Surgical biopsy for small breast?

I need to meet with my doctor and a surgeon yet, but I just had a diagnostic mammogram that showed some calcifications.  I met with one of the radiologists at the imaging clinic and he recommended a biopsy but said because of my small breast size, I'd probably have to have a surgical biopsy.  I'd obviously prefer a less invasive option.  Can his opinion be valid?

[braveheart2]

My understanding is that women with smaller breasts and those with microcalcifications that are close to the chest wall regardless of breast size might need to have their biopsy done via surgical excision for safety -- this is to reduce the risk that the needle might penetrate the chest wall...His opinion seems to be a valid one.

But discuss the details of your particular case with your surgeon, and by all means get a second opinion before proceeding so that you feel comfortable with the decision! Kind regards...

[slimonel]

hi there, I also was told my breast were too thin to do a fine needle biopsy or stereotactic biopsy.   I now have implants, but in 2002 I had a sterotactic (benign) before implants.  I had  two lumps and calcifications taken out sept. 18, '08.  I also would have rather opted for something less invasive but an open biopsy with wire localizaiton will give a much better diagnosis and besides the other two options were just not available to me.  MY age I just turned 50 and my mother and her sister both died of breast cancer.  I do not carry the BRCA 1 or 2 gene, not that puts anyone in the free and clear of familial gene mutations.  My breast are also small (I did not make them big)  Anyway the surgery was NO BIG deal.  My surgeon pulled everything out through a semi circle around my areola.  Now the waiting!   Good luck trust your doctor.

[JAB4648]

Thanks for your responses.  I figured the radiologist's opinion was valid - I guess I was just a little shocked that surgery would be potentially my only option - I've never had surgery or general anesthesia, so I'm a little fearful of "the knife."  I meet with my doctor next week - she'll be a great resource because she's had a mastectomy and she's around my age (46), so I know she can recommend a good surgeon if needed.  I've read a bit about the wire localization procedure and lots of women say it's quite painful - any thoughts on how to deal with that?  Is sedation for that procedure an option?

[blueskyabq]

Hi,

I have almost same situation, need surgical biopsy for calcifications.  Drs including radiologist and surgeon explain to me for 2 reasons.  First, after compress, breast tissue too thin for needle biopsy; second, calcifications are too tiny to use needle biopsy.  So wire localization surgical open biopsy has been recommended for my situation.

I also like you, never had any surgery to general anesthesia, and would prefer less invasion too.  So I seeking other options, so far, this seems the only choice.  I think I cannot avoid this procedure and I now have to go for it, although I have not family history of this kind and I am just in the early 50s.  I am scaring now, and hope it will be not too painful.

Thanks to kittyluv1, she wrote me a note for the details of the procedures she has bee went through, and her was smooth.  

If you prefer, give her a note she will wrote you back, hope that will help.

[braveheart2]

I was able to successfully have the sterotactic core needle biopsy (only a tiny moment of pain, like a bee sting, when the Lidocaine was injected), but now face the wire-guided excisional biopsy this coming Monday since my pathology report showed suspicious cells, and there is a need to take more tissue to rule out invasive cancer.

My surgeon gave me a choice between having general anesthesia and local anesthesia with sedation -- I have chosen the local + sedation route.

I will let you know how it feels! Kind regards...

[blueskyabq]

Thank for sharing your experience.

Hope everything will come out fine!

I had a surgeon consultation last week, about surgical excision biopsy, she offered same two options too, but recommended general anesthesia, even my calcification she needs to removed are not deep. I have not done anything yet, but will soon.

Please keep us posted.  The best regards!

[momzr]

I was in the very same boat that you are in this past July.  The day of my digital mammo where the radiologist saw the cluster of microcalcifications, they had me lay on the stereo table and measured to see if that would work and I was too small for that stereotactic procedure too.  

Therefore I had to have the surgical excision biopsy.  I am also 46 and ALSO never have had anesthesia for ANY reason at all (not even epidurals when I had my kids).  The thought of being 'put under' was freaking me out more than actually thinking of my body being cut open!  It all went very well, however, and the light dosage they gave me worked fine.  

My results were that I had a VERY tiny area of DCIS which I honestly think would NOT have been found doing the stereo procedure, so I think it all worked out for the best.  Entire area (1.6 mm - smaller than 1/8 of an inch) was removed and I had clean margins, so am having no further treatment of any sort at this time.  I feel lucky that they were able to get it out during surgical biopsy and in hindsight am really glad it was done in this manner although I was NOT happy that I wasn't able to go the 'easier' route either.

Good luck -- the wire localization was not bad at all for me -- hope things go well for you.

[braveheart2]

Thank you all for sharing! Funnily enough, I am also 46...

I have just returned from my wire guided excisional biopsy, and all went well. The worst part was waiting for the surgery date; then waiting for the wire placement; then waiting for the OR to come free; then waiting for the sugery to begin. The actual experience was just fine once I got through these anxious milestones.

The wire localization was not very painful, in my case just the small injection pain of the local anesthetic prior to wire placement (the actual wire is the size of a cat's whisker, not very thick -- although I chose not to look at the size of the hollow needle it was threaded though!) The wire was placed perfectly, practically on top of the titanium clip I had received at my stereotactic core needle biopsy 17 days ago, so gave the surgeon a good target. The sugery itself was done with more local anesthetic plus sedation, which was not scary -- I was awake but not anxious for part of it, and fell asleep for the other part. I woke up quickly in recovery, and am sitting here with an ice pack on my breast but having no pain.

My follow-up with the breast surgeon is in one week, but he will call me with the results as soon as the pathology report is in...more waiting! But I am greatly relieved this phase is over, no matter what the outcome will be.

Best wishes to you all, and positive thoughts for benign results!

[JAB4648]

Thanks, everyone, for all the input.  I'm not as worried as I was Friday when I originally posted.  Meet doc tomorrow, and will see what she recommends.  And, yes, here's hoping for benign results for all!!!!