Richmond Surgical and Henrico Doctors' Hospital partner to create an unparalleled experience in the treatment of breast diseases in Richmond, Virginia. We offer patients world-class care using the latest minimally-invasive diagnostic technology and techniques, expert and experienced surgeons, and custom treatment plans to give you and your loved ones peace of mind.

Our surgeons support a multi-disciplinary approach to care, working and communicating closely with other specialists (Breast Radiologists, Pathologists, Medical Oncologists, Radiation Oncologists, Nurse Navigators, Social Workers, etc.) to offer personalized care, while also providing support and education for the patient and their loved ones.

What is breast cancer?

Breast cancer is the most common form of cancer found in women, and is caused by the uncontrolled growth of malignant (cancerous) breast cells. (Breast cancer can also be found in men, though far less frequently.) A breast consists of glandular tissue called lobes. These lobes are divided into lobules, which can produce milk. Milk is carried from the lobules to the nipple by small ducts. All of this is surrounded by fatty and connective tissue, as well as blood and lymph vessels.

Breast cancer can start anywhere in the breast tissue, but starts most commonly in glandular tissue like ducts and lobules. The cancer cells may eventually form a tumor, or invade nearby tissue, such as the chest wall or lymph glands.

Most breast cancers are carcinomas—malignant tumors that grow out of the surface or lining of the glandular tissue of the breast. Other very rare types of breast cancer are formed in the surrounding and supporting tissues, and are referred to as sarcomas, acinar tumors, or lymphomas.

Breast cancer is classified by its invasiveness. “In situ” cancers are localized to the breast and are the easiest to treat and cure. “Invasive” cancers have begun to spread beyond the primary site to adjacent tissue or distant sites in the body, and require more intensive treatments.

In situ breast cancers include:

  • Ductal carcinoma in situ (DCIS) develops in the milk ducts, is commonly found on mammograms, and has a high cure rate.
  • Lobular carcinoma in situ (LCIS) develops in the lobules. It is not really a “cancer,” and is considered an incidental finding that increases future risk for developing the disease. It will be monitored by your provider for growth and development on an ongoing basis.

Invasive breast cancers include:

  • Ductal carcinoma develops in the milk ducts, is the most common form of breast cancer, and it accounts for 80% of breast cancer cases.
  • Lobular carcinoma originates in the milk-producing lobules of the breast. It can spread to the fatty tissue and other parts of the body.
  • Medullary, mucinous, and tubular carcinomas are 3 relatively slower-growing types of breast cancer. They are named based on their appearance under a microscope.
  • Inflammatory breast cancer is relatively uncommon, but is fast growing and difficult to treat. Cancer cells invade the lymphatic vessels of the skin and can be very extensive. It is very likely to spread to the local lymph nodes and require extensive coordinated treatment.

Who is at risk for breast cancer?

While both men and women can develop breast cancer, the disease is most common in women. The two most common risk factors are gender and age, which cannot be changed. The majority of women diagnosed with breast cancer are 50 years of age or older. Other factors that may increase your risk for breast cancer include:

  • Family history plays a role in a person’s risk, and is directly tied to how close the relations are. First-degree (parent, child, sibling) relations can as much as double a person’s risk, while second-degree (grandparent, aunt, niece) relations present little to no correlation. In all, only about 15% of all breast cancer patients have a noted family history of breast cancer.
  • Genetics play a role in risk via mutations in specific cell DNA that predispose for cancer development. These mutations are inherited, and the two most common are the BRCA1 and BRCA2 genes.
  • Medical conditions such as prior cancers, advanced maternal age pregnancy, excess weight, and increased exposure to estrogen, particularly after the age of 50.
  • Lifestyle factors like smoking, drinking alcohol, and being sedentary can contribute to your risk.
  • Ethnicity can play a role. In the US, Caucasian, Hawaiian, and African American women have the highest rates of breast cancer. The lowest rates occur among Korean, American Indian, and Vietnamese women.

