Poll on Sentinel Node Biopsy Pain

nd, and Wiser, I am so sorry that you both had such an awful experience with this procedure. There has been much debate on this site about this subject and why it is such a painful experience for some and a non event for others. Some have said that it is because some facilities us a ph balanced tracer and others don't. There is also the skill of the operator to consider. Some say they have used local anesthesia and numbing cream, some took medication prior to the procedure.

I was told,  by my Surgeon that I would have the tracer injected in around the nipple before surgery and then the scans would be done to locate the Sentinel Node, which would be shown on the x-ray that accompanied me to surgery. The blue dye would be injected after I was anesthetized, sometimes there are more than one node that has lit up. When I read the final pathology report I saw that my breast was stained bright blue, when it was examined and I also had remnants of that dye in my skin when I woke after my surgery.

As I mentioned in my post above, I was terrified by the stories from some others who had been through this procedure before me. When I had my own experience, and there was no pain whatsoever, I decided to post here, that although it was possible to have a bad experience with this procedure, it certainly isn't that way for  everyone and there are lots of us who have that pain free experience. 

I would never try to minimize your experience and I truly wish it had been different for you, but what scared the crap out of me was the definitions given "Oh it was worse than 10 natural childbirths!" "Like shooting broken glass into my breast". My fear had me thinking, good heavens, will this go on for days and days? The reality is, no it will not and how can anyone quantify a pain experience? A scale of 1-10 is all we have.

Those words were all I heard, over and over, for the night I spent alone in a Hotel near the Hospital. As it turned out for me, my experience was the total opposite and the adrenaline from that displaced fear kicked in, so that I went to my Mx surgery, which I wasn't afraid of, feeling absolutely bullet proof.

My point is, you are absolutely correct, there are some who have a really bad experience, as you did, but newbies coming here to read this thread should be aware, not all experiences are the same. Some will have a bad experience with pain, but others like me, will have no pain at all.

There is so much fear attached to this whole experience, I just want both sides to be seen by new members who are yet to have the procedure.

Hi Wiser, point taken, I really do understand where you are coming from. I just don't want to over emphasize the pain factor, to the new people scanning the boards for info before their procedure, that's all.

I don't know the answer to your question about the solution used for people who have the procedure done the day before. Mine was done at about 8.00am and my UMX surgery started a 11.30am the same day. It did take some time and lots of massaging and scanning before that tracer did its job.

There could be all sorts of reasons, but I am yet to hear any, that explain the huge disparity in experiences.

I wish you all the very best, take care!

Ariom, I agree about not scaring people.  I did not know that I would have this procedure until I had lunch with a friend and she told me that the SNB was the most painful part of the entire journey.  I really wish she had not told me this, because if I was not anticipating pain I would be fine.

Talk about barbaric procedures - I had a far worse version of this 20 years ago.  The lymphangiogram.  They give you injections of dye between your toes, cut open the tops of your feet and then shoot that burning tracer into your lymph system.  Hopefully no one does this anymore.  

So with memories of the lymphangiogram and my friends warning ,I was terrified.  The radiologist even said something to me implying that this was going to hurt.  It did hurt - but it was very brief.  It was certainly not worth all the anxiety I experienced.

Then after surgery, I read on this site how having my drains removed would be so painful.  I was dreading this (I think my PS thought I was nuts). It was nothing.  I guess some people want to know what will hurt.  I do not!

Hi Deborah! My experience was pretty much the same as yours, with a friend who didn't have any filter!

That procedure you had sounds like a real shocker, I haven't heard of that one before. I had a really barbaric procedure myself, a few years ago in Singapore. I had my sinuses drained in a specialists rooms without anything more than a bit of local anesthetic, while he used an instrument like an ice pick, that he hit hard with the heel of his hand, to break through the bones in my face, from the inside of my nose! Not a pleasant experience!!!! When I told a girlfriend who is a Doctor, she was mortified, that procedure is always done under a general anesthetic here in Aus.

