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.