Surgery...does this sound weird to you?

[Jena]

I went and saw the surgeon today for the breast biopsy.

First thing, she said she would just put me under. I'm ok with that because I get all anxious and I'd rather be asleep, but I was sort of caught off guard that she said that first off. Don't they usually try to do a local if they can?

THEN....she says that she will remove the tissue and someone will "run it over" to the center where I had my mammogram done so that the sample can be mammogramed to make sure she got the clip, which was left in there at the needle biopsy.

Um...ok. The center is down the street and around a corner. Why is someone going to go running around with my chunk-o-boob? What if they drop the dang thing???? I mean how can they do the pathology if it got rolled through a gutter or something???? And how come the hospital doesn't have a mammogram...and if they don't....wouldn't a metal clip show up on an x-ray?????

Not to mention, that while some yahoo is running around with my chunk-o-boob...I am still on the table, under anesethia. I figure it's got to take at least 20-30 minutes to process the chunk and in the meantime, I am unconscious and being billed by the minute, hopefully the anesethiaologist will stick around, but I bet the doc will be out on a coffee break or something. I can't see a surgeon standing around over my inert body for half an hour with nothing to do. What if she gets bored and starts "doodling"???? Yikes!

I don't get this whole set up, but when I was talking to her, it just didn't really hit me what it all meant. It just doesn't make any sense and I'm thinking maybe I need to just find me an entirely different hospital.

If someone can shed any light on this, I'd appreciate it. Yes, I will call her with my questions, but the more I think about this, the more it just seems absolutely DUMB!

Jena

[morrowsmowers]

Typical of most doctors and hospitals. Now serving number .... Take a look at www.cancercenter.org for a different approach to cancer care and treatment.

Ken & Sue in Glassboro, NJ

[Alice In TX/MO]

Normal. This is exactly how they did my sister's biopsy.

If the tissue is normal, then they just wake you up.

If not, they do more surgery.

[lilmommajnn]

I can understand the general anesthesia...the rest of it confuses me though. Is it possible that maybe between the visit and the remembering that something got lost or something? I know that when someone explains something to me, I often remember (or forget) details to the point where it no longer makes sense. Maybe x-ray the chunk-o-boob and fax the image to the mamm center? Would make more sense than taking a chance at a gutter-chunk.

[carly]

Jena,
Carly here...as a former surgical nurse and Er, too, I can tell you this is not a good thing. A reputable center has everything contained within to do the entire procedure from beginning to end, w/o running it all arond to. I would either find another doctor and center. I don't like the sound of this at all and would not consent to it for me.

No patient should be kept under as long as it seems like it is going to take to do the biospy. That is risky to the patient. The Dr would stay there, but they joke around while you are out and go in and out of paying strict attention.

the least you need to know:

pick a dr you can talk to--one that will answer yourquestions fully

pick a center that is encapsulated--everything under one roof.

pick the anesthesiologist and be sure to talk to her about how long you will be under and what they will use to keep you there.

[Alice In TX/MO]

Ok, do you folks really think they put the biopsied material on a plate and run down the road with it? I don't think so.

Geez.

It's put in a sample container. That container is put in another container. Every thing is labeled and secure. They take it to the lab. If they are doing the biopsy, it is cut in really thin slivers and looked at under the microscope to see if there are abnormal cells. If they are just looking for the clip, they will do whatever they have to do.

Not all towns are big enough to have a medical center with everything under one roof.

Hubby goes through this (with local anesthesia) for skin cancer removal about four times a year. He just waits till they get the results back in about 20 minutes.

You need to be informed and UNDERSTAND what you are agreeing to.

You have so much chaos in your life right now, I wish that you weren't having to go through this at the same time. Wishing you all the best.

Huggs,
Rose

[Beltane]

Jena - how very scary. I wish I had some advice...just lots of good thoughts pushing your way.

[halfpint]

It sounds a little odd to me, I'm not sure exactly what they are going to mammogram - that is an x-ray to look for a mass. Are they really taking it somewhere for a quick biopsy?

