Frequently Asked Questions

If you cancel within 48 hours of your appointment, you may be subject to a cancellation fee. You should receive both email and text reminders through our online portal prior to your appointment. If you arrive more than 10 minutes late to your appointment, we will make every effort to accommodate you but you may have to wait until our next available slot or be rescheduled. If you are a new patient, you will need to arrive 30 minutes prior to your scheduled appointment time in order to complete new patient paperwork. This can be completed online prior to arrival. If new patient paperwork has not been filled out and you are late for your appointment, we reserve the right to reschedule if you arrive at any point past your scheduled appointment time.

You may be scheduled to see one of our wonderful and highly qualified advanced practice providers (APP) rather than one of our surgeons. The supervising surgeon is available to review physical exam and/or ultrasound findings. All of our APPs are highly experienced and have undergone extensive training. In order for our surgeons to be able to see patients newly diagnosed with cancer, the majority of patients will see an APP.

All of our follow up appointments are scheduled as US rechecks. Depending on your history and breast density, an ultrasound may or may not be necessary. If you wish to have an ultrasound performed regardless, this is possible but please let us know (and it may not be covered by insurance). If you have had a mastectomy, an ultrasound is generally only performed if something is felt during the physical examination.

Athena is the name of the EMR we utilize in our office. This is different than the general Piedmont system (“MyChart”) and must be set up separately and with a different login. Our office notes will only show up in this system. Biopsy and surgery results will show up in your Piedmont MyChart as well. In fact, you may receive these results even before we do. We will certainly call you to review them as soon as we receive them.

Our exam rooms are equipped with bedside ultrasounds which serve as an important adjunct to physical exam. These allow us to provide additional screening, further characterize masses, and enhance our procedural capabilities. We are not radiologists, so our images are not available to share or burn onto a disc. In certain circumstances, a formal ultrasound with our radiology colleagues may be recommended to complete your work up.

We do not offer mammograms in our office but rather work closely with our radiology colleagues at the Piedmont Breast Center as well as other hospitals and imaging centers throughout the city.

A screening mammogram is a standard annual mammogram. We recommend you obtain a yearly mammogram starting at age 40 (or earlier depending on risk factors). The radiologist will read your images later in groups and you will receive the results via letter or electronic notification. A diagnostic mammogram is ordered if you have a particular complaint or if a screening mammogram is abnormal. This may include additional mammographic views to focus on a particular area or an ultrasound. The radiologist will review the images as they are obtained and tell you a recommendation while you are still there. Plan on this process potentially taking several hours. 3D Mammograms- Refers to a special type of mammogram (generally now widely available) which includes additional images which the radiologist can scroll through- almost like a CT scan. This provides a more detailed image and is particularly helpful for patients with dense breast tissue. This has been proven to reduce the number of callbacks from screening imaging (but do not be alarmed if your first 3D mammogram is abnormal).

The average screening mammogram exposes a patient to 0.4 milliseverts of radiation. An average person is exposed to 3-4 milliseverts a year just from existing in the world. As such, the risk of radiation exposure from a mammogram is negligible.

When radiologists read mammograms, they use a classification system called the BIRADS scale. A BIRADS 0 mammogram means that additional imaging is necessary. This can be frustrating for patients when they are referred to our office and we cannot necessarily clear the BIRADS 0 during our visit. However, many of our referring providers prefer that patients see a specialist early in the process and we are happy to determine what additional imaging is appropriate and facilitate it.

Breast MRI is another type of breast imaging. It is more time consuming and requires that the patient have an IV placed. It is extremely sensitive- but almost too sensitive- with a high rate of false positive findings, meaning that the patient may have to go back for additional imaging or even a biopsy for something that is actually nothing to worry about. Therefore, we generally reserve breast MRI for patients with a lifetime risk of breast cancer greater than 20% or an existing malignancy and dense breast tissue.