I'm sorry, I digress, I can totally understand how afraid you would have been, before your SNB too. I don't believe in sugar coating things, just being fair and not making people more afraid than they already are.

The injections for the SNB for me were painless and I had no kind of pain meds at all before, not even numbing cream!  I don't remember exactly how many, but I got at least four or five injections around my areaola!  This was all done upon arrival at the surgery center and the surgery (LX and SNB) were done within an hour or so of the injections!

So glad my experience was not painful!  

I had read here about how much this was going to hurt and I was about in a panic state about it because I'd had two very painful biopsies and so was (and am) already procedure-phobic, but I was one of the lucky ones: I didn't even feel it. At all. And they didn't use any sort of numbing meds on me beforehand. It was, for me,  a non-event.

I wish there was an answer to this question. The experiences are just so extreme and the subject has been hotly debated here, for a long time.

You rarely get anyone who says, it was a bit uncomfortable, it is either described as excruciating by those who felt pain, or it is a total non event, to all the others. I would love to know what the numbers are for pain versus no pain. I wonder if it has anything to do with pain threshold? I tend to think not, because for pain threshold to kick in, you need pain to deal with in the first place. I felt nothing with my procedure, not even the needles going in. I even asked the young man who did mine when was it going to start hurting? He just laughed and said "You're all done!"

I wonder if there are any studies done on it?

Me, too, no problem. And very glad I didn't see this thread beforehand.

I was injected at 3:30pm for surgery the next morning at 7:45. 

The nurse practitioner said, this May sting a little.

And it didn't, so I asked, did that mean it was in the wrong place? She said that no, people's experiences varied. She hypothesized that it was easy for me for two possible reasons, I was well hydrated and I had a lot of sub-cutaneous tissue (I think she was referring to my former D cup right breast!).

Me too, "D" cup! you may be on to something!

Also meant to say, I didn't even think of taking a pain med prior to the procedure, but likely wouldn't have, if I'd thought of it, because of the medication restrictions I was given by the Anesthetist. 

My Surgeon really was very surprised, when I told him of the fear I had from the stories of other women who'd had the procedure. He said he had never had a patient tell him it was a very painful experience, but I could have whatever I wanted to make the experience easier, which was his take on everything to do with my journey with him. He is the most caring Surgeon I have ever dealt with, so I know his reaction was genuine. I would have had a local anesthetic if my Tech was cleared to give it, or if I had allowed my Surgeon, who offered to come down to the Hospital early, to administer it himself. I am glad I didn't have it, because then I would never have known that the procedure its self was painless, for me. 

That's a really good point Ridley! There have been a few women who posted here that they wanted to skip the procedure because they had been so frightened by the terrifying reports from others. I too, am really grateful for the procedure. I saw what my Mother went through having a full Axillary Clearance in the 90's only to find they were all clear, she had LE from the get go. I know there is still a small chance of getting it with a SNB but I weighed up my odds and couldn't in good conscience refuse to have my SNB even though the possibility of invasion was unlikely.

I am with you, I hope the day comes soon, when everyone has a pain free experience with this procedure. 

I
wanted to add the following observations.

I was the guinea pig first ever SNB at my hospital when I had my mast in 03.  Back then they used large bore needles, heaps of dye and isotopes and pushed everything very quick and no meds or creams allowed. 8 needles over a 20 minute procedure because they are all so new and had lots of people there watching. Yeah I climbed the walls for that one and they could hear me in the next county. If they had not have been holding me down after the first needle i probably would have escaped.

The second SNB I did was different. Smaller needles slower push and whoo hoo some creme that helped some. Much different experience.

Everyone is different and everyone reacts differently. For some its the blue dye that hurts the most and for others its the isotope. For some its the needles themselves and for some its the contents of the needles. 

Some have both types done prior to the OR and some only have part of the procedure done before the OR and then there are those that have them both done in the OR. Each case is different.

