Concierge Breast Care Center

We are a comprehensive breast care center that offers state of the art services in the areas of screening and prevention, diagnosis and treatment, and supportive psychological therapy. Here our patients are offered a multidisciplinary approach to breast disease.

Our modern campus includes our central beautifully designed office center with various examining and treatment rooms, a fully-equipped surgery center, a psychology center, and a woman’s health imaging center, all within walking distance of each other.. testing

This allows privacy, efficiency, and convenience for our patients who are often unnerved by the possibility or reality of having breast cancer. Patients will be seen on the same day and in many cases biopsies will be performed and processed on the following day.

We strive to provide you a correct diagnosis on the day of your first office visit.

Our patients are reassured that we will be able to accommodate any of their needs whether they entail breast screenings, biopsies, breast surgery and breast reconstruction.


Signs and symptoms of breast cancer

  • A breast lump or thickening that feels different from the surrounding tissue
  • Bloody discharge from the nipple
  • Change in the size or shape of a breast
  • Changes to the skin over the breast,
    such as dimpling Inverted nipple
  • Peeling or flaking of the nipple skin
  • Redness or pitting of the skin over your breast, like the skin of an orange

Breast Cancer Prevention and Detection

What should a woman do to enable early detection of breast cancer especially if she has a family history? Screening for breast cancer refers to those women who have not detected any lumps through self-examination and have no symptoms such as pain and/or discharge from their nipples.

In most such cases a simple mammogram may be sufficient. Women with symptoms and/or with a strong family history would be recommended to undergo more scrutinizing and aggressive diagnostic screening.


Mammography

A mammogram is a x-ray picture of the breast. It is found that routine mammography screening may reduce breast cancer mortality by approximately 25%.

There is much controversy recently as to when to start having mammograms and how often a woman should repeat them. Our breast center supports the conservative guidelines which suggest a woman start having mammograms at 40, and repeat them annually thereafter.

Breast cancer generally affects women after the age of 40. After the age of 80 the incidence of breast cancer starts to decrease, and every other year is indicated.


Visit our breast center annually as we will retain your mammogram results from year to year facilitating any comparisons across test results.


Digital Mammography

With our emphasis on the latest technological equipment available, all of our mammographies are digital which means they are computer images. Research has shown the advantage of digital mammography over analog film mammography especially in premenopausal women with dense or fatty breasts.

This type of mammography allows for computer applications such as digital subtraction angiography, cross-sectional imaging and electronic storage and transmission.


Breast Ultrasound

Breast ultrasound is strategically important especially for mammographic imaging. The breast ultrasound allows the physician to detect whether a mass is a solid mass or a cyst.

Ultrasound is a necessary test for the characterization of a lump, regardless of the age of the patient. It is the primary test for evaluating patients younger than 30. It is also useful in performing image-guided percutaneous biopsy procedures.

In the event of a mass being suspicious or diagnosed of being a cancer, the breast ultrasound is advantageous in determining the extent of the disease within the breast and the presence of foci of cancer in the other quadrants of the breast. In the presence of cancer, it can assist in the evaluation of the axilla and the detection of abnormal lymph nodes.


Breast MRI

Breast magnetic resonance imaging (MRI) is an extremely sensitive tool for the detection of invasive carcinoma of the breast. Breast MRI screening is not recommended for asymptomatic women. It is likely to be used for high-risk patients such as those individuals tested genetically positive for a known mutation (i.e., BRCA1 and BRCA2), and for those with multiple family members with a history of breast cancer.

If the breast MRI detects a suspicious lesion and does not correspond with anything detectable through the mammogram, an additional look through an ultrasound may be indicated. The lesion then can be biopsied under ultrasound guidance or biopsied under MRI guidance.


PET/CT Fusion

The PET/CT scan generates a series of images and can detect breast disease that does not show up on conventional x-rays or nuclear medicine scans. PET/CT

scans consist of two parts: CT scan for attenuation correction and localization and PET scan. During the CT scan, a thin beam of x-rays is directed on the breast and enables multiple images to be processed from multiple angles enabling a cross-sectional picture of the breast.

During the PET scan , a ring of detectors picks up radiation signals from the patient’s breast coming from previously injected radiopharmaceuticals. The computer analyzes the input and constructs a volume display of the patient’s breast.

