Excisional Biopsy for LCIS

Hi VJE. Once you know you have LCIS it is pretty much assumed that it is diffusely through both breasts, but the other breast won't be biopsied unless calcifications or something show up on a mammogram or MRI.



The wire placement sounds worse than it is. The most discomfort I had was keeping my head tilted back and out of the way. The excisional biopsy was easier than the stereotactic one. I was bruised but not terribly uncomfortable. I just took one or two of the pain pills & switched to Aleve for a few days. You will have some lifting restrictions for a few days. Mine was a little longer bevause I'm allergic to steristrips so she used surgical glue to close my incision & I had to be careful not to pull it. They will probably tell you to wear a jog-type bra round the clock for a little while. If you can find one that opens in the fromt it is easier.



Sorry you're joining us. You'll have to join our six-months watch thread when this is over because you will probably be put on more frequent surveillance.

Oh, and if you're worried about appearance, she took a golfball sized chunk out of my not-very-big breast from the lower outer quadrant & after a while you can't tell at all unless I have my arm lifted straight up over my head. Then I can see just a divot. Scar very minimal in the crease of my breast. If I press on the divot that part of my breast feels empty, like there is a void under the skin. Of course I guess it might depend on where in your breast it is.

Melissa is right, as usual, although each of us has a different experience with the excisional biopsy.  I had a harder time, but, I think that was because (unknown to me at the time) I had a history of early trauma.  I would encourage you that **if** you do have pain - complain! - even if they tell you that you aren't supposed to move.

As you seem to have guessed, they often remove the LCIS found at biopsy - not in order to 'remove all the LCIS' - but because in roughly 20% of cases they can find something worse (i.e. DCIS or invasive cancer) in the vicinity.  You got through the first biopsy with nothing invasive, so your chances are some 80% they won't find anything worse in this biopsy. 

Your family history sounds similar to mine - I had genetic counseling but not testing - and they thought my chances of having a BRCA mutation was about 2%, though I have a higher incidence of other cancers in my family than usual.  I have several cases of breast cancer in my maternal aunts and paternal grandmother, but they were all postmenopausal, so they were likely sporatic cases.  They didn't even ask about any of my cousins on genetic evaluation in 2008.  They rated me as having a 'low risk' for a family history.

If they do go in through the same site as your core biopsy, that's what they did for me too.  I'm not a doctor, but from what I've read that's a good thing because in the *Very Small* chance that a) You have invasive breast cancer, b) they displace cancer cells through the track (this displacement happens quite commonly) *and* c) those displaced cells grow (very unlikely, but probably possible) - if all 3 of these are true - then they will be removing the needle track and thus any possibly displaced bad cells.   In other words, if you did have invasive breast cancer and those cells are displaced, most cancer cells don't survive because they are in a different milieu or die during treatment.  But if they remove the needle track, then they will also be removing the possibility of 'seeding'.

I found jogbra - I particularly second the comfort of a front-opening jogbra-  and tiny ice packs much better than any of the pain pills, but this, of course, is an individual experience.  I had to give up anything bouncy (like jogging) for a week or two.

I can hardly find my incision site. There is a very faint pink scar, but its really hard to find. I had about 2 tablespoonfulls of tissue removed, and I sure can't tell the difference after surgery. I did have a big hematoma though - my breast turned all sorts of autumnal colors which looked scary, but after a few months it totally went away.  So you may have to give up any career hopes of being a stripper for the next few months. :-).

It sounds like they are taking excellent care of you.  Hang in there!  We're all hoping the very best for you.

I am so sorry you were laid off of work, but I'm so glad you are covered through August. I went back to work 24 hours after I was discharged after my excision, though if I did it over again, it would probably have been helpful to take at least another day to recover.

I'm so glad you have learned to be proactive about asking for help.  I had mine done in 2006, so that's quite some time ago, and different places may do it differently, but at my place they had the wires inserted by radiology, using the radiologist and a radiology technician.  At my place, that is important because they can't give any systemic injectable sedatives or anesthetics because you don't have an RN present, and you aren't monitored.  At my place they were continually running in and out the room to develop the mammograms to check the placement of the wires.  Since after wire placement, you have the surgical excision, at my place you  have to be NPO (nothing by mouth) from the midnight before, so no oral meds.   I did a survey here (in 2006) and several people said they didn't use any systemic anesthesia during wire insertion -even when it was done at a Major Institution.

