Pending Excisional Breast Biopsy

StrongJess

Good afternoon all,

First post here. I am 33 years old, married for 11 years, no children. About 8-10 months ago I started noticing nipple discharge. I really didn't think much of it, as it was clear at first. Then it changed to a variety of colors from yellow, to white, to green to brown. Still didn't think to much of it, just thought it could be medication I was taking for my endometriosis.

About 3 months ago, it turned bloody, and then the pain started. My doctor scheduled me for a mammogram, and I had that on 12-19-17. After the mammogram they wanted to do an ultrasound the same day, and the radiologist told me that my milk ducts were inflamed and that they saw fluid. They ordered a breast MRI. Insurance company denied the breast MRI, so they sent me to a breast surgeon. The breast surgeon said she wanted to try again to get the MRI approved, and she did. Had the MRI last week, and received a call yesterday from the breast clinic saying that a spot was seen on the MRI and they wanted to do a repeat ultrasound. I went this morning for my ultrasound, the radiologist came in, and advised me that they were able to see the spot that was shown on the MRI via ultrasound. She said the spot has a blood vessel running right through it. She thinks that it is just possibly fibrocystic changes in the breast, but that we need to make sure.

She said with the placement of it, and the fact that there are blood vessels involved that it would need to be surgically removed and biopsied. She also said that the surgeon may want to excise the milk ducts while we are already in there.

She gave me a little information on what would happen the day of surgery. She said they would insert a wire into the spot on the breast while I am awake, and then I would go to have surgery. She wasn't able to tell me how they would go in, I'm sure I will find that out Friday. I have my appt with the surgeon Friday, and I'm sure I will learn more about how she is going to go in, what she plans to do, est.,

Just wanted to see if anyone else had been through this, or is going through this, and if anyone had any tips for surgery? Thanks so much in advance!

djmammo

StrongJess

On the ultrasound did they say that spot they saw on the MRI was inside a duct or outside?

Did anyone recommend a ductogram to evaluate the ducts?

Would you be able to post the MRI report here?

StrongJess

Thanks for the reply djmammo,

I wasn't given access to any of my reports. I didn't ask, I really didn't know if I was able to have that information or not. I was hoping I could get them via the hospitals online portal, but apparently their portal is only being used for current inpatients of the hospital. Should I maybe ask the surgeon if I can get copies when I go in there on Friday?

They didn't say whether it was located inside the duct or not, I am not sure how far the ducts stretch out in the breast, but they did tell me the spot was "at 12 o'clock". Where she was doing the ultrasound this morning I would say about half a finger length up from the nipple. I did ask the size of it, the radiologist told me it was about the size of the tip of the pinky, so small.

My surgeon did speak with me about a ductogram before I had the MRI, this was when the MRI was denied the first time. She said that she wanted to get the MRI approved first, but if the MRI wasn't approved we could do a ductogram but she really didn't want to do that, that she would rather me have the MRI done.

Icietla

Hi StrongJess. Welcome to BCO.

There is first a local anesthetic injection, and probably an injection of colorant also. Then a thin wire guide is put into the breast to lead to the tumor or suspect tissue. Then mammogram views are done to make sure the wire is properly placed.

After the surgery it is advisable to wear very supportive bras until the excision seam has healed. At all times until then, except for necessary cleaning times, wearing a very supportive bra with a close-fitting sports bra over it for additional firm support would be good. Without adequate support, the weight and motion of one's breast can cause one's excision seam to open.

StrongJess

Thank you so much Icietla for the reply and for explaining more about the wire placement. I will definbe getting a front zipping sports bra.

Silbar

I had a stereotactic biopsy last month and the BS recommended an excisional biopsy due to finding a papilloma with a cluster of micro calcifications. The excisional has been postponed due to my getting a huge hematoma after the stereotactic. I was supposed to meet with him today to see if the hematoma has resolved enough to procede with the surgery but snow came in today and the office was not able to open. I have been rescheduled for next Wednesday.

One of the questions I want to ask him is in regard to the placement of the wire. I know that the radiologist is the one who inserts it but I want to know in advance exactly where my BS wants to make the incision on my breast. I also want to know if he confers with the radiologist about this prior to the wire being inserted or does the radiologist just pick where ever he feels is easier for him to place the wire.  If the BS uses the wire as a guide to the papilloma is the BS then committed to make his incision at that place(where the wire is inserted)  rather then where his preference would have been? This might be something you would want to ask about.

Also, find out what facility the wire will be inserted. Some facilities are in the same building as the BS but I have read here that some people had to drive for an hour from the radiologist to the BS's office. It would be good to know this ahead of time.

Yes, definitely get a good supportive sports bra that zips or hooks in front. Be sure to wear some form of support even at night. Also get  some small circular gel ice packs such as  https://www.amazon.com/LotFancy-Reusable-Comfortable-Heating-Arthritis/dp/B01A6E24VM/ref=sr_1_6_a_it?ie=UTF8&qid=1516234600&sr=8-6&keywords=round+gel+ice+packs These do not get hard when frozen so they are very easy to slip inside of the bra.

