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Clip Left In

I had 2 breast biopsy's one year ago- a stereotactic (which showed cluster microcalcs and was benign with ADH) followed by an excisional biopsy (benign/negative for ADH).  The breast surgeon assured me that she had tested the correct area but because of my very small breast size, she knowingly left in the clip, saying she had taken enough tissue.  When I went for a follow-up mammogram - the radiologist was concerned that the clip was left in and wants me to have another excisional biopsy for that fact even though no microcalcs showed up on the diagnostic mammo this time.  The clip had migrated slightly prior to the wire-local biopsy.  Should I have another biopsy to make sure?  I'm going to question the surgeon about this again.  If I had the clip taken out, Would this leave an indention, etc. in my breast (it's close to the nipple).
Tags: adh, clip, biopsy, left
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When a titanium marker is placed during a stereotactic biopsy the breast is still in compression (flattened).  When the compression is released the marker may move along the axis of the needle tract as the breast re-expands.  Even though it's called a clip, most do not actually clip onto tissue.  After the biopsy a mammogram is obtained to determine whether there was clip movement upon release of compression, so called clip migration.  The reason it's good to get the mammogram immediately after the procedure is because there's no better time for the radiologist to determine if there was migration, because everything is still fresh in her/his mind.  Usually if there is clip migration, which is normal, the amount of migration is documented so that if the surgeon needs to go back in to excise the tissue, they don't accidentally excise the tissue that the clip is sitting in, but the tissue that had the original calcifications.  It's perfectly acceptable to leave the clip behind in this case as it is not marking anything important and to retrieve it would entail additional tissue excision without benefit.  

So in your case, I wouldn't have another biopsy until your prebiopsy, biopsy, and postbiopsy films have been thoroughly re-reviewed, because the answer should be deducible by the radiologist if she/he spends some time going through all the films.  So you need to pressure the surgeon to sit down with the radiologist to sort everything out.  It is possible that after reviewing all of the films and reports in great detail that there will still be doubt as to whether the correct tissue was removed, and in that case you will have to make the decision whether to have another surgery.  But don't go back under the knife until you feel confident that the surgeon and radiologist sat down together and put the needed time into trying their best to sort it out.  Sometimes it's like an episode of CSI, but it usually can be done.  Ask the surgeon if he would present your case at the weekly conference most breast centers have, if your place has one, as this would force the issue to be sorted out just so it could be presented coherently.

The clip is so tiny, it would not leave any indentation but the tissue around it that may be removed could have cosmetic consequences.
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