The PET/CT exam results have important impact on the physician’s diagnosis of potential breast disease and should cancer be detected on how it will be most effectively treated.

If you are not responding to an indicated treatment as well as expected, you can be switched to a more effective treatment immediately. And as every cancer patient knows, time is of the essence.


Genetic Testing

Heredity accounts for approximately 5% of the breast cancer cases diagnosed annually in this country. Recently scientists, through studying blood samples of families with a history of breast cancer, have identified a gene linked to breast cancer.

Through genetic testing, a person who has this modified gene labeled BRCA-1 has a 85% risk of developing breast cancer, as well as a significantly higher risk of ovarian cancer. Such testing will provide the patient with information that can prompt close vigilance to monitoring any early signs of the cancer. The earlier the physician can detect the breast cancer, the more effective treatment will be.


Diagnosis and Determination


Fine Needle Aspiration (FNA)

This is a simple office procedure for biopsy purposes. A small gauge needle is placed into the lump or suspected breast region and cells are extracted for pathology analysis. This simple procedure which only takes a few minutes can be instrumental in accelerating the diagnostic process.

This procedure can oftendistinguish between benign and malignant findings. However in 30% of the cases,a definitive diagnosis might not be determined by the fine needle aspiration and a core needle biopsy may be warranted.


Core Needle Biopsy

While a fine needle aspiration provides cells from a targeted area, the core needle provides a sample of tissue. Core needle biopsies usually provide a specific pathologic condition. In some cases if results are benign, such as if a fibroadenoma is diagnosed, the patient needs no further treatment.

If the core biopsy finds malignancy in the lesion of concern, it will typically distinguish between invasive or non-invasive cancer. It will provide important characteristics regarding the type of cancer- ductal vs. lobular and high grade vs. low grade cancer. It also provides for measurement of hormone receptors and other protein markers.

Clinicians are often aided in determining the patient’s stage prior to therapeutic interventions by core needle biopsies. This is important in cases where preoperative chemotherapy can be considered. Core needle biopsies are often conducted with either ultrasound or x-ray guidance.

It is important for patients to realize that a core biopsy does not cause metastatic spread into the system. It is considered to be the safest way to biopsy.


Vacuum Assisted Stereotactic Biopsy under X-Ray and Ultrasound

When a lump or calcification can only be seen on a mammogram, a stereotactic core biopsy is the usual recommended procedure. In such a procedure, the patient lies on a table and inserts her breast into an opening on the table. The biopsy device below the table inserts a core needle into the patient’s protruding breast.

An aperture in the needle opens up and extracts a sample of the tissue, sucks it into the needle and then is removed. There is a vacuum-assisted device (VAD) which uses a vacuum powered instrument to collect multiple tissue samples during one needle insertion.

A tissue marker is placed in the area of biopsy to facilitate location in case there are malignant findings from the biopsy and the entire malignancy needs to be extracted.The stereotactic procedure is often facilitated with x-ray or ultrasound guidance.


MRI Biopsy

Breast MRIs can be used for both screening and diagnostic purposes. Lumps can often be detected by self-examinations, physical examination, mammography, or other imaging studies.

However it is not always possible to tell from these imaging studies whether a mass is cancerous or benign. Image guided biopsy is performed when the lesion is too small to be felt by palpitation.

An MRI biopsy has the advantage of identifying suspicious masses that were not identified by mammograms or ultrasounds. It can show such breast abnormalities as an area of distortion or an area of abnormal tissue change.

Breast cancer is considered to be either invasive or non-invasive.breast cancer image

Non-invasive cancer is a local disease while invasive is both a local and a potentially a systemic disease.

Both are often treated locally with the same surgical approaches. Most patients with an invasive cancer will see their oncologist after surgery.


Lumpectomy

Most patients with early stage cancer should be considered for a lumpectomy and radiation therapy. Contraindications to such a procedure include large breast cancer relative to a small breast size, inability to receive radiation therapy, and multicentric disease. For single lesions of appropriate size, a lumpectomy is the technique of choice. The surgeon will excise the tumor, obtain adequate margins surrounding the cancer, and strive to provide the best cosmetic outcome.


Simple Mastectomy

Mastectomy is considered appropriate for large areas of breast cancer relative to breast size, or for multicentric disease. Simple mastectomy includes removal of all breast tissue, usually including the nipple.


