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Dense Breasts, Lump & Second Opinion from Breast Surgeon

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dbworrywart
dbworrywart Member Posts: 10
edited June 2022 in Not Diagnosed But Worried

Hi:

I have BI-RADS Category C heterogeneously dense breasts. In the past, I got called back twice after screening mammograms & both times turned out to be false alarms.

I am in my early 50's. I found a movable lump in my breast that comes & goes. My GYN told me not to worry, but gave me a diagnostic mammogram order. After 5 images of 3D Tomosynthesis & Ultrasound, I was told it's negative, no suspicion found. I was relieved.

However, shortly after, I had an annual well-woman visit with my GYN. He told me if I was comfortable with the diagnostic finding. If not, he could refer me to a Breast Surgeon for the second opinion. Being a worrywart, I opted for the second opinion.

Now I am very nervous. I'd like to know if anyone here has dense breasts & could share any insight on what a Breast Surgeon's second opinion would be like in the office visit.

Thank you!

Comments

  • harley07
    harley07 Member Posts: 288
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    dbworrywart- a breast surgeon consult will likely involve a manual breast exam and possibly recommendations for increased screening intervals and / or a MRI. I don’t see a downside, other than cost and perhaps added stress, to having a consultation with the breast surgeon, especially if it will give you peace of mind. You might find this article of interest https://www.breastcancer.org/research-news/not-all-with-dense-breasts-have-high-risk

    I don’t know where you are located but I’m not a fan of the U.S. healthcare system because it is revenue driven rather than results driven. So, it is difficult to say if your GYN is cautious or if there is a financial incentive to refer you to a BS (and yes, this does happen).

    Ultimately, you need to do what is best for you and will give you peace of mind and good health.

  • dbworrywart
    dbworrywart Member Posts: 10
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    Thank you so much for your response. I appreciate it.

    I am a U.S. citizen; therefore, I concur with what you stated in your post regarding U.S. Healthcare System.

    That said, I genuinely feel my GYN is being cautious in this regard & I thank him for it. I have a Type A personality and suffer from panic disorder.

    I asked him were I his family member, would he advise the same regarding the 'optional' second opinion? He told me Yes. Going for the second opinion in my case is dependent upon my comfort level with the diagnostic finding.

    Thank you for sharing your knowledge in regard to what to expect in the Breast Surgeon visit. It's scheduled in early June. I think in my situation, I do want to play it safe. You are correct in stating that this second opinion does add on extra stress.

  • moderators
    moderators Posts: 8,067
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    Welcome to our Community, dbworrywart! We're glad you found us and hope even more other members can provide you some insight regarding your second opinion. We are sending positive energy your way and hoping for negative scans. Until then, we hope you can reduce the stress for the time being. If there is anything we can do to help you in this community, please don't hesitate to send us a personal message.

    -- The Moderators

  • rah2464
    rah2464 Member Posts: 1,192
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    dbworrywort I think you will find a breast surgeon will be even more investigatory when it comes to lumps and bumps. More than likely with your dense breast tissue they will reorder a sequence of imaging - ultrasound, 3D mammogram, MRI depending on prior reports and what is felt upon exam. If your breasts are very dense, it isn't a bad idea to be under the care of such a person. It is okay to do this for yourself. Doesn't mean you worry unnecessarily, rather that you respect yourself enough to take appropriate care. Let us know how it goes.

  • dbworrywart
    dbworrywart Member Posts: 10
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    A HUGE THANKS FOR TAKING YOUR TIME OUT TO RESPOND.

    I really appreciate it. I will PM you.

  • dbworrywart
    dbworrywart Member Posts: 10
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    THANK YOU FOR TAKING YOUR TIME OUT TO RESPOND TO MY QUESTION.

    I really appreciate it. I have BI-RADS Category C heterogenously dense breasts.

    I appreciate your laying out what might be done in the Breast Surgeon's office.

    Your "Doesn't mean you worry unnecessarily, rather that you respect yourself enough to take appropriate care. Let us know how it goes." really quells my anxiety down a level. That's so true. I think it's probably why my GYN asks me if I am comfortable with my diagnostic 3D & ultrasound finding, since the report declared no suspicious mass found, Negative. & If I am not, he would be willing to refer me to the Breast Surgeon.