If I had been more prepared after my stereotactic biopsy I think the hematoma would not have been as bad. I'm ready this time!

Good luck and keep us posted.

StrongJess

Hi Silbar,

Thank you for your reply. I’ll keep you in my thoughts and prayers for your excisional biopsy as well. I hate to hear your appt had to be rescheduled. The waiting is just really hard! I’m so glad I will be busy tomorrow so maybe Friday will hurry up and get here.

Thank you so much for the suggestions on the questions and the ice packs! I will be picking those up too.

I will update Friday on what the surgeon says. Luckily the breast clinic where the radiologist is, is in the same hospital that my surgeons office is, at the same hospital I will have the surgery. I couldn’t imagine an hour drive after having a wire placement, I can imagine that would be quite uncomfortable!

Silbar

As suggested, don't forget to get a copy of all of your test and biopsy results. It's always god to have these in a home file. Even if this incident turns out to be B9 you never know what is in the future and having all your records at your finger tips can come in handy. Not just for breast issues but any tests or xrays. Good luck tomorrow and stay busy over the weekend.

StrongJess

Thank you Silbar,

I did get a copy of my MRI and 2nd ultrasound report.

I will be having my surgery next Thursday on the 25th. Not sure what time yet, I won’t find out the time until the day before.

My surgeon will be doing the excision biopsy and breast duct excision.

She advised that she is going to try and go in from the one incision in the areola, but depending on the wire placement she may not be able to get to that area. So I am guessing I won’t know if I have one or two incisions until I wake up.

I picked up my front zipping sports bra and ice packs today. Luckily I will be busy Monday - Wed between work and getting my house work done so I don’t have anything to worry about after surgery.

Here are the results from my MRI and Ultrasound:

Gadolinium contrast was injected. Vitamin E capsule was placed by area of interest. Axial T1 and T2 images were obtained with a dedicated breast coil. Pre and post contrast images were obtained at 1 minutes intervals for 5 frames. Post processing was performed including color parametric mapping. Computer aided calculations of any tumor volumes and dimensions. 2d and 3d multiplanar reconstruction.

Right breast background enhancement is moderate. Left breast background enhancement is severe.

Current study was also evaluated with a CAD system.

There is an 8mm focus of enhancement in the left breast at 12 o’clock middle depth. This shows heterogeneous enhancement. There is a background of prominent left greater than right breast enhancement which may obscure small lesions. Bilateral mildly prominent axillary lymph nodes are also present which may be physiologic for age. No other dominant lesions identified. Anterior chest wall structure are intact. No drainable fluid collection.

Second ultrasound:

There is an 8mm oval lesion in the left breast at 12 o’clock middle depth. This oval lesion is of mixed echogenecity. This correlates with breast MRI findings. Color flow imaging demonstrates that there is increased vascularity. Question papilloma/fibrocystic change.

Impression: suspicious of malignancy - follow up recommended - the 8mm oval lesion in the left breast at 12 o’clock middle depth is at a low suspicion for malignancy, however indeterminate. An ultrasound localization and Surgical biopsy are recommended.

BI-RADS Catagory 4A

StrongJess

Phew, surgery tomorrow and I’m feeling nervous! I won’t find out the time of surgery for about another hour. The surgeons office allows you to call after 11 to get your arrival time at the hospital.

I have my front zipping sports bra, ice packs, phone charger so my husbands phone doesn’t die and he isn’t so bored while waited lol.

Gonna shave my legs and do my nails tonight. I can’t wear deodorant, makeup or lotion so I’m probably gonna be looking pretty scary tomorrow.

Gotta find the humor in it. I have a million things running through my mind.

Keeping myself busy with housework. Making sure everything is done so I can just rest and heal.

momto3sons

Best of luck Jess!!!

StrongJess

Thank you momto3sons

Georgia1

Best of luck to you! You may have a long day ahead of you, so bring something to read. This whole journey seems to have unexpected stretches of just waiting around...

teachermomfl

Good luck!! My surgery is next Friday, and I just realized I’m going to have to shave these hairy ape legs before then!

StrongJess

thank you Georgia! Yes the waiting is no fun at all! Contemplating not sleeping tonight so I can sleep while I wait! Lol!

Teacher - good luck with your surgery! I will keep you in my thoughts and prayers! Let me know how you are after! I had to shave my hairy arm pits today too LOL. It’s winter, my razor doesn’t need get too much use LO

Silbar

Jess~~Good luck today!! 

teacher~ Good luck tomorrow! 

I hope all goes well for both of you. Praying for b9 results. When you feel OK please post on how the procedures went .

StrongJess

Hi everyone,

Just an update on how yesterday went. Everything went well. I arrived at 6am to the hospital, got in a room and they drew blood, and put the IV in. They gave me Zofran and a Pepcid for my tummy. The anesthesiologist came in to talk to me and ask me some questions. Right after that, they gave me 2 Valium right before they wheeled me down for the wire localization.