I just had a surgery last Wednesday (7 days ago) to have a mass removed and biopsied. I was told that I would have the results in 2-3 days. I asked my surgeon why I couldn't know sooner, as I've had many friends in the past that were kept asleep while the biopsy was done - he told me that the quick biopsy's had a higher inaccuracy rate than he liked and he'd rather know for sure (didn't want to cut out more than necessary). I was not put completly asleep - which surprised the anesthesiologist as the mass was so deep. I was given enough in an IV to be groggy, but I was able to converse with the dr. and medical team throughout the procedure. Since my mass was close to the chest wall, I was able to feel some tugging, but no pain due to the local given in the breast.

I'm praying yours turns out to be like mine, a benign cyst.

Dawn

[suburbanite]

That's normal procedure, except that the pathology department is usually in the same building.

During the time that they run the sample to the pathologist, the docs will be looking at whatever they can see of the lump, trying to decide on what approach will be most effective if they need to do more extensive removal. That way when they get the result back, if it is cancer, they have a plan in hand for the remainder of the surgery that considers aesthetic result and leaves options for reconstructive surgery if you choose to do that later. If the result comes back benign, it has been a good mental exercise for them.

It is possible they are not doing local on you because they will be working near a mammary artery and want to be careful, which might require more exposure/bigger cut than they're comfortable with under local and sedation. It also depends on how you are as a patient--if you've been easily frightened or if you became emotional or combative under sedation before, they might decide to do general anesthetic. They may also think that if it *is* cancer, they'll have to have some discussions that would sound scary to you but may be routine for them, about which way to approach etc, and they don't want you to be scared and then have to knock you out entirely for the more extensive procedure. You can ask if you have a choice about anesthesia or not. Also ask whether they do both types routinely. If they only do local once in a blue moon, then stick with their habitual program. The more you deviate from routine the more likely a mistake.

The demand for lumpectomy and biopsy is, sadly, pretty high, so whoever is working on you likely does these things day in and day out. This makes the likelyhood of any surgical or anesthetic problems very low.

Jena, you should ask how many of these the surgical team does per month. If they don't do several, then yes, you should go to a larger medical center.

[Alice In TX/MO]

please note that she said they were going in to retrieve a clip left in during a previous biopsy

[frazzlehead]

Medicine is practiced much differently south of here, I know ... but you might try asking these very same questions to the doctor you are seeing. Can you do that without it costing you a fortune?

It would seem to me that if they are trying to retrieve a metal clip left in there from a previous procedure, then yes, they need to take out a decent chunk of something (and yes, it will travel to the 'checking it out place' in a sealed container, that's not so weird) ... but then again, why are there clips left from a needle biopsy? Isn't a needle biopsy ... well ... a needle? Like poke, slurp, check slurped stuff? Where does the clip come into the whole story?

I would start by asking more questions of your current physician and see how you feel about those answers, then go from there. You might want to take a tape recorder (like the little ones for memos and meetings, from office supply places) with you to the meeting so you can listen again later to what was said, or for a low tech option, take someone with you to the appointment to make notes. You might also try writing out your questions and faxing them to the office ahead of time so the dr has a chance to think about the answers, or taking them with you in writing with blank spots to put your notes about the answers.

I work with computer geeks who sometimes blather on about things I don't understand in detail. Somehow, I can still tell if they are skimming over the details and just trying to make me shut up and go away, or if they are really truly making an honest effort to answer me. If you don't get the latter feeling from your doctor, definitely get a second opinion.

Good luck!

[suburbanite]

The clip left during the previous biopsy was not an error, but a marker of the spot from which they got the biopsy sample, so that they can find the exact same spot again.

[Alice In TX/MO]

Now I have a question. Are they going in to retrieve the clip? Or are they going in to do a follow up biopsy?

[prairiecomforts]

I don't have any medical advise to share with you Jena, but I wanted to let you know that I will be praying for you that everything goes well with your surgery.