    Being Type A as I am, I opted for it. I just need to practice mindfulness at the moment to get through this.


  • wondering44
    wondering44 Member Posts: 260
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    Hi db,

    I think it is more about getting the right doctor for your concern. Your GYN was correct to refer you to a Breast Surgeon if you have concerns after a negative finding.

    I had a concern last year that my MO and Radiologist referred me to a Breast Surgeon. The Breast Surgeon dismissed my concern and sent me on my way. This year I had it looked at again at MD Anderson. My concern was found on MRI and biopsied. Luckily, the area was benign. I am waiting on the last biopsy results for another area of concern that was missed at my local facility on mammograms. The area was found on my first mammogram at MD Anderson. Two other areas were also found and set up to be followed every six months with MRIs if I choose to keep my left breast. Those two lumps were not found during ultrasounds and mammograms and were dismissed at my local facility (I was told it could be scar tissue during the imaging appointments but the lumps were not findable).

    I also found that if my concerns had not been dismissed and a thorough review was done (which should have been done right after my August surgery), I may have found out sooner than later that I had multiple areas of concern that must be corrected on my cancer side. I learned this past Friday the plan moving forward is that I will need multiple surgeries over the next year to fix the "not found" areas that were not of any concern to look for at my local facility. Had I not pushed doctors or not questioned doctors, I don't know what the results would be later on.

    I, too, have dense breasts, making imaging more difficult to find areas of concern. The MRIs are great for picking them up but also find a lot of "false positives." While an area found on an MRI is stressful while waiting for results, I'd much rather have it biopsied and laid to rest rather than worry for twelve months before my next annual imaging appointment.

    It is okay to push doctors for more thorough checkups. If you feel a lump, I'd believe that a lump is there. A "good" Breast Surgeon will review your prior imaging and hear your concerns. A "good" Breast Surgeon will check again. My new Breast Surgeon did just that. Not only did she listen to me, but she also reordered every scan done at my local facility. She found every area of concern that was missed. She gave me a heads up to mentally prepare myself (before imaging) that I more than likely would lose my right breast. My new Breast Surgeon is redoing my right mastectomy, and we discussed the left breast mastectomy. She listened to why I would not want the left mastectomy and biopsied everything to be 100% that the option of keeping a "good" breast is safe if that is what I choose to do if the last biopsy results are benign.

    A "good" doctor will hear your concerns and be thorough like your GYN. Put your expectations high during your visit with the Breast Surgeon and get those expectations met. When your expectations are accurately met, your concerns should be found, validated, and followed up on, or you should receive birads 1, 2, or 3 result. I hope you get a great Breast Surgeon and that your worries are addressed. Please keep us posted.

  • dbworrywart
    dbworrywart Member Posts: 10
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    Hi Wondering,

    Thank you so very much for taking your time out to write me a lengthy & thorough response. I really appreciate it.

    You are correct in stating that we as patients need to be more vigilant & take 'proactive' ownership of our well-being, especially in light of the current circumstances where medical staff suffer from burn-out.

    I have BI-RADS Category C – heterogeneously dense breasts. I am well aware of the fact that the declaration of 'negative' or 'benign' diagnostic results are not 100% certain, especially for women with Category C or D.

    You put it so well regarding the MRI having a lower sensitivity in regard to false positives & would much rather have it done despite anxiety.

    I am in my early 50's, normal BMI, no family history of cancer. I know those factors alone do not 100% shield me from the chance of having breast cancer. As anxious as I am, I am grateful to my GYN to urge me to re-assess my comfort level. In this case, ignorance is not bliss. In the beginning, I'd much rather forego all this & not pursue any more testing. However, an inner voice nagged me to give this Breast Surgeon referral a chance.

    Based on the review on this Breast Surgeon, she comes highly recommended. I hope when I see her on 06/09/22, I will find her being thorough & having excellent patient communication skills.

    I cannot thank you enough for laying out how to assess a good Breast Surgeon. I will take serious notes of that. My biggest shortcoming is being too polite & thus fails to advocate my own concerns & interests.