Mastectomy

can often be immediately followed by breast reconstruction in the same operation. A plastic surgeon performs the breast reconstruction. Reconstruction has become highly sophisticated and provides outstanding cosmetic results and patients should give strong consideration to this option. Simple mastectomy without reconstruction results in a smooth, flat chest wall with a horizontal scar.


Modified Radical Mastectomy

A modified mastectomy is similar to a simple mastectomy but the lymph nodes under the arm are removed along with the breast. This procedure is only necessary for patients who are found to have tumor in the lymph nodes under the arm. If there is any suggestion of tumor in the lymph nodes from mammogram or ultrasound images, a needle biopsy is performed to help identify tumor cells.


Radical Mastectomy

A radical mastectomy includes the removal of the entire breast plus the removal of the underlying chest wall muscles and the removal of the axillary lymph nodes. Thirty years ago this was standard treatment for breast cancer but it is rarely performed today.


Sentinel Lymph Node Biopsy

Most patients with invasive cancer will be advised to have some form of lymph node removal surgery. Sentinel lymph node biopsy is generally used for patients with extensive disease, high-grade lesions or those requiring mastectomy. The status of axillary nodes provide important information to the patient as well as to the physician as how to proceed with treatment of the breast cancer. Patients with tumor-free lymph nodes have a statistically improved prognosis, while others with tumor in the lymph nodes would be encouraged to seek more aggressive forms of treatment such as chemotherapy.

In the past it was routine to remove a large sample of lymph nodes from under the arms with all patients with invasive breast cancer. This would sometimes result in lymphedema or arm swelling due to the lymph removal surgery. Nowadays, the standard of care is the sentinel lymph node biopsy for a clinically negative axilla. An intraoperative histologic examination is performed by the surgeon. If the node is negative, then it is not necessary to perform an axillary dissection during the operation.


Radiation Therapy

Radiation therapy is a treatment that should be considered standard care after lumpectomy for invasive and most noninvasive breast cancers. Radiation therapy involves using a focused beam of high-energy particles that is designed to rid the body of any stray cancer cells after the removal of the breast cancer. It is a virtually painless procedure but after-effects can be skin redness and some skin blistering. Typically radiation will involve whole breast radiation with a boost to the tumor area that involves approximately six weeks of treatment.

Indications for radiation post-mastectomy depend on a patient’s tumor size, histologic characteristics or number of positive lymph nodes. It can be used for larger invasive or aggressive cancers.


Oncology

Patients will be referred to an oncologist that works closely with our breast cancer surgeons. Many times patients will be encouraged to consider chemotherapy and hormonal therapy for invasive cancer and hormonal therapy for noninvasive disease. The oncologist will formulate an individualized treatment plan based on the patient’s age, general condition, and tumor factors.

It has become quite common to the patient to see an oncologist before a treatment plan has been formulated. In many cases, the oncologist will attempt to shrink the size of the tumor before any surgery to optimize breast conservation.


Dr. Galliano is the most experienced Board Certified Colorectal Surgeon with Da Vinci Robotic Surgery in Lee, Charlotte, Sarasota, and De Soto Counties! He has performed over 100 DaVinci Robotic procedures!


Minimally Invasive Procedures

Experience less pain, minimal scarring, faster recovery, and better results.


Robotic Surgery
via Da Vinci


Laparoscopic Surgery


FENIX for Accidental Bowel Leakage (ABL)


TEM Transanal Endoscopic Microsurgery


NOSCAR/ NOTES Painless Natural Orifice Trans-endoscopic Surgery


Solesta is a sterile gel injected into the anus to treat the symptoms of fecal incontinence.


Esophyx long-term incisionless solution for chronic acid reflux GERD


The LINX System stops acid reflux (GERD) at the source.


The Stretta procedure results in significant GERD symptom control and patient satisfaction.


STARR Staple Transanal Rectal Resection


ENTERRA -- Gastric Electrical Stimulation for Gatroparesis


Barrx - Radiofrequency Ablation in Barrett's Esophagus with Dysplasia


TIF Transoral Incisionless Fundoplication procedure corrects the root cause of GERD


ABS - Artificial Bowel Sphincter


SECCA - for incontinence


Sacral Nerve Stimulation


Anorectoplasty for anal incontinence


Pelvic rehabilitation for incontinence and constipation, anal / pelvic pain


Anal Fistula Plug