I got the equivalent of 3 seconds with an ice cube (a cold spray-probably ethylene chloride),  was stuck in a mammo during wire insertion, then 1 shot (into my breast - so its local and not systemic) of lidocaine when he looked at my face, but that hurt just as much as the wire insertion, and they must not have hit the right spot because it did not provide any anesthesia.  I am sure if I had a human for a radiologist, instead of some kind of robot, and if this robot had expressed some sort of empathy, it would have been better.  (Sorry, I'm still angry at him.)

On my survey, most people did just fine.  

I just want you to be safe and make your experience as comfortable as possible, so that's why I'm trying (and probably not succeeding) in describing a little more what you may expect.  You may want to inquire at least before they start the procedure whether or not they can give any systemic injectable anesthesia or sedatives.

Your chances are good that they, indeed, will not find anything worse than LCIS. 

After my excision and my results came back, it took me 3-4 months to get an appointment with an oncologist to get tamoxifen.  My original oncologist had only seen a handful of LCIS patients. (He retired so I had to get a new one.)  Probably, I could win my oncologist's 'Least Likely to Die of Breast Cancer' award, so I'm sure that's why it took so long to get an appointment.  I personally think its more prudent for an oncologist to order tamoxifen for LCIS patients than breast surgeons, because, in general, oncologists are much better trained in non-surgical meds than are surgeons.  If you have other medical conditions, oncologists would be more likely to judge how it may affect other conditions you may have.

Let us know how it goes, OK?

VJE------ I was diagnosed almost 10 years ago and my risk level is further elevated by family history of bc (mom had ILC); even with my lifetime risk of 36.6% and my 5-year risk of 4.8% (both very high) my medical team concurred that bilat mastectomies were not medically necessary. I had a lumpectomy, took tamoxifen for 5 years, have now taken evista for over 4 years and have not had any further issues necessitating further biopsies or lumpectomies. But I am always open to reconsidering that option if necessary in the future.

As Melissa said, the excisional biopsy is not to remove all the LCIS, but to make sure nothing more serious in lurking in there along with it. I do high risk surveillance of alternating mammos and MRIs every 6 months with breast exams on the opposite 6 months, so I am watched very closely. My wire placement was not painful, as I was numbed up really well, but it was uncomfortable to sit for so long (nearly an hour) with my head awkardly turned to one side. I had conscious sedation for the lumpectomy, so that was a breeze (except for my IV). I was snuggly wrapped in a chest binder when I awoke, which I had to keep on for 2 days, so no special bra needed. After that I could shower with the steri strips, which fell off by themselves after about 7 days. I just kept a little gauze bandage on the area for a week or so. I took it easy for a couple days and was back to normal activities in less than a week. No real pain at all, just a little tender. Praying you get good benign results soon.

anne

After my traumatic wire insertion, I had conscious sedation for the excision, and that part was just fine.  There was an anesthesiologist there, and I had zero pain.  Every time I had 'Ahhhhh'  - I was merely expressing 'Where am I?  What is going on?'  rather than 'I am in pain.' - I got another slug of propofol.  I remember briefly seeing the blue-green walls of the operating room. (I couldn't see my chest.)

I'm not trying to decide for you, and each person is individual, but I was fine with conscious anesthesia.  The only other thing I remember was a gentle 'pat, pat, pat' sensation at the incision site to soak up blood.  I didn't have any pain during the procedure.

Hang in there!  Best wishes,

leaf

 Hi, i just had my localized excisional yesterday and it went very well.I guess the only things that annoyed me was the waiting! I been in the hospital @730am, did the wiring then after that ...long wait for surgery.. Inserting needle and wire was not a big deal but a bit uncomfortable. I don't even have pain right now and i got a very small cut from my surgery...I wondered if they did an excision or maybe it was not that bad. The nurse that was with me said that when they took x -ray while they doin the localization, they cant see the calcification anymore. But why they did the excision anyway?..Kind of confused, but all i need to do now is to wait for the result.It will take 4 working days, which is like a year to me.. So for those who are on this process , dont be afraid, it is not hurt at all ! God bless