A lot of things can play into what type of pain there is, this can be personal pain perception, needle size, amount of each dye/tracer and even the speed at which the medicine is pushed. The person driving said needle also plays a part as does the location of the shots.

No person is the same and no procedure is the same but I think it is far better to be concerned about the pain before the procedure and have the opportunity to mitigate for it in advance as a standard than for people to rock up having NO idea what is involved and potentially being blindsided. 

There is NO reason why they cannot offer pain management whether it be in the form of a cream or lido within the needles in this day and age.

In many cases women facing this are on the edge of a cancer diagnosis and to have them submit to a procedure that can be traumatizing for some with no prior warning is ridiculous. 

I would rather see people be scared about what they read here and at
least discuss the options with their medical team or know what is involved than for them to not
be told until its too late to do anything about it and then suffer because of it. 

I don't know how the SNB is done during surgery for some. The huge scan machine that I had to be scanned by, to find the sentinel node, after the tracer was injected, wasn't something you'd find in an operating suite.

The blue dye was injected in the OR and the node removed during my Mx. 

As I mentioned in a previous post, I was one of the very fortunate ones that had absolutely no pain whatsoever from the tracer injection. I did have to massage and be re scanned several times before the node showed itself.

I agree with cybermab, that the underarm, where the node was removed was the most discomfort I felt for the whole Mx procedure. I didn't have any pain per se from the whole surgery. I am 18 months out and I still have numbness and occasional discomfort from that area under my arm. It isn't debilitating in any way, just occasional discomfort.

Ozzygirl, I am sorry you had such a dreadful time with your first one, but I am so relieved they refined the procedure after the first one:) I can't imagine how afraid you must have been, going in for the second one. If it weren't for the first ones, like you, to have the procedure, it wouldn't be available for all of us.

I was far more terrified of having the SNB than the Mx, because of people sharing their horror stories with me. I agree with you, that everyone needs to have an overall picture that this procedure isn't the same for everyone, but I do feel that it is unfair to describe it in gory detail with comparisons like I have seen here, in the past, saying it is worse than all kinds of indescribable things. That doesn't do anything but give newbies the hebejebes! Like everything associated with this journey, just balance in information is what's important.

I am sorry some ladies have had such bad experiences. Maybe things have changed or I was lucky to have the surgeon I did .I think she is very "into" SNB methodology.  I was unconscious for the whole procedure. She told me before there was a very small chance they may not be able to find the sentinel node and may have to take others . She did find it and only one node was removed which thankfully was negative leaving my arm pretty much unaffected. The lumpectomy/SNB was far less distressing than the core biopsy which hurt like heck and left me black and blue.  A lady who works with me and had BC 6 years ago mentioned that she did have the dye injected while she was conscious before her lumpectomy.

Procedures for the nuclear SNB vary as do so many other things in breast cancer surgery, reconstruction, and treatment.  It can take a good long while for the tracer to migrate, but sometimes it does happen quickly.  Scanning and marking the skin gives the surgeon a starting point, but typically they also use a radiation detector probe (like a mini-Geiger counter) in the OR to confirm and to zero in on the first (sentinel) radioactive node.  Some places skip the scanning altogether and just use the probe in the OR.

Erinsoule, please try not focus too much on this procedure. The facts are, that although some have a bad experience, many, many women have, like me, absolutely no pain, and some have some discomfort. It isn't the same for everyone, so there is every chance that you will not have a bad experience.

I went into this with fear like I had never felt before, all because people wanted to share their experiences in the most colorful descriptive ways. I asked my surgeon for help and he was genuinely concerned, told me he'd organize anything I wanted, to make it easier, but he hadn't had anyone tell him, that it was a terribly painful procedure. He had worked in London and South Africa before coming here so he'd done plenty of Mx's. 

I feel for you, because I know how awful all this is, the fear of the unknown is brutal. For me, looking back, I wish I could have gone in with more of an open mind, because none of it was anywhere near as bad, as I had worked myself up for.

Take it easy, and I wish you all the very best. Let us know how you get on!