel lymph node and may have spread to other lymph nodes.

Although a positive sentinel node can change the stage and prognosis of a breast cancer, it does not always mean that additional node removal is necessary.

Risks and Complications of Sentinel lymph node biopsy:

  • Lymphedema (risk increases with the number of lymph nodes removed
  • Fluid collection
  • Numbness, tingling, swelling, bruising, or pain at the site
  • Infection
  • Difficulty moving the affected upper extremity
  • Skin or allergic reactions to the blue dye used

Lumpectomy, or partial mastectomy, is a surgical procedure to remove a breast cancer and a rim of healthy tissue surrounding it. It is a breast-conserving operation that best preserves the natural shape and feel of a normal breast. Most patients will be discharged shortly after surgery and will not have to manage drainage tubes in the post-op period.

During a lumpectomy procedure, the surgeon also removes one to three lymph nodes from under the arm; this is referred to as sentinel lymph node procedure. A pathologist carefully examines the lymph nodes to check for any signs of cancer. If the sentinel nodes are negative, it is very unlikely that other lymph nodes contain cancer cells, and most women who have a lumpectomy with sentinel node procedure avoid the more debilitating axillary lymph node dissection where all axillary nodes are removed.

Lumpectomy is the right choice for you if:

  • You have a tumor that is relatively small in comparison to the size of your breast.
  • You want to avoid complex and reconstructive surgery.
  • It is good to talk to your surgeon about how much tissue needs to be removed and how it may affect your breast’s appearance.

Risks and Complications of Lumpectomy:

  • Infection
  • Bleeding
  • Fluid collection (seroma)
  • Nerve pain
  • Loss of sensation or numbness (temporary)
  • Uneven breasts