    At present, I am thankful & grateful for the fact that I live in a city with top-notch cancer research centers; I have access to good health insurance; I have a husband with 3 decades of marriage for support. My heart ached for those in the diagnostic waiting lounge who were told they had cancer & had no access to decent healthcare insurance.

    I thank you & the previous responders for your being willing to share & kindness. It means a great deal to me. I will certainly keep all of you posted. My profound gratitude.

    Edit to Add:

    I will keep you in my thoughts, as you go through your current journey.

    I am a novice in regard to breast health; hence, I lack proper knowledge & experience to offer in return. Apologies.

  • K-Gobby
    K-Gobby Member Posts: 144
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    dbworrywart and all.


    I have been logging in for pertinent looks at boards that apply to me. Breast surgeon. I believe mine is the one who started me on my road. My new primary doctors PA examined me. Ordered a mammogram and briefly went over what was found. She also sent me for a blood test. After findings. I was sent for guided US. A day before that, a biopsy was added. Cancer, stage 2. T3

    Lastly, she referred me to a local surgeon or the City of Hope. I went home, checked my insurance site and found a breast surgeon with a office farther from COH, but coming to COH for consults and surgery. On my very first visit, she wrote out a few pathways for me. Chemo, radiation and likely removal of my breast. My tumor was 5 cm. A lumpectomy would have margins that would disfigure me. I am not big busted.

    She ordered an MRI to rule out cancer spread and a bone scan. She then referred me to an MO. The MO to a gyno surgeon and then to a dermatologist. Oh yes, then to the plastic surgeon.

    What I asked for was if I could have implants, to be about my same small size. No significant change. I may have wanted a larger size when young, but I am 61 going on 62. No thanks.

    I feel like my surgery went well. My removed left side with the expander is the same size or so as my real right. I was supposed to have my healthy removed May 31st. But in early May, I developed a blood clot in my leg. Leg scan.

    Surgical team decided risk not good for me. Postpone. My BS surgeon said she was now moving to a new cancer center nearer her office. Mid July is the first she can do my surgery and it would need to be there. I told her I would go there. She said my plastics Dr operated out of the new hospital part time too. I said please find a date in August. I want my right side done my left size team. If they can, I want them.

    Having a women BS, with expert credentials and manner still gives me confidence. Authentic and listened. I asked for a "best outcome" for my body and she and plastics gave me a good option. Skin saving.

    My insurance has covered my whole road. I thought a PPO meant I paid 20%. No. 20% of deductible. The women of decades have fought for insurance for breat cancer and reconstruction and now it is law in California. I do not know if it is federal. It may be.

    Thank you all for posting.

  • dbworrywart
    dbworrywart Member Posts: 10
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    Hi k-gobby:

    Thank you for sharing your experience. I appreciate it.

    I am so happy to hear your Breast Surgeon listens to your concerns & assists you in your diagnosis and provide effective treatment.

    My consultation with my Breast Surgeon is not until 06/09/2022. I will make sure she's a good fit, despite her excellent patient review.

    I am not in CA, so I don't think we have any mandates on Breast Cancer treatment. I am just thankful that I have decent insurance. I've heard too many unfortunate stories.

    I am a novice in this process; so sadly, I don't have much to offer in return. I will keep you in my thoughts along with everyone in this forum.

    One thing I have learned from all the posts in this thread is that I need to be vocal & be my own advocate.

    Take care & keep us posted.

  • K-Gobby
    K-Gobby Member Posts: 144
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    I need to add a bit. Since I was 2 have surgery May 31st, a mammogram was scheduled. My last ever. No breasts only US and MRI's left for regular tests. My BS scheduled an US after reviewing what she thought was noting in the images. The rad team thought a 2nd look was needed. So US. Likely benign is the final result. Adding Brca2 as well.

    I will keep my MO and this breast surgeon. I only have 2 breasts to remove, but she is young and any work ever she will be there.

  • dbworrywart
    dbworrywart Member Posts: 10
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    Hi k-gobby:

    Thank you for the update. I will keep you in my thoughts. Take care.

  • Ssc110907
    Ssc110907 Member Posts: 22
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    dbworrywart-

    I'm in a similar situation. Waiting dor my second opinion on 6/8. After my local clinic did an mammo and ultrasound and sent me on my way with out further investigation of the palpable lump on my upper chest. (It was too high for the mammo, and the ultrasound showed nothing. I also have dense breasts.) My PCP told me to trust the imaging, and check back in a year.

