Outpatient Clinic Assessment
Patients with breast complaints are seen at The Harley Street Clinic Diagnostic Centre, 16 Devonshire Street, London W1G 7AE.
All patients with a breast symptom or lump are managed with triple assessment. Triple assessment has 3 components:
- clinical examination by Mr Hadjiminas;
- imaging tests using ultrasound, mammography and MRI;
- if an abnormality is found either on clinical examination or in any of the imaging investigations, some form of tissue sampling usually with a wide bore needle.
Triple assessment patients see Mr Hadjiminas first for consultation and examination then possible tests done during the same clinic appointment include mammography, and ultrasound. Ultrasound-guided needle biopsy under local anaesthetic is also performed if required/indicated. Depending on clinical circumstances immediate cytological assessment of this biopsy may provide results within one hour of the biopsy being taken. Whenever possible biopsies are performed during the same clinic.
Mammography often but not exclusively is performed on patients 40 years and over. 3D digital mammography with tomosynthesis is performed for best results particularly in younger patients with denser breasts. Breast ultrasound may be required depending on clinical circumstances, there is no radiation involved with this test. MRI of the breast may also be indicated in certain cases and if so it is available on site. For premenopausal women it may be best to perform MRI between day 6 and 16 of their menstrual cycle.
All imaging tests are read by specialist breast radiologists and discussed with Mr Hadjiminas in order to ensure the highest possible diagnostic accuracy.
Having an x-ray guided vacuum-assisted breast biopsy
Why do I need a biopsy?
Occasionally, a mammogram may show an unusual area within the breast, which cannot be felt on examination or seen on an ultrasound image. This is often an area of microcalcification that can be part of benign changes in the breast.It is sometimes necessary to take a biopsy in order to find out more. A biopsy involves taking a small sample of breast tissue from the area of the mammographic abnormality, which is then sent to the laboratory for further tests.
In order to do this, the doctor uses mammography to help to accurately locate and target the area in the breast that the biopsy will be taken from.
How do I prepare for the biopsy?
There is no special preparation for this procedure.
Please tell the radiographer or doctor in the room if you are taking any drugs that interfere with blood coagulation or platelet function commonly called “blood thinning drugs”. These include aspirin, heparin or warfarin. If you are not sure it is important to bring a list of all your drugs and discuss this with your doctor prior to your biopsy.
What happens during the biopsy?
You will need to be positioned in a similar way to when you had your last mammogram, but you will either be seated or lying down throughout the procedure. Using the computer attached to the mammography equipment, the area to be biopsied within the breast can then be accurately seen.
We will numb the area to be biopsied with local anaesthetic (lignocaine) using a very fine needle. You may feel a slight sting as the skin is numbed, but this will wear off quickly.
The doctor will make a small cut in your skin and, using the mammography equipment as a guide, insert the biopsy needle into your breast.
Once the needle is in the correct place we will take samples of tissue. Once we have taken the samples a small marker clip will be placed into the biopsy area. This is very small and will not cause any further discomfort. The clip is made of titanium and is compatible with future x-rays and MRI.
After the samples have been taken the radiographer will apply pressure to the area before securing a dressing over the wound. We will then take 2 further mammograms to ensure the marker clip is in the correct place.
Will it hurt?
The doctor uses local anaesthetic to numb the area before the procedure. We will check with you throughout the procedure that you remain pain free. Most people report that they feel local pressure but no pain.
Are there any complications?
Very rarely, a wound will begin to bleed a little after you have left the hospital. You should apply direct pressure to the wound for ten minutes. The wound should then stop bleeding. If you have any worries or concerns, you can telephone the hospital for advice.
What happens afterwards?
A self-adherent dry dressing will be applied to the wound. Please keep your wound clean and dry during the first 48 hours. You will be given an aftercare sheet after the procedure, which will have more specific guidance on the removal of your dressing.
Most people feel fine following the procedure and return to their normal routine straight away. However, we recommend that you should avoid strenuous exercise and heavy lifting for 24 hours to give the wound time to heal. We also recommend that someone accompanies you for the journey home, you should not drive yourself.
After the biopsy you may experience some tenderness and bruising in your breast. This is normal following this procedure. To help with the tenderness you may take a regular over-the-counter painkiller such as paracetamol or ibuprofen (NOT aspirin). The bruise should get better within a week. Arnica is a homeopathic remedy that is available in many high street pharmacies and health food shops that has been found to reduce bruising.
When can I expect the results of my biopsy?
The result of your biopsy will be ready in about 2-3 days.
What if I have more questions?
Please contact the secretary, or breast care nurse