Refusing Titanium Marker

Meadowmoon

I am 38 and for my baseline they found a mass they want it biopsied. I have no issue with that but I am leaning toward refusing the titanium marker. Has anyone refused it? My family has a history of this happening and then finding out it's benign. If there is a issue will it make it harder to locate the mass

edj3

Yes, if there's an issue and even if there isn't, not having the marker means they will not have that pinpointed location for whatever triggered the biopsy. And if you do end up with BC, the marker comes out w/ the surgery.

Sunshine99

I had the marker placed when they biopsied the lump in my armpit in March of this year. It's still there, but I've not had any issues with it and actually don't even think about it - well, at least not until today!

Harley07

The marker is a very useful tool for future mammograms so they can identify a previous biopsy and area of concern. What is your concern with the titanium marker? I have had one in my left breast since 1999 with no issues.

Meadowmoon

Thank you everyone for your responses.I’m nervous of having a reaction, feeling it, it migrating etc....

Dulcea

I have sensitivities to metals and can no longer wear earrings of any kind or bracelets that are too tight. My skin itches, turns red and swells.

I had a titanium marker placed nine years ago and haven't had any issues with it. Titanium is less likely to cause sensitivities although some people still react to it.

These clips are so very tiny.

I also had one placed during a stereotactic biopsy in September of this year. During the mammo after biopsy, they noted the clip had moved due to "snow plowing" and was not in the right location. Further surgery still did not remove the clip. I have another surgery scheduled next week so maybe 3rd time's a charm. I am not worried if it stays.

I am not suggesting you do or don't have it placed but am just sharing my experiences. Are you sensitive to other metals? Do you think it is important to locate the biopsy site in the future? I'd discuss your worries with the radiologist or surgeon.

AliceBastable

I told the radiologist that I might have a reaction. I've never been tested for metal allergies but I've had enough skin reactions to gold and silver (and other metals) that my orthopedist used a non-metallic hip replacement 10 years ago. After discussing this with the radiologist, she snipped the marker off and did the biopsy without it. But I didn't say anything to my surgeon, so I have a few markers from surgery. So far, no problem in almost two and a half years. Of all metal, titanium seems to be lowest on the list for irritations, which is why it's used in procedures. And for me, there was a big difference between a large hip joint and a very tiny marker, so I don't worry about the surgical ones.

LivinLife

I have autoimmune issues. I've had three stereotactic biopsies all total - so had two markers in my right breast and one in my left. I never had any reaction or noticed them in any way. Since I had a BMX they are gone now.... It was always reassuring when I had diagnostic mammograms for them to point out the clip and no change. when there was a change is when it led to more evaluation which is important...

Spookiesmom

I had a 4 level cervical fusion over 20 years ago, surgeon used titanium. Absolutely no problems.

MelissaDallas

You certainly don’t hear about any folks having to have their joint replacements jerked out because of reactions. Not saying that has never happened, but I don’t know of any

AliceBastable

MelissaDallas, the screening questions at the orthopedic surgeon's office were the most thorough I've ever encountered. Once the metal issue came up, it led to another long set of questions. I'm in a non-metal joint replacement registry at the local university as a result of that surgery. And there are replacement joint failures that most of us don't hear about, due to infection, rejection, and other problems.

edj3

Chiming back in on this thread to say that I do have a nickel allergy, which ruled out the SAVI marker my BS wanted to use to guide him in surgery. I had to have the wire instead. But to Alice's point, I will definitely need to be thoroughly screened for any other metal allergy should I need to have a joint replaced.

leaf

Titanium allergies are possible but are VERY uncommon. There are only a handful of case reports of titanium marker allergies in the literature, such as this: https://pubmed.ncbi.nlm.nih.gov/31695515/ More than 1 million women have breast biopsies each year in the United States. https://effectivehealthcare.ahrq.gov/products/brea... <emphasis mine>. Yes, undoubtedly are other people who do have titanium allergies that do not make it into the literature, but its statistically unlikely.

There are MANY different types of biopsy markers made of various materials. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC74728...

In this study, they had pretty successful (>95%) 10 year implant survival in about 70 total knee replacement patients who had a declared and proven metal allergy with a special polymer that did contain some titanium. https://pubmed.ncbi.nlm.nih.gov/33010769/ I don't have access to the original paper, so I don't know if there were other reasons to remove the implant, such as infection, etc. https://pubmed.ncbi.nlm.nih.gov/33010769/

The authors also point out there is lots of controversy about allergies. Since of course joint implants undergo a lot of friction, and breast markers don't, the titanium exposure to the body may be different. In this one paper done in skin cell culture, they suggest that titanium may have an irritant rather than a sensitizing potential. https://pubmed.ncbi.nlm.nih.gov/32677096/ These results classify titanium salts as irritants rather than sensitizers and indicate that titanium implant-related complaints could be due to localized irritant-mediated inflammation arising from leachable agents rather than a titanium metal allergy. This is also done with titanium salts rather than the metal. And done in cell culture, not humans.

This paper https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510463/ found metal allergies are increasing, and patch testing was not always reliable. None of the patients in this study had a reported reaction to titanium though. Furthermore, immune regulatory molecules such as interleukin-10 have been shown to be increased in patients with metal allergies that do not develop complications after metal implants.2 So predicting bad outcomes from metal allergies/sensitivities may be difficult.

So, this is yet another area of controversy. Its good to discuss with your doctor.

WC3

Meadowmoon:

I can only wear clip on earrings because I have a reaction to even gold posts but I had a titanium marker and have a numbet of titanium clips in me and have not had a problem.

Even if the lump turns out to be benign, the marker will help them monitor it or distinguish it from other lumps and possibly spare you from needing future biopsies as it may prevent a radiologist from thinking it might be a new lump.

Noeluck

People actually do have to have joint replacements swapped out due to reactions. There are entire Facebook groups dedicated to the issue.