Our providers can perform ultrasound guided biopsies in the office. If you have a palpable mass this may be fairly straightforward. If you had abnormal imaging at an imaging center, our providers must be able to recreate that imaging and identify the area that should be biopsied. Therefore, it is helpful for you to bring a copy of not just your imaging report but also your images (usually burned onto a CD) to your biopsy appointment. If your imaging was done in our office, this is not necessary. While we do perform ultrasound guided biopsies, some patients require biopsies using a mammogram as guidance(stereotactic biopsy). We do not perform these in our office and will refer you to one of our radiology colleagues. If our providers are not able to accurately recreate your outside images with our ultrasound (for example if the abnormality is extremely small), we may also recommend that you obtain the biopsy at an imaging center. During a breast biopsy, you will receive local anesthesia. This injection burns when it is performed but afterwards, nothing sharp should be felt. A biopsy device, specifically designed to prevent spread of any abnormality, will be used to take several samples of the target. This device does make a loud clicking sound, which we will demonstrate prior to performing. After the biopsy it is standard for a biopsy clip to be left behind. These are made of titanium like other surgical implants. They are extremely small (size of a pen tip- barely visible to the eye) but show up easily on mammograms. Therefore, if something is benign, it will be clear that the area has already been biopsied. If it is something that needs to be removed, the biopsy clip helps to ensure that the targeted area has successfully been removed. You will receive a copy of post-biopsy care instructions but they can also be found here: Post-Biopsy Instructions

It is not uncommon for a ridge of dense breast tissue to feel like a mass. One of our favorite appointments is when we get to tell a patient that what they are feeling is just healthy tissue. These areas may become more prominent with hormonal changes and may be tender. However, self exam can certainly be difficult and we would never want to assume that any masses, particularly if new, are nothing to worry about. An US in our office is a great way to differentiate this. Dense breast tissue alone is actually a risk factor for breast cancer. This is separate from the fact that mammograms may be more difficult to read. As such, after your mammogram you may receive a letter stating your breast density. Anyone with dense breast tissue can see us for a bilateral breast ultrasound as an additional form of screening. We will calculate your overall risk including factors like personal and family history to determine whether you may be eligible for additional studies.

Sometimes masses represent cysts. Some patients may have a single cyst while others may have multiple. Cysts can fluctuate with hormonal changes, stress, and are very sensitive to caffeine. If a cyst is symptomatic, we can drain it in the office. Some cysts are considered simple and imaging follow up is not required. Some cysts are considered complex and serial imaging follow up may be required.

Breast infections can be very painful and symptomatic. As the nipple is an opening to the outside environment, sometimes breast infections can occur without a clear underlying cause. During a visit for a breast infection, we will try to differentiate between mastitis (an infection of the skin of the breast which is usually managed with antibiotics) and an underlying abscess(a deeper infection that may require drainage or aspiration in addition to antibiotics). It is not uncommon for several visits to be required as sometimes the body is able to fight the infection without forming an abscess but other times the formation of an abscess is the body's natural form of fighting the infection.

Nipple discharge can be normal or abnormal. With enough palpation/squeezing, discharge will eventually happen. Generally, multi-duct, clear or milky discharge that comes only with palpation is reassuring. Discharge that always comes from the same single duct, is spontaneous, and particularly if it is bloody, can be more concerning. We will likely test your discharge for blood in our office and determine how much additional work up is necessary.

Breast pain is an extremely common issue encountered by women today. We like to provide reassurance that the vast majority of malignancies are not tender. However, we will perform an exam and likely an ultrasound to look for causes of breast pain that could be addressed during your visit. Often times, we must rely on conservative options such as vitamin supplementation, caffeine cessation, or herbal supplements. We have handouts which outline recommended dosages in detail. There are prescription medications that may help but they have several side effects and as such, we will usually request that patients attempt conservative measures before resorting to these medications.

