Wire localization & lumpectomy

Roxi1

I have a BR5 on the ultrasound and have been scheduled for surgery (lumpectomy) on 1/5. They will first do a wire localization. My girlfriend, who has gone through this herself, said she just had a lumpectomy with no wire localization, to decrease the risk of missing the complete tumor area, subsequent dirty margins, etc. She told me to find another surgeon. What do you all think? Thank you
Roxanne

troyryans

I had two wire localizations before surgery, both on the right breast, a couple of months ago after suspicious calcifications were confirmed from stereotactic core biopsies. I was told that in the situation of calcifications, wire localization is necessary because calcifications are not detected to the naked eye during surgery, and the wire directs the surgeon to the proper area. In my instance, I was told that additional tissue needed to be taken because it was necessary to make sure everything was taken out (confirmed by mammos after). My understanding is that a doctor will try (hopefully) to make a diagnosis with the least invasive procedure. Just as a sidenote, but one of the biopsied areas this time was in the exact spot that I had a needle biopsy (benign cyst) in 1998, so I am a little suspicious of the invasiveness of needles. However, I was also satisfied with my doctor's decision to do the most recent wire localizations to make sure everything was taken out. If you are uncomfortable with your decision, talk to your doctor and/or get a second opinion. It never hurts to get a second professional thought on anything that is invasive to your body. Either way, good luck on January 5. I will be thinking of you.

Kathy

Roxi1

troyryans said:

I had two wire localizations before surgery, both on the right breast, a couple of months ago after suspicious calcifications were confirmed from stereotactic core biopsies. I was told that in the situation of calcifications, wire localization is necessary because calcifications are not detected to the naked eye during surgery, and the wire directs the surgeon to the proper area. In my instance, I was told that additional tissue needed to be taken because it was necessary to make sure everything was taken out (confirmed by mammos after). My understanding is that a doctor will try (hopefully) to make a diagnosis with the least invasive procedure. Just as a sidenote, but one of the biopsied areas this time was in the exact spot that I had a needle biopsy (benign cyst) in 1998, so I am a little suspicious of the invasiveness of needles. However, I was also satisfied with my doctor's decision to do the most recent wire localizations to make sure everything was taken out. If you are uncomfortable with your decision, talk to your doctor and/or get a second opinion. It never hurts to get a second professional thought on anything that is invasive to your body. Either way, good luck on January 5. I will be thinking of you.

Kathy

Thank you, Kathy. I don't remember any of the reports discussing calcifications, but the lump can not be felt; therefore, maybe this is why wire localizations need to be done. In any case, it sounds like it does not increase the possibility of not having clean margins? Were the wire localizations painful?

hummingbyrd

Roxi1 said:

Thank you, Kathy. I don't remember any of the reports discussing calcifications, but the lump can not be felt; therefore, maybe this is why wire localizations need to be done. In any case, it sounds like it does not increase the possibility of not having clean margins? Were the wire localizations painful?

Wire localization is needed if the suspicious area is too small to find otherwise. I did request they try and not stick the wire into the lesion. They said they couldn't guarantee that, so I just prayed they wouldn't and they didn't. It was not too painful, but will admit I took a xanex before I went, I know, not supposed to but did anyway.
hummingbyrd

troyryans

Roxi1 said:

Thank you, Kathy. I don't remember any of the reports discussing calcifications, but the lump can not be felt; therefore, maybe this is why wire localizations need to be done. In any case, it sounds like it does not increase the possibility of not having clean margins? Were the wire localizations painful?

I did not have any detectable lumps, just the calcifications. Without the wire localizations, my surgeon would not have been able to determine where to operate. Mammograms taken right after the operation determined whether everything was removed (before I came out of the operating room). Regarding clean margins, I believe that is why the additional tissue was taken, to be safe. To be honest, the wire localizations weren't really painful due to the pain shots, but I almost fainted twice during the procedures because 1) I was on an empty stomach, 2) the thought of what was happening frightened me, and 3) one of the needles bent because my breast was so dense! So, I actually had three needles put in for two locations. Once the needles were in place, everything was fine, although it did seem odd walking around with wire sticking out of my chest! Felt like a martian or something! Thankfully the radiologist and doctor who performed the localizations were a gem and treated me with kid gloves.