[marvella]

try not to worry, jena. we are all here rooting for you, and wishing only the very best.

this is normal procedure. it's very understandable that you are anxious. no need to change doctors or hospitals. rose and others gave you the correct advice. they keep you under like that just in case they find something serious, so they don't have to do it again.

you will have opportunity to ask questions again, so please don't be afraid to do so. you have the right to understand completely what is being done to you, and don't settle for anything less. don't sign the consent until you do.

but i want to repeat, this is normal proceedure.

here's good wishes and blessings flowing your way........>>>>>>

[suburbanite]

My guess is she had an inconclusive initial biopsy. Most commonly this is because the sample was inadequate, not because they couldn't make up their minds about what they saw. Also sometimes they'll use an x-ray guided needle to mark a spot on the mammogram with a clip, without doing a biopsy at that time, and then go in for the biopsy, in which case there isn't an 'initial result' because there was no initial sample.

Cancers are not always easy to see during a surgery, especially if they're small. Plus if what they're looking for turns out to be normal tissue--scar tissue or something--they won't know if they've found the spot from the mammogram. If they look and see nothing, are they looking in the wrong place and should dig around more, or is the breast healthy and any further digging just does more damage? That is why they use the clip/marker--so that they can tell if they found nothing because there's nothing to find.

[Jena]

I had a stereotactic needle biopsy. The pathology results from that showed a papiloma. Needle biopsies are not considered accurate enough for a papiloma, so they are doing the surgical biopsy to get the whole chunk. The papiloma was on the big side, from they tell me....1cm. That added to the doc's concern regarding the needle sample size.

After they extracted the sample with the needle, they sent this clip down the needle to mark the location so that it can be found again if surgery was needed and to mark the spot for future mammos if surgery wasn't. Since surgery is needed, retrieving the clip is another verification that they took out the right spot.

I was told that the sample being mammo'd was to check for the clip and also to check to see if the mass was within the surgical chunk. I suppose if they mammo it and it's just plain fat or clear breast tissue, they know they "missed".

This is NOT about sending it to pathology while I am out. I won't get the pathology results back for 3-4 days. I understand that they do that sometimes when they strongly suspect cancer and wish to continue with a masectomy if it is found. They don't like my papiloma, but they do not think they will find an invasive cancer that needs to be further treated with surgery. A "in situ" cancer is more likely and the biopsy itself should take care of that (lumpectomy, basically).

My doctor is out to lunch, but I am going to call and talk to him first. He is the man I trust, as he always gives me straight answers and hasn't steered me wrong yet. If he is ok with how they are doing this, then I will accept his opinion. If he has concerns, he will likely call them for me so that he can get the straight info and explain it to me. If he is not happy with this...he'll tell me and we can find another center.

My doc wanted me to to to Indy to have this done. That facility is not on my insurance network, so I opted for this one instead....which makes me nervous anyways. It's a bummer to not get to go to the doctor of choice.

Another concern regarding the anesthesia is that the last time I was under, I threw PVC's. It was all ok and my subsequent stress test was ok, but it just doesn't seem wise to spend more time being "under" than necessary. I don't know what they will do if it happens again, but the last time I was put in ICU overnight, mostly for observation. I don't want to do that again!

I will update when I talk to the doc to let you all know. OH.....I do know they aren't going to run down the street, dangling the chunk from some forceps of something. I just keep getting this visual of the chunk bouncing down a storm drain (Tom Cruise's eyes in Minority Report????). A little humor always helps.

Jena

[ET1 SS]

We certainly hope that this all turns out to be a small matter and that you can still laugh and smile about it when everything is done.

May God bless and your family.

[Taylor]

It never hurts to get a second opinion; Vincennes is probably no farther away from you than Indy. Good Samaritan just opened a new Breast Care Center; everything under one roof, etc. http://www.gshvin.org/goodsamaritan/
Hoping for the best outcome for you - sort of been there, and know it can be confusing. Keep us posted.

[Maura]

I hope all goes well for you