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Topic: Is titanium marker safe after biopsy?

Forum: Not Diagnosed but Worried — Meet others worried about developing breast cancer for the first time.

Posted on: Feb 26, 2009 11:04AM

fulloflife wrote:

I keep reading that the markers 'can stay in the body indefinitely'. Does anyone reallly know if there are safety issues involved? Can they migrate further into the tissue after a period of time? Can they cause infections down the road? After all it's a foreign object in the body I would think it would cause a reaction that hasn't been learned yet by the methods of science.

I've been hesitant to have a stereostatic core biopsy done for micro-calcifications because of this permanent 'marker' being placed. I know they all say 'it's nothing to worry about' but I'm not skeptical.

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Feb 26, 2009 01:37PM ecm wrote:

I have a titanium marker. They are the size of a sesame seed and you can't feel it. Titanium is a really unreactive metal, not ferromagnetic (don't expect to set of any metal detectors) and the clip is mean to stay in place so future mammos can pinpoint where you have already had a biopsy. Titanium is the metal of choice for things like knee/hip replacement and it is very safe. It's a good thing to get the clip placed and have the baseline mammo with the clip so that it can be compared to future films. Good luck with everything- don't let the clip hold you back from getting a biopsy.

Erica

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Feb 26, 2009 01:40PM lvtwoqlt wrote:

Full, I had 3 sterotactic biopsies with the markers, but due to the findings after the biopsy, the markers were removed in follow-up lumpectomies or the last time bilat mast. The orthapaedic doctors use titanium in the joint replacement surgeries. I also have a titanium rod in my back for correction of scolosis and it has been in place since 1971 and no problems with rejection or infections.

Sheila

Women are like tea bags, we don't know how strong we are until we were thrown into hot water. Eleanore Roosevelt Diagnosed ADH Feb 2005, ADH Sept 2006

Dx 4/27/2007, DCIS, Stage 0, Grade 1, 0/7 nodesSurgery 02/12/2005 Lumpectomy (Left)Surgery 09/10/2006 Lumpectomy (Right)Hormonal Therapy 10/12/2006 TamoxifenSurgery 06/01/2007 Mastectomy (Both)
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Feb 26, 2009 01:52PM leaf wrote:

It is possible, although VERY RARE, to have an allergy to titanium.http://www.ncbi.nlm.nih.gov/pubmed/11180773

In this paper, the clips seemed to associated with decreased recurrance for women who opted for BCT. www.ncbi.nlm.nih.gov/pubmed/11...

It is Possible for the clip to move, but, again, since they care to write a case report, that is unusual too.  Note the clip did NOT enter a blood vessel or travel around the body or anything like that.  The clip is too big to do that. http://www.ncbi.nlm.nih.gov/pubmed/11687696

Titanium metal should be very low in the interference scale with MRIs.

If you're going through hell, keep going-Winston Churchill

Dx 12/8/2005, LCIS, Stage 0, ER+/PR-Hormonal Therapy 07/15/2006 Tamoxifen
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Feb 26, 2009 02:29PM awb wrote:

I was told the clip could stay in the body indefinitely without any problems, although mine did end up being removed during my lumpectomy.  They said  they are the same kind used in cardiac surgery and the do stay in for good without a problem.

Anne

"I don't know what the future holds, but I know who holds the future"

Dx 9/5/2003, LCIS, Stage 0, 0/0 nodesSurgery 09/16/2003 Lumpectomy (Right)Hormonal Therapy 10/30/2003 TamoxifenSurgery 04/05/2005 Prophylactic Ovary Removal (Both)Hormonal Therapy 02/28/2009 Evista
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Feb 28, 2009 05:40AM fulloflife wrote:

Thank you everyone. I am so glad I found this site. I have received more information from all you wonderful people than I have received from my GYN or radiologist. Leaf, you brought up another concern I didn't even consider such as the chip migrating into a blood vessel. I'm in my 50's and there is a good possibility my cells won't be cancerous because all they see are a tiny cluster of micro-calcifications about 3mm, the width of the tip of a pen (the radiologist said). Six months ago they wanted a biopsy done and instead I agreed to a six month follow up. My six month follow up showed the same micro-calcifications without any change at all. They still want the biopsy. Sometimes I wonder if they left my breast alone the micro-calcifications would stay in situ for years. I think I'd rather have them than the chip and IF they turn out to be cancer cells in the area, the needle tract from the biopsy would help them migrate to other areas of my breast. I'm still hesitant, although I told my GYN to write the prescription.