Roxi1

hummingbyrd said:

Wire localization is needed if the suspicious area is too small to find otherwise. I did request they try and not stick the wire into the lesion. They said they couldn't guarantee that, so I just prayed they wouldn't and they didn't. It was not too painful, but will admit I took a xanex before I went, I know, not supposed to but did anyway.
hummingbyrd

I hadn't realized I needed to be concerned about hitting the lesion with wire localization. How big of a concern is that? Does that spread the cancer inadvertently? Do I need to somehow make sure that does not happen? How do I know if it does occur?
Thank you for your responses
Kathy, I think I would have passed out, if the needle had broken during the localization. The fact that that did not happen, and that you have such a sense of humor about the entire incident, is a key trait of a 'survivor'.....in this case, you!!!! Thank you for your response, Kathy

Sharon345

Roxi1, my lumpectomy was in Jan 2003. I had it done at MD Anderson Cancer Center which is well known as the best cancer center. My surgeon was Eva Singeltary who is known to be the best breast cancer surgeon. I say all that because I also had a wire put in before the operation. They used some type of mammogram while they were inserting it. I sat on a chair while they did it. It was painful but when they realized it was they quit and gave my another pain shot. It was OK after that so if it does hurt you, be sure to tell them. It was interesting how they were able to insert the wire into my breast and then circle the tumor area! Afterwards they put a small sytrofoam cup over the area so they could leave the wire sticking out and wheeled me to surgery. The doctor told me they did this to make sure they got the margins they intend to get. Once you're opennned up, the tissue is not in the same spaces as when you're all closed up.
We could not feel my tumor either - just see it on the mammogram even though it was 1.2 centermeters. I've had no reaccurances of the cancer.

Roxi1

Sharon345 said:

Roxi1, my lumpectomy was in Jan 2003. I had it done at MD Anderson Cancer Center which is well known as the best cancer center. My surgeon was Eva Singeltary who is known to be the best breast cancer surgeon. I say all that because I also had a wire put in before the operation. They used some type of mammogram while they were inserting it. I sat on a chair while they did it. It was painful but when they realized it was they quit and gave my another pain shot. It was OK after that so if it does hurt you, be sure to tell them. It was interesting how they were able to insert the wire into my breast and then circle the tumor area! Afterwards they put a small sytrofoam cup over the area so they could leave the wire sticking out and wheeled me to surgery. The doctor told me they did this to make sure they got the margins they intend to get. Once you're opennned up, the tissue is not in the same spaces as when you're all closed up.
We could not feel my tumor either - just see it on the mammogram even though it was 1.2 centermeters. I've had no reaccurances of the cancer.

Sharon
The logic you used, of tissues not being in the same location when closed, as when opened, makes sense. I can see the reason for wire localiation. My visualization of what this tumor looked like, was probably not very accurate, nor as completely accurate as a surgeon would need to operate.
Also, thank you for the clue re: pain with the wire localization. I guess I thought I would just have to grit my teeth and bear it, if there was pain involved. Did you have a sentinel node dissection after your lumpectomy? Did the isotopes they used burn? How did you tolerate that part of the procedure. Yes, MD Anderson is the best. Guess if they do it a certain way, it should give all of us confidence that, even though we might not be in a National Cancer Center, that our own team is following state of the art guidelines.
Thank you again
Roxanne

hummingbyrd

Roxi1 said:

Sharon
The logic you used, of tissues not being in the same location when closed, as when opened, makes sense. I can see the reason for wire localiation. My visualization of what this tumor looked like, was probably not very accurate, nor as completely accurate as a surgeon would need to operate.
Also, thank you for the clue re: pain with the wire localization. I guess I thought I would just have to grit my teeth and bear it, if there was pain involved. Did you have a sentinel node dissection after your lumpectomy? Did the isotopes they used burn? How did you tolerate that part of the procedure. Yes, MD Anderson is the best. Guess if they do it a certain way, it should give all of us confidence that, even though we might not be in a National Cancer Center, that our own team is following state of the art guidelines.
Thank you again
Roxanne

Good explanation Sharon as to why they do wire localization. Mine was inserted at the breast care center THEN they wheeled me over to the hospital through the parking lot in a wheelchair. LOL I'm sure I looked smart with my "madonna styrofoam boobie"! : )
They are doing studies on effects of wire localization and biopsy vs. lumpectomy vs. mastectomy. So far the lumpectomy and mastectomy have equal cure rates. The verdict on wire/biopsy is not in yet. Someone posted a note on site about preliminary trial results. Go down to search and type in biopsy/risk/outcome results...just whatever clues work then click the link to see the study. Docs will tell you I'm nuts and there's no evidence of increased risk by cutting into a malignant lump. I say use common sense...you got a baby with a dirty diaper and you stick a needle in it guess what's going to leak out? Bear in mind I DID have the wire localization done, however I asked them to be careful and try not to lance it. Of course they can't gaurantee that, so for me, more importantly, were my prayers. Mine and any Christian prayer list that someone wanted to put me on!
God bless! You will be JUST FINE! Keep the faith, hope and peace and there won't be any room for fear!
(((HUGS))) hummingbyrd

Sharon345

Roxi1 said:

Sharon
The logic you used, of tissues not being in the same location when closed, as when opened, makes sense. I can see the reason for wire localiation. My visualization of what this tumor looked like, was probably not very accurate, nor as completely accurate as a surgeon would need to operate.
Also, thank you for the clue re: pain with the wire localization. I guess I thought I would just have to grit my teeth and bear it, if there was pain involved. Did you have a sentinel node dissection after your lumpectomy? Did the isotopes they used burn? How did you tolerate that part of the procedure. Yes, MD Anderson is the best. Guess if they do it a certain way, it should give all of us confidence that, even though we might not be in a National Cancer Center, that our own team is following state of the art guidelines.
Thank you again
Roxanne

Rox, For me there was nothing painful after the wire was inserted. The day before the operation I was given a shot in my breast that would find the sentinel nodes. I guess this was the isotopes you mentioned. I don't remember. I do remember that whatever it was worked and they didn't have to put in the blue dye to find the nodes. This shot wasn't too bad. It sounds worse than it was. By the time you have this done you will probably have had so many shots for blood work and MRI's that you'll be used to it.
I wasn't in the prep room long before they came and gave me a "relaxer" I-V.
I don't remember anything after that even though my husband says I was awake when they wheeled me out. My operation was at about 11 a.m and I was told I did wake up sooner but it don't remember anything until about 5:30 pm. I was sick to my stomach when I tryed to get up to get dressed to go back to the hotel. The nurse gave me crackers (remember you don't eat after midnight before the operation) The anethes. kept me sleepy the rest of the evening but it also kept me from feeling uncomfortable. I slept great! You'll have a very thick bandage and a special bra put on. I took these off the next morning to shower and found a suprisingly small incision aound the nipple (about 1.5 inches long) and an even smaller one where they took the sentinel nodes. Do get the pain meds filled at the pharmacy though. By the second day my anethes. completely wore off and I began to feel some pain but I wasn't totally miserable. This was the first operation I had ever had and I was expecting a lot more pain. You'll be fine. A masectomy would involve more pain, drains and recontruction operations so I consider myself very lucky.

Roxi1

Hummingbryd,
Thank you so much for the hugs. I feel like a wimp next to the brave women of this group; many of them who have gone through so much, and here I am, afraid of the 'worse case scenario" I am giving you many hugs back.

Sharon 345: Thank you for the detailed information about how all of this takes place. Could not find that type of info anyplace, and it is exactly what I need right now (the devil is in the details, eh . Yes, the isotopes you describe are exactly what I was referring too (had been told that the burning sensation from the isotope.....not the needle......felt just like someone had put your hand over a flame and told you to hold it there for 4 seconds). So, hearing you say that you hardly even remember the incident, means you did not experience the burning. So..........maybe.....I won't either.
Thank you to both of you
Roxanne

troyryans

Roxi1 said:

Hummingbryd,
Thank you so much for the hugs. I feel like a wimp next to the brave women of this group; many of them who have gone through so much, and here I am, afraid of the 'worse case scenario" I am giving you many hugs back.

Sharon 345: Thank you for the detailed information about how all of this takes place. Could not find that type of info anyplace, and it is exactly what I need right now (the devil is in the details, eh . Yes, the isotopes you describe are exactly what I was referring too (had been told that the burning sensation from the isotope.....not the needle......felt just like someone had put your hand over a flame and told you to hold it there for 4 seconds). So, hearing you say that you hardly even remember the incident, means you did not experience the burning. So..........maybe.....I won't either.
Thank you to both of you
Roxanne

Roxanne,

I just wanted to send best wishes for next week (little in advance, but am heading to Colorado to be with my mother while she undergoes hip replacement). As Sharon and Hummingbryd have mentioned, if you start to feel pain, let the doctor/radiologist know and they will work to make the procedure easier on you. Another suggestion, and one that helped my "light head" was that I was able use a special chair at the mammography machine while the wires were being placed. I intitially started out standing, but found that the sitting position was less stressful. Of course, I was amazed that my breast could be so contorted, but it seemed to work for me.

Overall, I found the stereotactic core biopsies more painful than the wire localizations, but both which I felt in my instance were necessary to undergo. And, once the wires were in place and I was wheeled to further surgical prep where I was given meds to put me into la-la land, I felt better!

Anyway, a big hug to you for next week. Just keep thinking "this too will pass", which continues to help me through difficult moments.

Kathy

DanaS

I just posted a reply to your question about sentinel node biopsy and pain.

I had a suspicious mammogram in October, followed by a core biopsy that showed ductal carcinoma in situ. As part of the preop workup I had a breast MRI. I was scheduled for a lumpectomy, with preop needle localization, under mammography. The night before surgery, I got a call from the radiologist, who said the MRI showed something, and they couldn't tell if it was the lesion that was biopsied or not, and asked me to come into the hospital an extra hour early to look at it under sonogram.

