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Dr. Chip
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 26383
Experience:  Over 20 yrs of Family Practice
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I am 58 years of age, and have breezed through menopause with

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I am 58 years of age, and have breezed through menopause with very little discomfort. I am in good health and exercise regularly. I have recently developed abnormal tissue which is below the surface on my left breast. It is like a thickened, tough tissue but not tumor-like. It is located below the nipple and elongated; approximately two to three inches in length. It is not red, swollen, and there is no pain. It did not show up on the routine annual mamogram that I had four months ago. There is no history of breast cancer in my family. What would be the next course of action. My GP didn't know what it is and suggested it was my bras. We gave it a month with no underwire bras; there was no change. She wanted to do a biopsy but I suggested an ultrasound. Now she suggests a repeat mamo and maybe have a dermatologist look at it.. I don't think she has adequate knowledge to make a diagnosis and I don't want to mess around and delay a diagnosis. I want to see an expert but not sure what type of doctor should look at it or what tests should be conducted. Will I need a referral? Should I ask the GP for the referral?
Hi--the skin over this is completely normal looking?
Customer: replied 3 years ago.

If it is stretched you can see a slight discoloration; slightly tanish but it is under the surface skin layer. The surface looks normal.

And your last mammogram four months ago was normal?

Customer: replied 3 years ago.


OK. I would get both a repeat mammogram and an ultrasound to fully evaluate this. If it's really at skin level and not truly in the breast, it could just be a simple cyst or eczema, but it might be Paget's disease which is a type of breast cancer that affects the skin of the breast. It could just be a benign cyst of the breast itself or something called fibrocystic disorder which is a lumpy bumpy breast condition. If it only appeared since your last mammogram, it isn't at all likely to be cancer but it should be thoroughly evaluated.
Customer: replied 3 years ago.

What type of medical doctor would be best qualified to make the diagnosis?

Well, if there's anything abnormal on the tests, I'd have you see a general surgeon for a biopsy. If this is more in the skin itself, then a dermatologist.
Customer: replied 3 years ago.

I appreciate the advice. My question is more specific to the the evaluation, tests and subsequent diagnosis. I have reservations that the GP that I saw does not have the knowledge to evaluate, require the correct tests or diagnose the problem. Therefore, I would like to know if I should find a specialist such as an OB/GYN, or a different GP or other type of doctor?? to help make the diagnosis. I also, need to know what doctors require referrals which may be required from a GP. I am considering a different doctor even prior to having the tests done in order to maximize the benefits of the tests during the interpretation phase. Would a GP or possibly a OB/GYN most likely be making the diagnosis based on the tests or would it primarily be coming from a radiologist?

The radiologist could only interpret the tests but not make a firm diagnosis. In your case I think a GYN would be more than capable of doing the workup and determining whether you need to see a surgeon for a biopsy. As for referrals, if your insurance is a PPO you don't need one to make an appointment with a specialist covered under that policy.
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