Visiting The London Breast Centre

What to expect during your visit

London Bridge Hospital’s One-Stop Breast Clinic is structured to provide expert advice and any test that you may require in just one clinic visit. In this way we hope that by the end of your appointment your breast problem will have been fully investigated, diagnosed and explained to you. Most breast symptoms turn out to be due to relatively minor breast changes so that the one-stop clinic is often the only visit you will have to make to the hospital and you can leave with one less problem to worry about.

Following registration you will have an initial consultation with one of our Consultant Breast Surgeons. They will ask about the details of your problem and perform an examination of your breasts and arm pits. Any investigations that may be required can then be carried out. In many cases this will involve a mammogram of both breasts and an ultrasound scan of one or both breasts. These tests will be carried out and reported by one of our Consultant Breast Radiologists.

It is often necessary to have a needle biopsy to complete the investigations and this will usually be done at the same time under ultrasound guidance. The cells or tissue from the biopsy are examined immediately by our Consultant Breast Pathologist (Dr Glen Dixon). Finally you will see your Consultant Breast Surgeon again who will explain all of the test results and the final diagnosis. Any treatment that may be required can be started straight away (the Pharmacy is in the adjacent building). A full summary of your consultation will be posted to your GP.

What to expect during your visit to The London Breast Centre

On arrival you will need to register At the London Bridge One-Stop Breast Clinic, you will have an initial consultation with one of our Consultant Breast Surgeons. The majority of breast problems are unrelated to breast cancer but are best checked out to be on the safe side. This is most easily done in the One-Stop Breast Clinic where there is immediate access to any investigations that may be necessary and where the results can be explained to you before you leave.

Your Consultant will discuss your particular problem and will ask about any other medical and family details that may be of relevance. It would be helpful if you could bring a list of any medications that you take regularly. A family history of breast cancer is sometimes important and the details of this and any members of your family who may have had ovarian cancer will be discussed. Please also let us know the date of the start of your last menstrual period, if this appropriate.

If you have had a mammogram in the past and films are in your possession please remember to bring these with you. If your appointment is with regards to a recent health screen mammogram you should ask the screening centre to let you have the x-rays before your visit.

Your referring GP will often provide you with a letter explaining the background to your problem, often this is faxed to the One-Stop Breast Clinic office before your visit. It is quite appropriate however to make an appointment with the One-Stop Breast Clinic yourself, and in this case a letter or fax from your GP is not required.

Once we have a clear idea of your problem you will be examined by the consultant. Every effort is made to make this as quick and discreet as possible. A chaperone is available if you should wish this. The breasts are examined and the lymph glands in the armpits and neck are felt. It is important to examine the breasts both in the sitting and lying position.

After this initial assessment, any investigations that are required can be carried out immediately. This may include a mammogram (breast x-ray) of both breasts, an ultrasound scan of one or both breasts, or a needle biopsy. All results of these investigations are immediately available to your consultant and can be explained and discussed during your visit.

Mammograms are generally only carried out in women over the age of 35 years. This is because the breast tissue in younger women is relatively dense with the result that the details of breast tissue being x-rayed are lost. However over the age of 35 a mammogram is probably the most effective type of investigation of breast problems. Most women of the appropriate age group will be advised to have a mammogram during their visit.

Mammograms are carried out in the same building as your consultation. There may be a short wait before the x-ray is carried out. You will need to slip your top garments off and put on a gown. A mammogram is carried out by a female radiographer who has specialised training in the form of x-ray.

Each breast in turn is gently compressed between the two surfaces of the X-ray machine, the X-ray itself takes just a few seconds and is repeated on the other side. Each breast is X-rayed from top to bottom and from side to side, making in total four individual X-rays. The whole procedure probably takes less than 10 minutes. The X-rays will be viewed and immediately reported by one of our Consultant Breast Radiologists. If you have brought your own mammograms from a previous occasion, these will be compared with the present mammograms

Ultrasound scans are very similar to the type of imaging that is carried out during pregnancy. They work by using a very high frequency sound which is not audible and which is entirely harmless. It is particularly effective in younger women who have denser breast tissue that does not show up well on mammography. However ultrasound scans are effective for breast diagnosis in all age groups and many women will be advised to have a mammogram and an ultrasound scan.

