Poll on Sentinel Node Biopsy Pain

I had my SNB tracer done the day before surgery to save time and like Beatrice, they gave me a numbing shot first (lydocaine I think) which was a pinch and within seconds it was all over... absolutely nothing to worry about...

Do they really give this without a numbing shot first????

I would like to add that this is NOT a necessary test.
My surgeon was part of the clinical trials for SNBs, and was quite capable of doing the procedure just using the blue dye after I was under anesthesia.

However, it may be that many younger surgeons just aren't good enough, and the nuclear medicine dept is quite a profit maker for hospitals...

My SNB was done just prior to BMX one week ago and I remember the pain well! They stuck me once on each side in the areola and it burned like fire!!!! Thankfully it only last 30 seconds but I squeezed the heck out of the nurses fingers!

mazie73 - When nuclear sentinel node localizations were first being done it was assumed that the most accurate results would result from injecting near the site of the tumor. Over time it has been shown that the lymph drainage patterns are the same whether injected at the tumor site or around the nipple. Some departments have adopted the standard technique of injecting around the nipple. It makes the procedure a bit more straightforward and doesn't require having mammogram films available or making decisions on how to split up the doses if there are multiple tumors, etc. I don't think injecting around the nipple is necessarily more painful than injecting around the tumor. Some have a great deal of discomfort no matter where the injections are made and others have mild discomfort no matter the location.

Migration of the tracer really varies from patient to patient. Sometimes the node(s) light up very quickly, but in some cases it can take hours. Rather than disrupt the whole O.R. schedule, it isn't unusual to do the nuclear scan the afternoon prior. This is especially true if the surgery is scheduled for early morning.

Hi Everyone: I just had the radioactive injections in my right breast, two hours prior to surgery to check my sentinel lymph nodes. I went to a Top Ten breast surgeon in Troy, Michigan. I was SO scared because of all the awful things said about the pain of this shot. Didn't sleep for two nights before the procedure, worrying! Well.....it was PAIN FREE!!!! But....this is what you need to have set-up with your doctor, (ahead of time during your office visit) so they can order your radioactive injection to be set up this way.....my doctor ordered the radioactive shot (which normally lasts 3 seconds), to have "lidocane" (a numbing agent) put in the shot, so that my breast would be numb before the radioactive stuff hit. Wonderful!!!! Didn't feel a thing. Forget the cream....get the lidocane in your injection. My top ten dr. said that they have now proven that adding lidocane does NOT interfere with the radioactive tracking. Wow....what a relief to have no pain. Had to massage my breast for the next 2 hours, to make sure the radioactive stuff reached my lymph nodes. Then before my surgery, the dr. came in with her little geiger counter, and followed along my breast from the injection site (just above where my lumpectomy was) to my arm pit....it made a tapping noise, where it was reading where the node had absorbed the radioactive material. She marked it with her permanent marking pen, and off I went to surgery. After I was asleep, she also added the blue dye to my breast (having BOTH radioactive & blue dye is most accurate)...the blue dye is painful, so they inject it after you are asleep. (Yay) They found 3 nodes that were blue/radioactive,(sentinel lymph nodes) and removed them, did a frozen section right then & there, while I was still asleep, and saw that they were non-cancerous, so then she did NOT have to remove any more ancillary (regular) lymph nodes. The whole procedure was only 45 minutes. Woke up with no pain, and no pain afterwards. Went to work the next day....feel great. No pain meds needed, not even Tylenol. Also wanted to mention....someone on this site mentioned that they had "blue dye in their urine"....baloney....impossible, and not true. Also wanted to mention, that they have changed the PH levels in the radioactive tracer injection, so it is nothing like it was before, even if you don't get the lidocane. I recommend the lidocane in the shot....piece of cake!!!! Wonderful to go to a caring, experienced doctor!!!!

My SNB was done when I was having my surgery so I didn't feel anything as i was completely under anesthesia. I am horrified at what you all have to go thru when the SNB is not done under anesthesia--it's barbaric in my opinion. I'm so sorry you have to go thru it this way.

I had no problem with the injections for the SNB. It felt like a pinch that lasted about 5 seconds for each shot. BTW I wrongly thought the needles were inserted into the nipple but they go around the nipple.

Thank you to everyone on this discussion board! It's nice to commiserate with you all!

I had smurfs blue urine for a day and it was fun. I even took pictures of it. It absolutely comes out blue.

There have been many, many women here with the same blue urine result. I have read of it often. It didn't happen to me, that I saw, but when I read the MX path report it was mentioned how the tissue was stained dark blue, so it seems there is a lot of dye to excrete. Both my surgeon and the tech who did my tracer mentioned that I may have blue urine after my Mx. I guess it all depends on how long it is is the system and how hard the kidneys have to work to get rid of it.

Newgirl, I am sorry you had such a bad experience with your SNB, I have no clue why some have such a bad experience and others just breeze through it. It just isn't fair. No one is trying to minimize your bad experience.

My objection, is only to say, that I think it is terribly unfair for those who have a bad experience to project their sometimes, over the top description of the procedure to those who are just beginning the journey and are terrified before they go in. I had one woman telling me that she'd rather suffer 10 natural childbirths, and another saying that the pain was so excruciating that she thought she'd die from it. You can imagine how I was feeling as I arrived at the facility to have it done. I too, have as many procedures as possible done with out pain meds. I hate how they make me feel.

All I am saying is, there is enough fear attached to this BC journey without having the added fear of a procedure that can prevent us from having to have a full Axillary clearance and the lifelong fear of LE. I have heard of some who actually decide they will take the chance and not have a SNB because of the fear instilled by others, or for the very real, but small chance of the threat of LE.