The sonogram showed a distinct mass, she put a needle into it, under sonogram, and sent me over to mammography, where she decided it was a different lesion. Then she pulled that needle out, placed a wire into the original lesion from mammography, then I went back to ultrasound, and had a second needle placed there, and then got sent off to surgery. After surgery, one lesion got sent to mammography to make sure all the calcifications got out, and the other went to ultrasound to make sure it was all out. Of course, I did end up with more surgery, but it wasn't supposed to happen.

Neither of these tumors could be felt, one could only be seen with mammmography, and the other could only be seen with MRI or ultrasound.

Wire localization is used a lot when the tumor is small, and the doctor wants to make sure she's operating at the right place.

Good luck with surgery. My advice, take whatever painkillers they offer.

Dana

Roxi1

DanaS said:

I just posted a reply to your question about sentinel node biopsy and pain.

I had a suspicious mammogram in October, followed by a core biopsy that showed ductal carcinoma in situ. As part of the preop workup I had a breast MRI. I was scheduled for a lumpectomy, with preop needle localization, under mammography. The night before surgery, I got a call from the radiologist, who said the MRI showed something, and they couldn't tell if it was the lesion that was biopsied or not, and asked me to come into the hospital an extra hour early to look at it under sonogram.

The sonogram showed a distinct mass, she put a needle into it, under sonogram, and sent me over to mammography, where she decided it was a different lesion. Then she pulled that needle out, placed a wire into the original lesion from mammography, then I went back to ultrasound, and had a second needle placed there, and then got sent off to surgery. After surgery, one lesion got sent to mammography to make sure all the calcifications got out, and the other went to ultrasound to make sure it was all out. Of course, I did end up with more surgery, but it wasn't supposed to happen.

Neither of these tumors could be felt, one could only be seen with mammmography, and the other could only be seen with MRI or ultrasound.

Wire localization is used a lot when the tumor is small, and the doctor wants to make sure she's operating at the right place.

Good luck with surgery. My advice, take whatever painkillers they offer.

Dana

My gosh, Dana, I can't even imagine how you felt with diagnostic screening finding another lesion.
I did have the lumpectomy yesterday (the doctor used a lot of topical anesthesia in the wound, so pain was minimal afterwards). No drains (don't know why, maybe not deep enough; lesion was only 1 cm from surface). The wire localization previously was also without pain. And the radiologist and technician were wonderful. They walked me through the entire procedure, explaining step by step what was being done prior to it being done, and the reason for it.
After surgery, I took one lortab at 10 p.m before going to bed (as hated the thought of waking up with throbbing pain), and today, Tylenol once. Haven't needed anything else. So, guess I am very very lucky, or the surgeon was very very competent.............Awaiting the path report now. Will get that tomorrow afternoon. I am picking up a copy at the office, then will discuss it with the surgeon next week. The office was very accomodating about allowing me to get a copy prior to the visit. Am praying for a miracle in the report, with with 95% chance, that the lesion is malignant.........hmmm, but I do believe in miracles, so never know (smile)

DanaS

Roxi1 said:

My gosh, Dana, I can't even imagine how you felt with diagnostic screening finding another lesion.
I did have the lumpectomy yesterday (the doctor used a lot of topical anesthesia in the wound, so pain was minimal afterwards). No drains (don't know why, maybe not deep enough; lesion was only 1 cm from surface). The wire localization previously was also without pain. And the radiologist and technician were wonderful. They walked me through the entire procedure, explaining step by step what was being done prior to it being done, and the reason for it.
After surgery, I took one lortab at 10 p.m before going to bed (as hated the thought of waking up with throbbing pain), and today, Tylenol once. Haven't needed anything else. So, guess I am very very lucky, or the surgeon was very very competent.............Awaiting the path report now. Will get that tomorrow afternoon. I am picking up a copy at the office, then will discuss it with the surgeon next week. The office was very accomodating about allowing me to get a copy prior to the visit. Am praying for a miracle in the report, with with 95% chance, that the lesion is malignant.........hmmm, but I do believe in miracles, so never know (smile)

the second lesion was supposed to be cancer. The operative report says that they thought it was another cancer, but they didn't tell me that before surgery.

I'm glad your surgery went well. I didn't think the wire localization and lumpectomy was a problem at all. I never had any drains, either. I had a general anesthetic with both my surgeries (I was supposed to have a local with the first lumpectomy, but because I ended up with 2 wires, they decided to give me a general.

I hope your path report is good, let me know. The problem with my lumpectomy is that it was the Friday before Thanksgiving, and I didn't get the report until the Monday after Thanksgiving, it was hell waiting so long. Never have surgery just before a holiday is what I learned.

Dana