A breast cancer patient’s guide to breast procedures

When I was diagnosed with breast cancer in July 2014, I started researching anything and everything about the disease and the treatments for it. There are plenty of resources that explain procedures from a medical perspective, but there wasn’t anything I could find that explained the procedure from the patient’s point of view. I caught bits and pieces about the experience of going through breast procedures from forums posts and from private chat exchanges with other women, but there wasn’t a single resource that I could read and absorb the information.

This blog post is my attempt to explain breast procedures such as ultrasound-guided biopsies, MRI-guided biopsies, mammograms, and wire-localized lumpectomies from my point of view as a breast cancer patient.

 PLEASE NOTE: I am not a medical professional, nor is this post meant to provide medical advice. This is a first-person account of the breast procedures that I underwent. This post contains descriptions based on my experience with these procedures and situations, and is not meant to provide guidance regarding your individual treatment choices. Consult your medical provider(s) for what treatment options are best for you. 

I have a breast lump – or not
Not every breast cancer patient has a tumor that is palpable. Some tumors occur close to the chest wall and are found only by diagnostic imaging. The tumor in my left breast, a stage 1 invasive ductal carcinoma (IDC), happened to be close to the skin so I was lucky that I could feel it with my fingers. If you are being treated at a teaching hospital (like I am), everyone will want a chance to feel your lump. I quickly got used to (1) being topless in a room full of strangers, and (2) having each of those people want to feel my breast lump.

Literally every medical professional you encounter will want to feel your tumor for themselves. I had a bruise on my left breast after the first day of diagnostics from people feeling and pushing on my lump  after I was diagnosed. Keep in mind that palpable tumors are not always the case, so you really are helping students learn what it feels like. However, I have since learned to give feedback when I think someone is being a little too enthusiastic with my breast. Those same students are also learning their bedside manner and how to touch a patient. It’s your body; speak up when things aren’t right for you.

I had abnormal cells called lobular carcinoma in situ (LCIS) on the right side. This cluster of cells were not in the form of a breast lump, so “seeing” these cells were very different from what was happening on my left side. If you are someone who doesn’t have a palpable lump, you will be subjected to an array of imaging for diagnostics, including ultrasound, MRI, and mammography. There is much less physical touching of your breast since there is nothing to feel.

Genetics testing and counseling
What it is: There is a large genetics component with breast cancer, which is something I didn’t realize until I was diagnosed. Understanding your genetics and your family history will help your medical team understand your breast cancer, as well as your risk for related cancers like ovarian cancer.

What happens to you: They will need to take your blood in order to run the genetics panel. They may also interview you about cancers in your family. Be prepared to know the ages, diagnosis, and treatment dates and outcome of anyone in your family who has had cancer.

What you need to know: Learn what genes are associated with breast cancer and what they mean. The National Institutes of Health (NIH) has a page that will get you started. Knowing this information will help you understand your genetic test results.

Mammogram
What it is: A mammogram is an x-ray of your breast.

What happens to you: Your breast is flattened between two clear plastic panes. You may be put in awkward positions that require you to literally hug the machine and/or smash your face against the side of the machine, depending on your breast size and the angle that they are trying to image. Since I had a lump they were trying to image, they used a smaller paddle on my left breast than what is normally used. They also tried to get that area as flat as possible for imaging. The small paddle plus the amount of force applied over that small area made me involuntarily burst into tears. Under “normal” mammography conditions, it’s not as painful as that experience.

What you need to know: The flatter they can get your breast, the better the image. As long as you can remember that the technician isn’t hurting you on purpose, just grit your teeth and get through it. There is no lasting pain once you are done with the mammogram machine, but you may feel a little sore or manhandled after the procedure.

Ultrasound-guided core needle biopsy
What it is: This procedure uses ultrasound imaging to guide a needle that will take samples of your breast tissue.

What happens to you: You will disrobe from the waist-up and lie on your back. Depending on what side they are biopsying, you will lie with that arm over your head. I was also propped up on a pillow so that the doctor could get the correct angle. The area of your breast where they will take the sample will be numbed with a local anesthetic. In my case, they used lidocaine to numb not only the tissue just under the skin, but also deeper into the breast. After the local anesthetic is applied and given a few minutes to work, you should feel no pain – only pressure and movement when they are doing the biopsy. I didn’t know this, and my first biopsy would’ve been more comfortable had I known to ask for more lidocaine.

After you are properly numbed, the doctor will use what they call “the introducer,” a large gauge needle that will create the channel for the smaller needle to collect the sample. For the two ultrasound-guided core needle biopsies that I underwent, both used a biopsy tool that had a firing mechanism that made a sound like a heavy-duty stapler. The doctor took anywhere from four to six samples that are about the size of a grain of rice.

A small titanium clip is inserted after the biopsy is complete so that anyone imaging your breast(s) will know that area has been biopsied already.

What you need to know: Bruising is common with this breast procedure. I was advised to take Tylenol (no NSAIDs or aspirin) for any discomfort and to use ice packs to reduce pain and swelling. My tip: Don’t wear an underwire bra. Wear or bring a soft cup bra or a jog bra for after the procedure. Your breast(s) will be sore as the anesthetic wears off, and the underwire may press on the area in or near the biopsy site.

You will be sore for a few days, but can return to normal activity within 24 hours. I was definitely sore during the first 24 hours and then was very aware that I had a biopsy for the following 2-3 days.