My surgeon told me that he wasn't expecting any invasion with my DCIS, but said that it would be "remiss" of him not to do the SNB as he would be so close to the nodes in that surgery. There's no definitive answer till the SNB path report comes in. I had no hesitation whatsoever, in agreeing, even with my fear, because my Mother had a full Axillary clearance when she had a UMx in '94 and always had LE as a consequence of that clearance. SNB wasn't available at that time, so that is what all women went through in those days. The irony was, that she didn't have any invasive component in any of those removed nodes.

I am truly sorry that you feel that the procedure was painful and unnecessary for you, but I am so glad to hear you were negative for invasion.

New-girl, I hadn't realized that you had 16 nodes removed, even though the Sentinel was clear, why was that? I am so sorry that you are dealing with LE too.That's just awful for you, I am so sorry you're dealing with all of that.

I understand your comment about having a tech who is good at doing this procedure, I was incredibly lucky that mine was very good at it.

There are always going to be differences in experience. The point I was making, was that not too long ago, women were having Axillary clearance as a matter of course and many, like my own Mother sustained LE, and ongoing effects from the removal of those nodes. The irony was, that my Mother's nodes were all clear. I just wish she could have had the option of the SNB. Even if it had been a painful experience for her, it would be unlikely she'd have suffered anywhere near what she had to put up with, after losing all those nodes.

When the SNB became available it must have cut the LE numbers dramatically and the Se's left by the disruption of the node removal must have improved too.

Don't think I was trying to minimize your terrible experience. I was only comparing my own experience, to that of my Mother's.

I wish you all the very best for the future and hope your LE improves over time.

My entire point of this is not that I suffered and I want validation for my pain but rather that for some reason some women find this procedure horrible and we need to be aware instead of saying it doesn't hurt. Lots of the stuff we endure dealing with cancer is painful. Biopsies for some are painful, radiation for some is awful, DIEP is hard on most, and the list continues. This is not a" I win the pain contest" or " I get a badge for suffering the most". I am thrilled when someone tells me some procedure was easier than they expected. But I personally would have very much appreciated someone telling me that this procedure can be painful and to do my homework before agreeing to it. Being blindsided the morning of my 13 hour surgery was dumb on my part . I wish I had found this site and known the possibility that this procedure could hurt so much. I would have asked lots more questions and made an informed decision.

Jessica makes a good point.

When I expressed my intense fear of the procedure to my surgeon, after the horror stories I had heard, he was really puzzled too. He said, "If you want a local anesthetic, we can do that , it is up to you, we will do whatever makes you comfortable!" which was his stand on everything, it was all up to me. He then said he hadn't had the experience of this being a very painful procedure, that his patients had not experienced extreme pain, having it done. Now, this is a breast surgeon who has set up breast clinics and operated in South Africa, London and Australia, so no novice to the procedure.

As it turned out, on the morning of my SNB before my UMX, the tech who was doing it wasn't authorized by the Hospital to give a local anesthetic, so he actually called my surgeon at home to ask what to do. My surgeon offered to come to the Hospital at 7.30am to give me the shot. I was mortified that my fears were going to bring him in early, to do this simple injection on a day that he had surgery all day. I refused, and said I was fine with going au naturel!

As I have reported here before, my tracer procedure was absolutely painless, so for me, the local was definitely not required. In fact if I had, had it I would have thought that was the reason for the painless procedure.

When my surgeon saw me in pre op, he came in and said "Oh, how did the tracer go, you were "brave" and refused me coming in!" When I said it was a "Non Event!" he laughed and said "Yes, that is what I expected!"

So, as always, when this subject is raised there will be a great disparity in experience between us. Whether it is the PH of the actual tracer fluid, the density of the breast or some other reason, we will never know why this procedure has such different effects on us.

I never considered, not having it done, because of my inherited fears from the others who saw fit to scare me, with their horror stories, before my procedure.

Although it was unlikely, there was going to be an invasive component in my final pathology, I couldn't in good conscience, refuse to do this, because the fear of an Axillary clearance, if something was found, scared me far more than this SNB pain ever could.

Whenever I am asked about this procedure, I always say, some people find it uncomfortable, even painful, but for me there was no pain at all.

New-girl:  I very much understand your point, as I, too, trusted my health facility & was totally blindsided by the agonizing pain.  I have a high pain threshold, gave birth with no meds & never had this much pain.  I'm happy for the people who had no pain, but that didn't help me!  4 injections around the areola (perhaps the injections into the side of the breast are less painful?).  

I am determined that this barbaric practice end.  So it's a lot of trouble to do it in the OR; Women ARE Worth The Trouble.  Or at least have conscious sedation available for those who have the terrible pain.  Maybe the solution can be tested on our arms to see if we will truly react with pain.  On a scale of 1-10, mine was 1000.  Not to scare others, but that's the truth & you have a right to know that.  

I am talking to all my doctors & nurses at the health facility, & will not stop until they change this terrible procedure.  I have had many, many biopsies, re-excisions, & 5 wire locs with no complaints.  I have never even needed tylenol after surgery.  This procedure is a disgrace to modern medicine & must be changed.  Women don't complain enough.  When I ask them, most of them experienced terrible pain, they just never mentioned it because they thought it was only them & they must be babies.  This procedure belongs in the middle ages.  Thank you, breast cancer.org for making this forum possible.

So glad everything was done once I was under general anesthesia. When I asked my PS she said she does a combination of the dye & the radioactive tracer. I guess cause you're out for 3-4 hours for mastectomy with immediate reconstruction, there's time for the radioactive tracer to work.