Friday, September 26, 2008

The Actual Stereotactic Breast Biopsy Procedure and Afterward

If you've been following along, you may remember my last (and first) post on this topic mentioned that I was scheduled for a stereotactic breast biopsy yesterday. As it turns out, what the radiologist and the scheduler had told me would happen matched up pretty well. Although actually experiencing it is far different than having an intellectual understanding of what would happen.

Leading up to the procedure, I had been sharing with friends and family my anxiety and answering any questions they had. By the time yesterday morning rolled around, I was in a pretty good head space and ready to forge ahead, facing my fears. So many kind folks called to wish me well, and that was just the most helpful and loving thing they could do. Many others called afterward with love and kind wishes for my speedy recovery. It makes me a bit misty to think of all the love that's been shown to me during times of need. It's hard to express how grateful I feel for all of it. So, I'll just move on and tell you how it went without moving my left arm too much because I'm pretty sore.

John had taken a work-from-home day, and had been typing away on his laptop until we had to go. He packed away the computer and took it with him because the biopsy was expected to take about 2 hours. It took much longer than that. My appointment was at 12:30, but I didn't get into the actual room where the procedure would take place until 1:30. I was so nervous I must have peed at least 5 times while waiting. In fact, when I finally was called into the room, I had to go again.

When I returned, the two women who were assisting the radiologist (Cathy and Stephanie) asked me a few questions, set up the room, took my vitals, and had me sign a few forms. Then, in walks the same radiologist who had given me the bad news in Hillsboro, NJ, Dr. Paster. The facility where I had the biopsy was in East Brunswick, NJ, but the original mammogram was taken in Hillsboro. I was very comforted by the fact that it would be someone who already knew my history, had seen all my films, and had explained the procedure to me in the first place.

When it was time, I climbed up onto the table with the hole on it. The table isn't completely horizontal; it dips about an inch or so where the hole is. I had a feeling I'd be having back spasms later, and I was right. That hole was pretty uncomfortable for a hole. The edge of it was not cushioned, and it pressed up against my already tender ribs (the reason I started this mammogram business in the first place -- we still don't know why I have rib pain). Cathy told me that they were then going to take some images of my breast and that I'd have to get into a position that would help get the best images. I had to turn my head to the right and keep my left arm at my side. In that position, I faced a wall for the entire procedure. Mainly I just kept my eyes shut and tried not to move. I've never wanted to take a deep breath more than I did during the biopsy.

Image from Visalia Imaging.

Meanwhile, under the table, Cathy was positioning my breast between what seemed to be a vertical steel plate and a much smaller and thinner steel plate that looked like a window about 2 inches square. Her goal was to get my microcalcifications within that window so that the computer taking the images (essentially mammograms) could exactly position the needle for Dr. Paster to take the samples. This positioning involved compression, but it wasn't nearly as bad as any I'd experienced in mammograms. However, it was a bit unsettling to have a stranger moving my boob around through a hole in a table. But Cathy and Stephanie kept up a conversation with me the entire time, asking me questions about myself and telling me what they were doing as they were doing it.

Just as an aside, when I described the procedure to my friend Rich, it was he who said it must have been a man who designed the procedure. I replied, "An angry man."

After all the images had been taken for the first set of microcalcifications (there were two sets, so the procedure would be duplicated because the two sets weren't close enough together to fit them into the same window -- which is not to say they didn't try), and everything was ready to go, they called Dr. Paster back into the room. That's when my anxiety level spiked again. But she warned me about exactly what would happen, "You're going to feel a pinch and then a burn when I give you the numbing agent (lidocaine)."

It didn't hurt/burn anywhere nearly as much as I'd expected or experienced previously in all the dental surgeries I've had. However, because I have a reaction to epinephrine, Dr. Paster gave me the straight stuff, and a LOT of it. So much of it, in fact, that I could see the clouds of it in my breast later when Cathy took me for a post-procedure mammogram and I came around to her side of the machine to see the images. More about the lidocaine later...

After I was numbed up, they began the first biopsy. Now, I'm not sure exactly what happened because I couldn't see under the table. I told them that I wish I could have filmed it, but they said I wouldn't have been able to due to legal reasons. Oh well. But, what I do know is that once the coordinates were all checked and double checked, Dr. Paster used a needle like the one below to take samples of the calcifications and then used the vacuum setting to capture extraneous tissue afterward for a second or two.


