Titanium clip. Can I refuse? Where can I get an allergy test?

Coco_Sade

Hi all,

I was booked for a stereotactic needle biopsy today to draw a sample from some microcalcifications surrounding a possible mass in my breast. I believe the mass is simply a fibroadenoma I had biopsied five years ago when I lived in the UK, although I had no calcifications then, so I understand there is reason to be cautious. However, that is not what I am posting about.

I didn't end up having the procedure and walked away to research and consider my options. This is because I was only informed minutes before I was about to have the procedure that they would leave a titanium marker clip in my breast that would likely stay there forever. I felt completely blind-sided by this news. The radiologist explained the reasons why the titanium clip was necessary but I still found the idea of having a foreign object inserted into my body very unsettling. I was visibly upset and we agreed that I should take a week or two to process this and then rebook the biopsy.

From my research (much of it on this forum) I see that many women have had bad reactions to these titanium clips, even if most do not. I do get a rash from nickel jewellery so it seems the smartest thing to do would be to get an allergy test for titanium. Many people have mentioned MELISA testing but they are in Germany and their site says due to Covid-19 and postal service delays they are not currently accepting samples from the USA. Can anybody tell me if there is anywhere in the USA that does these tests? It seems patch testing (as opposed to blood testing) is less sensitive for titanium allergy testing so I'm not sure a simple patch test would allay my concerns.

Also, the radiologist mentioned that he would probably NOT want to perform the biopsy without leaving the titanium marker. He mentioned that if I were to refuse the marker he would likely recommend I talk to surgeons about a lumpectomy, which obviously is far more invasive. I am feeling like I do not have many options. I have a 15 year history of fibroadenomas in this breast and on most days (when I am not freaking out) I feel like fibroadenomas are still what we are dealing with. The radiologists themselves do not seem that worried. Has anyone had any luck with a radiologist performing the biopsy even if you refused the titanium clip? Does anyone regret NOT getting the titanium clip because it made the biopsy site harder to find later on?

Thanks for reading, everyone.

Jerry

PS. I had assumed it was an error or oversight that I only found out about the clip minutes before the procedure but I see from this forum that it is pretty standard and that some people aren't even told until after it's already done. I'm honestly just so shocked about this.

AliceBastable

I didn't have the biopsy clip left in because I've had possible allergic reactions to metals in the past. My hip replacement was non-metal because of it. The radiologist still did the biopsy, but detached the clip before the procedure. She and the ultrasound tech and the nurse were dissecting the clip because, as she explained, they are rather expensive and they hadn't had a chance to examine one closely before.

But I've noticed from CT scans and mammograms that I do have clips from the surgery. I haven't had any reactions to them and it's been over two years. They're really the only way to mark a soft tissue surgical site for future imaging, otherwise the scar tissue would show up as questionable areas needing further tests, including - you guessed it - biopsies.

edj3

Obviously this is just my experience but I share in as a data point for you.

I've got a nickel allergy too, and had a biopsy with the titanium clip left behind. It was only in my body for about 6 weeks between the biopsy and the lumpectomy and I didn't notice any bad effects. With nickel, it's immediate and incredibly painful, like I'm being burnt.

However, because of that nickel allergy my surgeon had to insert a guide wire in my breast the morning of surgery rather than the Savi clip he prefers to use. That's because there may be trace amounts of nickel in the Savi clip. So if you do end up needing a lumpectomy, be sure you mention the nickel allergy. My care team questioned me about that allergy ("are you sure??" "Um yes, yes I am").

But like you, should I ever need a joint replacement, I will make sure I get tested for any titanium allergy. I sure wouldn't want to learn the hard way that oh yes, I actually am allergic.

Best of luck as you go through this and make your decision.

MelissaDallas

Your assumption in your original post is that issues with titanium markers are “common." In reality, they are very, very rare, and subjective at that..

izzy16

hi i also refused having a marker inserted during the biopsies of my calcifications. I was not informed about it until I was at the appt either so not much time to think about it and it's already a stressful situation. I have titanium in my back i just didn't want a marker in my breast forever if it wasn't needed. At the time i was hoping it was not cancer but it was. Although the radiologist strongly encouraged the marker, afterwards my breast surgeon said they could still locate where to do the lumpectomy without it. With a lumpectomy or mastectomy the marker is obviously removed.


Alice's point though is a good one that the marker may be helpful long term although there are reports of markers migrating long term also.


There used to be a lab in Chicago that did blood metal allergy testing for implants. I can't recall the name but by now my guess is some of the teaching hospitals may do the testing so you could call around if you really want to get the testing but this takes time vs just getting the calcifications biopsied and out of your body.

gb2115

Hello there! I have a nickel allergy also, but have had the titanium clips for 4 years now, without an issue. It helps because they know on future mammograms that an area was already checked out. Otherwise, it could be an ongoing and definitely unwanted cycle of "what's that? Let's check it out!"

I hope everything works out for you!

Beesie

Jerry, as MelissaDallas said, reactions to titanium markers are extremely rare. It's true that if you do a search, it's not difficult to find posts about it here or in other places on the internet, but you have to keep in mind that people who have problems complain whereas people who are just fine say nothing.

There are more than a million breast biopsies done every year in the U.S. and millions more around the world (this site draws people internationally). On this site, over 15 years, there are only 1589 posts that mention titanium (including the 6 posts prior to mine in your thread) - and that includes any reference to word "titanium" in any context, including all the people who've replied to a question, like yours, saying that they never had a problem.

Unless you have significant allergy problems related to all sorts of materials including other metals, I don't think you have anything to worry about. Titanium allergy has a low prevalence rate, and usually affects those who are known to be allergic to many other metals. As for not having the titanium clip inserted, the risks associated with a surgical biopsy, while extremely low, are undoubtedly many times higher than the risks associated with the titanium clip. And if you have a needle biopsy, unless you have the clip inserted, you put yourself in the position of requiring biopsies over and over again in the same location - and that too seems higher risk that having the clip inserted.