MRI-guided core needle biopsy
What it is: This breast procedure uses magnetic resonance imaging (MRI) to guide a needle that will take samples of your breast tissue.

What happens to you: You will disrobe from the waist-up and lie face-down in the machine. They have you lie on a raised tray that has two holes – one for each breast. There may be some maneuvering after you first lie down to get your breast(s) in the correct position. As what I have explained above: The area of your breast where they will take the sample will be numbed with a local anesthetic. In my case, they used lidocaine to numb not only the tissue just under the skin, but also deeper into the breast. After the local anesthetic is applied and given a few minutes to work, you should feel no pain – only pressure and movement when they are doing the biopsy.

Once you are adjusted and numbed, they will put your breast under compression and use a grid to map out their approach. You will take a few rides in and out of the machine as they take a few images throughout the procedure. For my MRI-guided core needle biopsy, they used a vacuum-driven biopsy machine so there was no stapling noise. It sounded like a tiny fan/vacuum cleaner when they were taking samples.

A small titanium clip is inserted after the biopsy is complete so that anyone imaging your breast(s) will know that area has been biopsied already.

What you need to know: (Same as above, but copied here for easier reading.) Bruising is common with this breast procedure. I was advised to take Tylenol (no NSAIDs or aspirin) for any discomfort and to use ice packs to reduce pain and swelling. My tip: Don’t wear an underwire bra. Wear or bring a soft cup bra or a jog bra for after the procedure. Your breast(s) will be sore as the anesthetic wears off, and the underwire may press on the area in or near the biopsy site.

You will be sore for a few days, but can return to normal activity within 24 hours. I was definitely sore during the first 24 hours and then was very aware that I had a biopsy for the following 2-3 days.

Tumor typing
What it is: Your treatment is based on certain factors, like the tumor’s reception to hormones. The doctors need to know whether your tumor in particular will feed itself from hormones or not.

What happens to you: You’ve already had the biopsy or biopsies at this point. Figuring out the type of tumor you have is based on those samples already collected from you.

What you need to know: Learn what terms like estrogen positive/negative (ER+ or ER-), progesterone positive/negative (PR+ or PR-), triple negative, and human epidermal growth factor receptor 2 (HER2) positive/negative mean so that you can understand your pathology report.

Wire-localized lumpectomy
What it is: A lumpectomy is a type of breast conserving surgery where the cancer is removed from the breast along with a margin of healthy tissue. If needed, wire guides will be inserted into your breast(s) prior to surgery to help the surgeon determine the area to remove.

What happens to you: At my hospital, a lumpectomy is considered an outpatient procedure, which basically means it will be a long day at the hospital for you. My pre-op included a visit to Nuclear Medicine for the sentinel lymph node mapping (see below), as well as a chart review. The chart review includes a health history and a physical exam (if one hasn’t been done already) and a discussion with the anesthesiology resident about the general anesthesia that will be used during your surgery.

Wire insertion occurs before surgery as part of the pre-op process. Imaging – either a mammogram, ultrasound or MRI – is used to insert thin wires into your breast(s) to outline the area where the surgeon needs to remove. My radiologist explained that the wires have a fish hook shape at the end to keep them in place. The ends of the wires will be coiled and taped over, so don’t think you will be walking around with wires sticking out of your breast. The wires are also removed during surgery so they are not permanent.

What you need to know: Healing from a lumpectomy will take weeks, as opposed to days for a biopsy. This is major surgery so give yourself time to recover. I took a week off from work since I had an extra incision in my arm pit for the sentinel lymph node mapping and I wasn’t able to do much with that arm. I was able to return to work at my desk job in about a week, and continued to feel much better day after day. However, activities like washing your hair and any push-pull movements will be a challenge for the first few days.

The words “clean margins” will be music to your ears when the pathology results come in. That means the surgeon removed the tumor and enough of the healthy tissue around it so a second surgery – called a re-excision – is not necessary.

Sentinel lymph node mapping and biopsy
What it is: This procedure is done in conjunction with a lumpectomy to determine if the cancer has spread to your lymph nodes.

What happens to you: A radioactive tracer is injected in your breast using a small needle (much smaller than the other needles you have encountered already) a few hours prior to surgery. Sometimes the injection is the night before surgery if you have a very early morning OR time. The tracer will drain out of your breast and into the lymph node(s) in your arm pit, allowing the surgeon to find and remove those nodes while you are in surgery.

What you need to know: Besides small pinch of the injection, this procedure is painless. The pathology for the lymph node biopsy will come back around the same time as the results from your tumor removal. Negative means there were no cancer cells in the node; positive means that there are.

 Feedback?
I’ve tried to capture what it feels like to go through these procedures as a patient. If you have any additional insight, please share it in the comments so that we can all benefit from understanding what it really means to go through these breast procedures.

Related posts
Read my continuing posts about breast cancer. 

 

4 thoughts on “A breast cancer patient’s guide to breast procedures

  1. I have a friend undergoing these procedures at the moment and I wanted to understand what was happening to her from the patient perspective, so thanks for this, it’s very helpful.

  2. I am about to undergo the procedures (sentinal lymph node, lumpectomy) you described in less than one week. We have quite a bit in common, including our names, relative ages, etc. I am so glad to find your posts. I am feeling mostly positive, and trying to remain hopeful.

    1. I wish you the best of luck, Linda! It’s been almost a year since my lumpectomy and sentinel lymph node biopsy, and I am doing well. Stay strong and stay positive. Attitude is everything – the doctors and nurses take care of the rest.

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