Image from Ethicon.

When I told John about the needle, he said it was like an auger with a sheath around it. I'm not sure if that's how I would describe it, but my understanding is that the point is solid, but there's an inch-long hole on the top of the needle that has tiny blades within it so that it can cut and capture tissue when it's taking samples and vacuuming tissue. Either way, I was so numb that I couldn't feel it. I could hear the vacuum machine, but it wasn't that loud.

The procedure was repeated so that Dr. Paster could get samples from the second area of microcalcifications. During both procedures, she gave me a lot of lidocaine. Also, Cathy held my hand, and sometimes, Dr. Paster put her hand on my arm. Both were very comforting.

After each biopsy, Dr. Paster inserted a tiny (about 1/16 inch long and a millimeter deep) marker into each spot where she took samples. One marker was in the shape of an M and the other, an O. Cathy had shown me the M marker prior to the procedure, which I thought was pretty neat. Good thing I didn't have more spots to biopsy, I might have been able to spell something.

By the end of the procedure (which took about an hour and 15 minutes), I was having a tough time answering their questions. Meanwhile, Cathy had cleaned me up, put steri-strips over the 1/8 inch long incisions, and taped some gauze over my breast. I didn't understand why I was thinking alright, but couldn't put a sentence together until after I'd gotten up off the table. I had a tough time focusing my eyes and felt, well, high. More accurately, I felt drunk, but without the warmth and goofiness. Just the weird lack of physical control. I had felt a similar weirdness after my last dental surgery, but not to the same degree.

My lips and tongue felt numb. When I finally could go pee again, I nearly fell off the toilet from lack of balance. However, I played it cool because it was already 3 pm, and I wanted to go home. Suddenly, I was exhausted. Then, after I'd changed back into my clothes, Cathy recited the post-biopsy instructions and gave me a copy. I'm so glad she told me what to expect as far as bruising -- gravity will cause the bruising to show up in unexpected places, like under my breast. Finally, she told me I can't work out with weights for a week, although I can go walking. Then, she gave me a small ice pack to stick in my bra. That was a surprise. I was told that I needed to sleep in my bra and keep ice packs in there on and off for 30 minutes at a time. I thought I'd be braless for a few days. No dice. :(

I struggled to walk out to John because I just felt so weird, and told him so as soon as I saw him. He quickly saved the work he had been doing and got me out into the fresh air. I told him that I felt drunk and was very chatty the whole ride home, drinking as much water as I could. By the time we arrived home, I was ready to crawl into bed and fall asleep. But, I had to phone a few folks who were on pins and needles. Then, I turned on the TV and vegged out for a while until the lidocaine wore off. That when the pain started. It wasn't unbearable, but I had to send John out for some Tylenol. I wish I could have taken some Alleve, but that seems to cause bleeding, so no dice. I toughed it out, though, as I've done so many times with pain before.

This morning, I'm pretty sore and it hurts to lift my left arm, but I'm sure that will pass. I have one of John's homemade ice packs (a water-soaked washcloth frozen in a ziplock bag, warmed enough to shape into a breast-friendly pack) in my bra, giving me some comfort. I had a lot of trouble sleeping since (as I discovered in January when I had the foot surgery), I sleep on my left side, and that's where the biopsies were done. Otherwise, Stephanie has already called to check on me and to remind me if there was any bleeding to call them. I haven't checked yet, but my guess is that there isn't any because I would have seen it through the gauze.

So, that's the story so far. I should get the results either Monday or Tuesday. I'm sure that whatever the results, I'll be fine. In the meantime, I'm going to get some rest.

Thanks again to Cathy, Stephanie, and Dr. Paster, who made a tough procedure much less icky than it could have been, and who did a good job helping me through my anxiety. They get high marks in my Patient Survey. ;D

Thanks also to everyone who put John and me in their thoughts and prayers and who continue to send positive energy out into the universe about my results. I am truly grateful to you and am overwhelmed by your generosity of spirit.

20 comments:

julie said...

Dear Deb and John,

Been there, done that on the breast biopsy. I'm an RN here in Michigan, got a suggestion for your breast pain that I hope will make you smile. Take a cold cabbage leaf and put it inside your bra to ease your post biopsy breast pain. (We use this on Mother/Baby for moms with engorged breasts). I did this after my biopsy and it really helps. There is something in the cabbage itself that eases the pain.

