The Dr. Marga Practice Group

What good things in life come in 3’s? Triplets!!!

Check out this cheerful ditty from “Explain Planet” (https://explainplanet.com/good-things-that-come-in-threes/) for a few more good “3-things”!

“Explain Planet” did miss a few excellent other “3-things” - The Father, Son and Holy Spirit for Christians AND the “3-things” you need to appropriately evaluate a new breast lump!

If you find a new breast lump on self-breast exam, you should be seen by your Primary Care Physician for a formal breast exam – “formal” means in the n**e with palpation of the breast tissue with your arms by your sides and above your head when lying down on your back. Additionally, your physician will visually look for dimpling with arm movement with you seated up-right. It will be important to identify any differences in ni**le bud shape and if you have had any crusting in the region of the ar**la - the pigmented portion of the breast skin. Keep an eye out for any possible ni**le discharge – clear, yellow, milky white or blood-tinged. The final component of the exam includes palpating the lymph nodes under your arms, above the collar bones and in your neck. The formal breast exam with your Physician is typically followed by a screening mammogram with a radiographic “marker” over the area in question and a breast ultra-sound. If there is radiographic concern on the mammogram and/or ultra sound, additional studies may include a diagnostic mammogram series prior to a needle aspiration or core tissue biopsy. Breast MRI may be indicated for some patients especially those with Silicone Breast implants or if one suffers from silicone or saline breast implant associated capsular contracture (peri-prosthetic scarring) that can limit appropriate “push-back” views of the breast. Breast MRI is not a part a typical evaluation and is not a routine part of the breast “3-thing”.

All 3 of these investigations (formal breast exam, mammography and breast ultra sound) must be completed to fully define a change in your breast exam as “normal”. Breast tissue does change to feel more “lumpy” with weight loss and this can be entirely normal. Breast architecture also changes with age as the breast tissue undergoes involution after menopause. Breast tissue is replaced by more fat as you age and this might feel different to you. The breast can also feel different as gravity has a downward effect on your tissues.

It is important to know that not all breast cancers can be identified by your Physician on formal exam. Up to 30% of breast cancers are not seen on routine mammography. Some slow growing tumors as lobular carcinomas of the breast may not demonstrate “structural distortion” or “malignant calcifications” that would concern your Radiologist. Not all breast masses seen on mammography are solid – you might have a benign, fluid-filled cyst which is best identified by ultra sound. These variations of findings make the breast evaluation “3-things” necessary to define what may or may not be a potential cancer.

If your breast “3-things” are all normal (formal Physician directed exam, mammogram and ultra sound) you are set to go! Continue self-exams and see your Physician in 6 months for follow up, or sooner if things change. If one of the breast “3-things” is different than the others, you may require a needle or core biopsy for a definitive diagnosis. These biopsies are commonly guided by mammography or ultra sound to target the area of the breast that is concerning. These biopsies do not require general anesthesia and are done as an out-patient. Best to have a driver so you may have medication to reduce any anxiety you might experience.

If you find a new lump – See your Primary Care Physician and get started on your breast “3-things” - Go Big 3!

Yes… I am binging six seasons of “This is US”! Kevin, Kate and Randall were referred to as “The Big 3” in this television drama relating the life journey of a set of triplets over several generations now available on Netflix.

Keep up with your monthly self-breast exams and check out “This is US”!

Patients often ask me "What do I need to bring with me to the hospital... THE most important thing?..."

ANSWER: TOOTHPASTE

Other than your specific and personal entertainment needs, we provide all that you will desire except GOOD toothpaste.

We provide dressing supplies, post surgical bra's, drain cami's, night gowns, socks, lip gloss, food, snacks, all home medications, new post operative medications, television, physical therapy, bath supplies including dry hair shampoo and Colgate toothbrushes that are the really good ones! But, the toothpaste leaves me wanting a better product....

BRING YOUR OWN TOOTHPASTE! Ours tastes terrible!

Hope your day is Minty Fresh!

Having bad weather in the South Strand tonight - Flooding, Wind and Tornado's, Oh My! Praying for Safety for All.