By the time I was in the room for the wire localization I was feeling calm, no worries in the world. I watched them do the whole thing, it was super interesting. The radiologist had to switch needles because the needle wasn't long enough to get the area they needed to get too. This was the first time I was able to see what they saw on the ultrasound. The wire was unable to penetrate the lesion, the ultrasound tech said something about the rim of the lesion? Who knows, I was all Valium'ed up. Then they did the mammogram pic to confirm everything was in place. For some reason the wrote the word "Yes", on my breast. They also drew an X on my breast. X marks the spot of the lesion. This took about 45 min to an hour and they wheeled me back to my room.

It was probably about another hour before I was wheeled into surgery, and before I knew it I was waking up in recovery. I went home after about an hour of observation. They were able to get it all is what my husband was told by the surgeon, and they did it with just one incision. It was a little bigger than what they thought.

I only had to take one pain pill yesterday, but today have had to take 3. I have only felt the pain in my incision once, I feel the pain where the lesion was removed rather than the incision itself. I have been really nauseous today, and have slept alot. Which is good.

I think I will feel good enough tomorrow to get out of the house.

The surgeon said that we should hear something in 2-3 business days with the first business day starting Monday. I'm really anxious and hoping everything comes back okay, but I've also been preparing myself mentally if it doesn't.

The follow up instructions I was given is that I have to wear my sports bra until I see the surgeon again. So looks like me and the sports bras will be best friends day and night until I am cleared. This sports bra has been a life saver though! I cannot imagine not wearing one.

Hoping this will help with anyone else that is about to have the surgery. I know each hospital is different, but maybe this will give some kind of insight as to how surgery day progresses.

Hope everyone is doing well and has a great weekend!

Silbar

Jess, I'm so glad that everything went good for you and that you only needed one incision!  I like that they were able to medicate you prior to the wire insertion. I hope I get that offer also. 

When you had your pre-op visit did they tell you to get the sports bra and bring it with you to surgery or did you put it on after you got home? Take your medication, use the ice packs and get lots of rest. Take it slowly when you start moving around. 

Thank you for updating as it really does help to hear that others have gone through this and that it wasn't quite as horrible as others have said. Good luck with the recovery and the bx results.

StrongJess

Hi Silbar,

I'm glad hearing about the experience helped! It helped me to read about others experiences as well. They didn't tell me to get the sports bra and bring it with me, but I went ahead and wore it to the hospital. This zip up the front sports bra has really been such a huge support and probably one of the reasons my pain level hasn't been so bad! Only had to take one pain pill so far today.

I didn't know they would give me Valium prior to the wire insertion, but I am so glad they did. You may want to let them know that you are extremely worried and scared about the wire insertion and maybe they will give you something, if they weren't planning on giving you anything, that may make them ask the surgeon if they can give you something to calm you.

Also, when I went in to the hospital, I wore a button up shirt so I wouldn't have to pull anything over my head or over my breasts after surgery. I also wore leggings just so everything was easier to put on.

Also, before your surgery you may want to go ahead and buy some tape that sticks to the skin, some gauze, and maybe something to help with constipation (stool softeners, enemas, or suppositories). I had some prescription pills for constipation left over from when I had my appendix out, but for some reason they didn't really help much. So I used suppositories.

I just changed my dressing about an hour ago, and the incision looks pretty good. I can't see alot because the surgical tape is still on the incision, but where they cut me is actually more from the bottom of my areola and the side of my areola. I think they had to cut a little closer to the side because of where the lesion was that they were cutting out.

Warning: TMI: My nipple did get hard, so I know that it is getting blood flow so that is good, but I cannot feel it. So I'm not sure if it will stay that way or if the sensation will come back. If it doesn't, it won't bother me. I knew that was one of the side effects.

If you have any other questions Silbar, feel free to ask on here or you can PM me. Let me know when you find out the date of your surgery. I have you in my thoughts!

teachermomfl

Thanks for posting, Jess! I’m glad everything went well. Less than a week for mine. I go in Thursday to have my Savi Scout piece put in. My hospital uses this rather than the wires. It’s a similar procedure to stereo biopsy, only rather than suck something out, they insert the Savi Scout antenna. It’s about the size of a grain of rice. My biopsy is Friday, and my surgeon will use some handheld device to locate the antenna so he know she where to cut. Pretty high tech, and I’m surprised my insurance would cover it, as it was just approved by the FDA a few months ago. Hoping for benign results for you

Silbar

Jess~~I'm so glad you are feeling a bit better today. Your suggestions about front button top, gauze, tape and stool softeners are great. I will be prepared thanks to you! 

My surgery is set for Feb.8, as long as my insurance authorizes it.

StrongJess

Teacher - that Savi Scout sounds awesome! Let me know how it goes for you!

Silbar - I'm sure your insurance will authorize it. You will do great with yours too!

Y'all keep me posted on how you both are after surgery!

momto3sons

Jess, I'm so glad to hear you're recovering nicely!