Richmond Surgical offers genetic counseling services that can help you better understand your risk factors and ways to help prevent or detect breast cancer markers early. Call us at (804) 285-9416 to meet with Susan Uhle, RN, MSN, CNP, and discuss what you can learn, what you can change, and how we can help.


What are "dense breasts?"

40% of American women have dense breasts, which are characterized by having more breast tissue than fatty tissue, the two components that make up the breast. On a mammogram dense tissue looks white. Since masses or lumps also appear white on a mammogram, a suspicious lump may be masked by the dense breast tissue. Dense breast tissue is also linked with an increase in the risk of developing breast cancer, and women with extremely dense breast tissue have a 4 to 6 times greater risk of developing breast cancer than women without it.

Richmond Surgical and Henrico Doctors’ Hospital offer specific 3D ultrasound technology to comfortably and quickly image women with dense breast tissue. Each exam takes approximately 15 minutes and is typically done after your annual mammogram. Click to learn more about our ABUS (Automated Breast Ultrasound) capabilities.


Learn from our expertise.

The surgeons of Richmond Surgical have been pioneers in breast care for the Richmond, Virginia, community for more than 35 years, starting with the vision of Dr. George Knaysi. Watch a few of our surgeons discuss the different aspects of breast disease, and the diverse treatment plans we offer.

Our providers also actively share their knowledge with the community, so we invite you to read their thoughts on various aspects of breast disease including its history, risk management, and what to do if you suspect something may be amiss. We continuously update this area with new content.


Meet the team you can trust with your care.

Richard Carter, MD, FACS

Richard Carter, MD, FACS, received his undergraduate degree in Chemistry from the University of Virginia in 1996. He received a Master’s degree in Pharmacology and also completed his medical training at Virginia Commonwealth University’s Medical College of Virginia. After medical school, Dr. Carter stayed on to complete his residency in General Surgery at VCU Medical Center. His areas of surgical focus include Breast Care, General and Endocrine Surgery, Laparoscopic and daVinci Robotic Surgery, and Complex Wound Care. He was voted a "Top Doc" by his peers in Richmond Magazine in 2016.

Clifford L. Deal, III, MD, FACS

Clifford Deal, III, MD, FACS, received his undergraduate degree from Washington and Lee University and completed his medical degree and general surgery residency at VCU Medical Center. He is board-certified in General Surgery and is a Fellow of the American College of Surgeons. Dr. Deal received the Outstanding Resident Physician Leader Award from Richmond Academy of Medicine and the Young Star Award from the Medical Society of Virginia, on both of whose Boards of Directors he serves. Dr. Deal has also served as Chief of Surgery at Henrico Doctors’ Hospital and been voted one of Richmond's "Top Docs" by his peers in Richmond Magazine multiple times.

Debra Hutchins, MD, FACS

Debra Hutchins, MD, FACS, graduated from Texas A&M University, Baylor College of Medicine, and completed her residency in General Surgery at the University of Colorado. She practices breast surgery, thyroid and parathyroid surgery, in addition to routine laparoscopic, general and melanoma surgery. Dr. Hutchins is Board-Certified in General Surgery and a Fellow of the American College of Surgeons. Prior to moving to Richmond, Dr. Hutchins practiced for eight years in Northern Virginia, where she was voted a “Top Doc” in Washingtonian Magazine.

Susan M. Uhle, RN, MSN, CNP

Susan Uhle, RN, MSN, CNP, attended Virginia Commonwealth University and Catholic University for both undergraduate and graduate nursing degrees. She holds a Master of Science in psychiatric and mental health nursing, as well as a post-masters Nurse Practitioner Certification. She practiced in both inpatient and outpatient settings treating anxiety, depression, and focusing on emotional responses to illness and loss before joining Richmond Surgical. Within the group, Susan focuses her practice on management of high-risk individuals, as well as benign and malignant diseases of the breast, and genetic counseling.