    After that I had an appointment with an ortho. For shoulder pain I've had for 2+ years, and he was very concerned that the lump was actually the cause of the shoulder pain, and couldn't believe they didn't do more testing on it. So he has ordered an mri for me.


    So...waiting, just like you. Waiting is the hardest.

  • dbworrywart
    dbworrywart Member Posts: 10
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    Hi ssc110907:

    Thank you for taking your time to share your experience. I am waiting for my Breast Surgeon appointment on 06/09. Meanwhile, my moveable lump of concern seems to disappear. However, I know how tricky these lumps can get.

    I am glad to hear that you took up on the Orthopedic Doctor's advice to get further testing. I think it's a wise decision.

    When my GYN asked what my comfort level was in regard to the negative 3D image & ultrasound finding, I sort of wanted to be done with it - playing ignorance is bliss.

    However, he stressed that if I felt ANY doubt regarding the negative finding, he'd be glad to refer me to the Breast Surgeon for a second opinion. I panicked & opted for the referral. I thank my GYN for pushing me; otherwise, I'd be too timid to go for a second opinion.

    You're correct in saying that waiting is the hardest. However, it's essential & important to follow up on any tiny bit of doubt. I try to tell myself that it's better to be safe than sorry, no matter how anxious I feel.

    I am also counting my blessings because I have access to decent healthcare insurance & top-notch healthcare providers. Sadly, this is not something everyone is privy to.

    Please keep us posted. You, along with everyone in this forum, are in my thoughts.

  • dutchiegirl
    dutchiegirl Member Posts: 76
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    I had dense breasts - my mammogram report came back with Extreme Dense Breasts. My mammo was in April and I was diagnosed with Stage 3 breast cancer in early November of the same year. If I had known then what I know now, I would have insisted on an MRI. I wasn't presenting with a lump though, just abnormal weight loss. I found the lump in October and the rest is history. I think the medical community needs to recognize that mammos don't work as well for us dense tissue gals and offer MRIs instead.

  • dbworrywart
    dbworrywart Member Posts: 10
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    Hi Dutchiegirl,

    Thank you for sharing your story.

    I am fortunate to live in the state where radiologists are required to send a letter of caution to women with Dense Breasts - BI-RADS Category C or D (I have Category C). In the letter, it states negative mammography results (2D or 3D) are not 100% guaranteed* & to discuss with doctors, if risks warrant supplemental testing. In the past, my risk was not assessed as high, so there's no additional testing performed.

    That said, any supplemental testing accompanying regular annual screening mammogram for BI-RADS Category C or D is NOT covered in my state. Currently, only few states require that.

    I hope that you are recovering well. I believe there should be more Dense Breasts awareness in Public Health campaigns. Very few people are educated regarding this topic.

    *Even for BI-RAIDS Category A or B, the negative finding is still not 100% guaranteed. Therefore, monthly self exams are still vital.

  • dbworrywart
    dbworrywart Member Posts: 10
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    Original Poster Follow up:

    On 06/09/2022, I had a consult with my breast surgeon. At the time of the visit, the lump on my upper left breast was no longer palpable about 1 ½ weeks ago.

    I really appreciate the breast surgeon for her thorough patient in-take, review of my diagnostic Tomosynthesis & ultrasound, as well as her physical exam on both of my breasts and lymph nodes.

    Since I have BI-RADS Category C heterogeneously dense breasts, I asked my breast surgeon to see if any supplemental screening is needed. She stated that my annual Tomosynthesis mammography is still easy to see, so there's no need. However, if I notice any more breast change, she will order an ultrasound.

    I am in my early 50's and a fitness enthusiast with high lean body mass. I lift heavy weights & do pull-ups. Possibly, this might explain my frequent breast change.

    Thank you for the ladies that responded to my thread. I still remain vigilant. I truly believe as a patient, I need to be more proactive in my health.

    My thoughts are with ladies going through the similar life stage as I am as well as ladies currently going through treatment, including my friend, who just got diagnosed with Triple Negative breast cancer.