The ultrasound scan is carried out by one of our Consultant Breast Radiologists, whom specialise in breast imaging. The scan will be carried out in the ultrasound examination room in the One-Stop Breast Clinic itself. Examination is carried out with the patient lying flat.

It is necessary to place a small amount of gel on the skin to aid the transmission of the ultrasound waves and this is sometimes a little cold. The Consultant Radiologist will move the ultrasound probe over the skin pressing only gently. The appearance of the inside of the breast is shown on a black and white screen and we will demonstrate our findings to you and explain the sometimes confusing appearance.

Although mammograms and ultrasound scans are good methods of diagnosing breast problems, it is often desirable to obtain definitive proof of a diagnosis by performing a needle biopsy. Very often this is carried out at the same time as the ultrasound scan so that the tip of the needle can be guided to exactly the right place in the breast.

There are two types of needle biopsy. One uses a very fine needle rather than thinner than that used for taking blood (FNAC). The other type of needle test is called a core biopsy and uses a larger needle. Sometimes one or other needle test is more appropriate, though often both are carried out.

The fine needle biopsy (FNAC) works by obtaining single breast cells or small clusters of cells which can be easily examined by our Consultant Breast Pathologist. The test often yields just a drop of fluid which may or may not be blood stained. The fluid is immediately spread onto a glass slide, after a short processing procedure (it takes around 15 minutes), is examined under the microscope. Our Consultant Breast Pathologist will usually take around 10 minutes to make a final diagnosis and produce a report.

The fine needle test is very quick and is usually not more uncomfortable than having a blood test. We do not usually use any local anaesthetic as the local anaesthetic itself has to be injected and often stings for a minute or two.

A core needle biopsy test uses a thicker needle and is able to take a very small slither of tissue. Because the tissue is intact as opposed to individual cells, more information is derived from this type of test. In particular the architecture of the breast tissue will be examined microscopically.

We always use an injection of local anaesthetic prior to the core needle biopsy. After injection of local anaesthetic there is a short and relatively mild stinging sensation. This rapidly wears off leaving the area of the breast completely numbed. As a result most patients will not feel anything further during the core needle biopsy procedure. Once again the needle biopsy is performed under ultrasound control so that we can be sure that the needle goes into the right place.

The needle mechanism is worked by a hand held machine that makes a sharp snapping noise when the biopsy is taken. The biopsy is usually is done 2-3 times with the needle being removed between each biopsy. It is necessary to press hard on the site of the biopsy following the procedure to minimise any bruising.

However, many patients will develop a bruise over the next 24-48 hours. The local anaesthetic lasts for approximately 2 hours and if any soreness remains following this you can safely take either one or two paracetamol tablets (500-1000mg in total) to provide effective pain relief. Most patients however find a needle biopsy quite comfortable and uncomplicated.

The small piece of tissue obtained from a core needle biopsy needs extensive processing before it is able to be examined by the pathologist under a microscope. This usually takes three-four days and the final result therefore is not available in the One-Stop Clinic. At London Bridge Hospital however, we have developed a method for obtaining a provisional result for you in around 30 minutes.

This will usually give you an accurate idea of the outcome of the biopsy but we will want you to return to discuss the final results after standard processing procedures have been carried out. This will normally involve a further clinic appointment three-four days later.

Following the completion of any of the above investigations you will have a further consultation with Mr Beechey-Newman. The results of all tests will be explained to you. It is usually possible to make a definite diagnosis by the end of the clinic visit. Any conditions will be carefully explained to you and any treatments that may be required can be advised and if appropriate started straight away.

The majority of breast problems are not serious and not related to breast cancer in any way. Many patients attending the One-Stop Breast Clinic will have their breast problem dealt with at one go and will not need further appointments. Sometimes it is necessary to return for a final clinic check a few weeks or months later.

A full summary of your breast problem, the investigations and final diagnosis will be sent to your local Doctor or General Practitioner within a few days of your visit and a copy will be sent to your Company Doctor if this is the route by which you were referred to the One-Stop Clinic. It is also very easy to send a copy of this letter through to you if this would help, please just let us know at the time.

For further information and appointments please contact us on:
+44 (0) 20 7234 2009, info.lbh@hcahealthcare.co.uk