If you ever need an ear or some suggestions if your results aren't what we all hope, PLEASE email me at Mitla96@aol.com.

I was on your site looking for agave nectar recipes!

Janet in Michigan

Deb Schiff said...

Hiya Janet!

Thanks for the good advice. Wish I'd known prior to it because I'd gotten cabbage and made cole slaw that morning! Oh well. Thanks for stopping by. Please check Altered Plates for agave nectar recipes.

Laurie in California said...

Hi Deb

I was doing a search on Stereotactic breast biopsy today and came across your blog. I am having this procedure done on Feb 3rd and I was thrilled to read about your experience. I learned a ton of stuff here! I can honestly say that I am not looking forward to a painful, red and purple boob. Cabbage leaves... who woulda thunk? That's on my list of things to buy this weekend now. I found the results of your biopsy. Great news! Hope mine is the same. Thank you for sharing your experience!

Deb Schiff said...

Hi Laurie,
Thank you for leaving a comment and stopping by. I hope that you'll share your results here no matter what they are. Please know you are in my thoughts and prayers.
Your pal,
Deb

Anonymous said...

Thanks for writing about your stereotactic biopsy procedue in such detail. I am a nurse that deals with teaching patients about this biopsy before they actually have it done and I think this is very helpful to me and my patients will benefit.

Deb Schiff said...

You're welcome. I'm really glad to be a resource.

By the way, I go for my 6 month follow up on Tuesday. I'll post about it soon.

Laurie in California said...

Hi Deb

I finally had my biopsy done on Feb 7th. It was orignally scheduled for the 3rd but the machine broke down that morning. So I ended up having to go to another Imaging Center. The procedure went okay but it sure isn't something I want to have done again! That table was very uncomfortable! I found out that I am highly allergic to the adhesive from the steri-strips. I now have two quarter size burn marks near my puncture wound! I got my results two days ago... Atypical Lobular Hyperplasia. I now have an appt with a Surgeon but I'm not sure why since it isn't cancer. I guess I'll find out when I see her. Hope your follow-up went well! I'm not sure if you posted that or not... I'll look after I post this.

Laurie

Deb Schiff said...

Hi Laurie,

Thank you for returning to share your results. I'm very sorry about the steri-strips allergy. Did you go back to get stitches? How are your doctors handling that? You don't want to get an infection on top of everything else.

Because I didn't know anything about Atypical Lobular Hyperplasia, I did a Google search and found this link to the Dr. Susan Love Research Foundation.

The article was particularly helpful in identifying the condition (sometimes a precursor to cancer) and issues with the treatment sometimes suggested. I hope you have an opportunity to do some research as well before you meet with the surgeon.

BTW, I had to reschedule my mammogram because I started my cycle right before the appointment. Now it's on the 18th. Then I have a dental cleaning. How much fun can you have in a day?

Please let me know what happens at the surgeon. Will keep you in my prayers.

d.

Laurie in CA said...

Hi Deb!

Had my appt with the surgeon the other day. I am now scheduled for a wire localization and biopsy under general anesthesia. Oh joy! I'm scheduled for that on March 23rd. She wants to make sure all of the weird looking cells have been removed and there are no cancer cells that were missed. That's better than the alternative but I sure would like to schedule a vacation soon! Oh and I don't have an allergy to steri-strips after all! The surgeon thinks it was the pressure bandage pulling on it and it tore my skin. I think she's right because there were two other strips beneath the one that pulled and I didn't have a skin reaction to those. She put a steri-strip on the inside of my arm and when I took it off two days later, you couldn't even tell it was there. I never did need stitches after the first biopsy but this cut will be about an inch or so. I think she said she will be closing it up with sutures. I can hardly wait.... not!!

Laurie

Deb Schiff said...

Hi Laurie,

Thanks for continuing to come back and keep me posted as to your continued recovery and fight against this condition. I'm glad the steri-strips turned out not to be the problem, and hope your skin heals up very quickly nonetheless.

Best of luck with the wire biopsy and the general. Remember to talk to the anesthesiologist before the procedure to make sure they don't over-dose you and you wake up feeling hung over.

Will be sending you positive energy and prayers.

Laurie in California said...