You may have a pre operative visit with your surgeon if it has been a long time since you have seen them and paperwork needs to be updated. All patients will have a pre operative visit with the hospital. This may be in person or if you are otherwise healthy may be conducted over the phone. This visit will review your medical history and ensure that there are no problems with you having anesthesia. They will also instruct you which medications to take on the day of surgery. They can give you the most up to date information about the current visitor policy as well as parking. They will likely discuss cleansing with a special soap for several days prior to surgery (we do not expect you to use this after surgery). They will also likely discuss drinking Gatorade the morning of surgery. This may be confusing as you are told to not eat or drink anything after midnight prior to surgery. However, studies have shown that a small amount of Gatorade if taken at the appropriate time may speed the recovery of bowel function. If you would like to drink something and can do this in the appropriate time frame, we are ok with you drinking the Gatorade. If you will be setting your alarm to drink it for a morning procedure or would like to avoid it, then our providers are certainly ok with you NOT drinking the Gatorade as we are not operating on your bowels in any way.

Surgery schedules are anticipated times but delays do happen for various reasons (staffing, equipment, patient factors, etc). As such, you may experience some waiting on the day of surgery. You will be instructed to arrive at least 2 hours prior to your scheduled surgery (earlier if you are undergoing localization). After check-in, you will initially be brought back to the preoperative area without your family. A nurse will get you ready for surgery, place an IV, and you will meet with the anesthesiologist. If there is time prior to surgery, a family member will be brought back with you after this (if you are the first case of the day this usually does not happen). You will see your surgeon prior to going back to surgery. After surgery, your surgeon will speak with your family (whether in person or via phone). You may speak with the surgeon, but it is not uncommon for you to not remember it. After surgery, you will recover under the watch of a nurse. The time spent in recovery can be very variable and depends on the type of anesthesia you had and how you respond to it. You may not be completely back to your normal level of functioning prior to discharge. The hospital requires you to have someone with you the first night at home following general anesthesia.

If you are having a lesion removed that is not palpable, you may undergo localization prior to surgery. There are two options for this: Savi Scout (a special clip that is placed adjacent to the clip left at the time of biopsy) or a wire (a wire that goes into the breast next to the biopsy clip). The Savi Scout can be done any time prior to surgery. The wire is only done on the day of surgery. If you are having a wire localization, you will check in for surgery and then will be transported up to the breast center from the preoperative area. These localization methods are generally interchangeable although there may be special circumstances when one is recommended over the other. Our surgery schedulers will arrange all of the logistics.

If you are undergoing a lymph node biopsy during surgery, you will likely receive a nuclear medicine injection as part of this. You may see a separate appointment in your Piedmont MyChart. At Piedmont, our surgeons are able to inject this in the operating room so you will check in for surgery as instructed and ignore this appointment.

The current visitor policy will be discussed at your hospital pre operative appointment. Generally, one person is allowed to be with you on the day of surgery. After surgery is complete, your surgeon will talk to this person if you so desire. The information that they will relay is generally fairly straightforward (as most of the important information from surgery is obtained after the pathologists have been able to look at the tissue removed under the microscope over the course of the next three to five business days). As such, please do not be anxious about multiple family members not being able to be there. We will call to discuss next steps as soon as your pathology report is available.

If you underwent reconstruction, please refer to the post-op instructions provided by your plastic surgeon rather than Atlanta Breast Care A copy of our Pre and Post-Op Instructions can be found here: Surgery Instructions For most procedures, our providers use sutures that are underneath the skin. The incision is then covered by a combination of skin glue and a surgical band-aid. This bandage is very sticky so may sometimes stick for several weeks. Please leave this on unless instructed otherwise.

You will generally receive pain medication after surgery which can be taken on an as needed basis. These medications are controlled substances so they are strictly regulated. Once you are checked in for surgery, it may be possible for us to prescribe them directly to your pharmacy. Otherwise, they require a paper prescription (which would need to be picked up or mailed if you would like it prior to the day of surgery).