Hello! Just wanted to let you know that surgery went well. Since I woke up I consider it a successful surgery! I now have another diagnosis... Lobular Carcinoma In-Situ (LCIS). There appears to be a lot of controversy surrounding LCIS on what exactly it is or what it should be called. Some say it's a marker for increased risk for invasive breast cancer in the future. Others say the cells are cancerous but they have not moved from the lobules into the surrounding breast tissues. I asked my surgeon to refer me to an Oncologist so I could find out what my options are. That appt has been scheduled for April 28th. In the meantime it's all I think about now. My incision is healing nicely. It's about 1 1/2" long. It took two weeks before the throbbing went away. It's been an emotional roller coaster which I am more than ready to jump off of! I am already dreading future mammograms. Sigh.

Laurie

Deb Schiff said...

Hi Laurie,
Once again, I thank you for taking the time to return and post your experience here. I hope you will post again after your visit to the oncologist. Additionally, please post a message that I will keep private, with your email. We can keep in touch offline as well.

Glad to hear your surgery was a success, and I will keep you in my thoughts and prayers.
P.S. I know exactly what you mean about the mammograms.

Becky said...

Thank you for your description of the stereotactic biopsy. I will be having mine done on March 2nd and I trying to find out as much information as I can to try to minimize my anxiety about the whole thing. I'm not one that handles pain very well so I appreciate your posting a lot.

Thanks,

Becky

Anonymous said...

Thanks for the detailed description. Since finding out I need a stereotactic breast biopsy, I have read many horror stories on the internet and have a good deal of anxiety. Your story offers me comfort that it won't be so horrible!
Thanks,
Jeanette

Deb Schiff said...

Hi Jeanette,
Please keep in touch and let me know how it goes. I'm glad you stopped by. Will keep you in my prayers.
Deb

Anonymous said...

Just got home from my stereotactic breast biopsy and it was not nearly as bad as I had expected. The radiologist (who specializes in breasts and has done thousands of these procedures)gave me a prescription for Valium to take prior to the procedure, and promised me he would give me plenty of lidocaine to numb the breast. I don't think the Valium did much, at least not for me. The shots of lidocaine hurt, but it was by no means excrutiating. He definitely did give me enough because I could barely feel the 6 or so biopsies he took. I was then taken back to mammography and 3 additional films were taken while the breast was still numb. The entire procedure took about 1 1/2 hours. The doctor is fairly certain it will be benign, but must wait for the results. Just wanted to post this as an rebuttal to all those horror stories I have read. If you have a competent, compassionate and experienced radiologist, it's really not that bad. If I had to do it again, I would, so that's saying something, since I am somewhat of a wimp when it comes to needles.

Thanks for the great information you provided!

Jeanette in Louisiana

breastimagingofoklahoma said...

Wow, great article, I really appreciate your thought process and having it explained properly, thank you!


Stereotactic breast biopsy

Deb Schiff said...

Thanks, Breast Imaging of Oklahoma. I appreciate your feedback.

Anonymous said...

I just got home from a stereo tactic biopsy and I was also horrified by others responses. I was worried about laying on my stomach for an hour, because I had cervical fusion and a titanium plate in my neck and lumbar surgery C5, S1. I did fine and was sweating from fear. It was uncomfortable and I did feel the needles, so they just numbed it some more. It felt like pressure, pulling, and pinching to me, but not extreme pain. My calcification was aspirated and about 1.2 mm. I left trembling out of nervousness, but also happy it was over. I hate needles, but without them they can't help us. I understood that shadowing is a result of milk ducts. This was my second biopsy and in the first one they used a smaller needle. I was laying down on my back and the sonogram hurt more than the needle. It came back negative, but the radiologist wanted an additional biopsy. The first marker appeared to be next to the calcifications. They removed calcification and hopefully results come back negative again. Better safe than sorry. I have several ice packs and as soon as one feels warm, I change it out. I can tell, because it starts getting a little painful. Table and procedure, just as described above. Everyone is different and discomfort varies. Now that I've experienced it, I can tell you that for me, my fear was the worst part. The pain and pinching are about as uncomfortable as a mammogram, except your laying down and your breast is hanging and stretched out. This only takes an hour compared to childbirth, piece of cake. Wheww! I pampered myself by buying me some fajita tacos and krispy cream donuts. Take a deep breath, because it's going to be OK and God Bless Us All.

Unknown said...

Thanks for detailed information and explains why I am feeling what I feel. Had two biopsy completed two days ago in same breast, yet still feel pain.
Thanks again