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Feb 28, 2009 10:02AM ecm wrote:

Just one more note. I still advocate the biopsy. The chance of the clip moving into a blood vessel is extremely minute. The needle track from the biopsy DOES NOT spread cancer cells. There is a lot of information on this if you google it. This may be different with other kinds of cancer, but breast cancer cells don't spread from a biopsy. Don't let something like that hold you back from getting a test your doctor is recommending.

Erica

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Mar 1, 2009 01:21PM leaf wrote:

If, for whatever reason, you are DEAD SET against having a marker, then ask the radiologist if they would be willing to do the biopsy and NOT put in a marker.  Unless you have a known allergy to titanium, I wouldn't worry.  Lots of soldiers get metal bits in their bodies and live their entire lives without getting them removed.

But if they are recommending a biopsy, I'd strongly suggest you get that done.  

Erica is right - if 'seeding' does happen in breast cancer, it is EXTREMELY unusual. I could only find a handful of cases in Pubmed, out of many millions of women who had breast cancer.  Probably at least some of these women did not have the usual recommended treatment.

  IF you do have breast cancer, then they have found cancer cells in the washings (to various degrees.)  HOWEVER, they think these cells die - they think that breast cancer cells need a specific environment to grow (unlike the case in some other cancers.)  Even if the breast cancer cells do not die immediately, if you get normal treatment, the cells get killed and/or removed.

If you are very concerned about this, then if you have a lumpectomy, have them remove along the needle tract.  If you have a mastectomy, then the needle tract will also be removed. Get the standard treatment recommended for your condition.

If you're going through hell, keep going-Winston Churchill

Dx 12/8/2005, LCIS, Stage 0, ER+/PR-Hormonal Therapy 07/15/2006 Tamoxifen
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Mar 1, 2009 01:54PM, edited Mar 1, 2009 01:56PM by fulloflife

Thanks---I've been reading this site all over and realize I shouldn't allow my fears of the procedure itself prevent me from making a wise decision. As hesitant as I feel about it I should feel fortunate that the radiologist spotted it on the digital mammo---I saw the film, it's definitive that there is a cluster of micro-calcifications in my right breast and none in my left---regardless of how small they are the radiologist did her job and found them---hopefully even if it turns out to be cancer, it's such a tiny area that the radiologist gets it all with the needle biopsy---there's no lump to do a lumpectomy so hopefully there won't be a need to see a surgeon.   Do all positive biopsy results from micro-cal result in surgical excision? The radiologist, by the way, told me she won't do the procedure unless she inserts the chip.

Another question is if they can insert a titanium chip via stereotactic needle then why can't they treat cancer that way by inserting cancer fighting substances through a stereotactic needle to target an area?

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Mar 5, 2009 02:32PM, edited Mar 5, 2009 02:34PM by teeko

Full of life: Back in September, I was faced with the same thing you are--what to do about microcalcifications. I ended up having a stereotactic biopsy, and then a needle-guided excisional biopsy. The stereotactic biopsy found certain abnormal cells growing in an unorganized fashion.

You are right; a group of microcalcifications does not equal a lump, but they may still need to take out a portion of that area of the breast to see what the abnormal cells are doing, if you have any, and they call it a lumpectomy anyway.

By the way, the needle placement done before the excisional biopsy to make sure of targeting the area of the calcifications was simple. (Just having the breast numbed while sitting in a chair and having a less-painful-than-usual mammogram done right there to make sure the needle was in the right place. I felt nothing and it was not scary.)

In the end, I was glad I had the stereotactic biopsy and the excisional one, because the latter found ductal carcinoma in situ--that is, cancer in the ducts that had not begun to spread outside. This is about the earliest you can find cancer. I had to have a second excisional biopsy to make sure that there was a large enough clean (no cancer) margin around what they removed the first time, and this time, the surgeon said they had got it all. I was asked to consult a radiologist and then an oncologist about the necessity for further (preventitve) treatment, but both of them said it wasn't necessary. I will continue to have regular checkups and mammograms.

What was strange and makes me doubly grateful for the skill of the technician who read the mammogram that first alerted them to the problem, is that someone along the line wrote in his biopsy report that he couldn't detect calcifications, and again, when they took a mammogram after placing the needle for the first excisional biopsy, the operator said how strange, he couldn't see any calcifications there. But if no one had noticed them and I had had nothing done, I could have an undetected and untreated cancer developing in my breast right now.

I don't know about using stereotactic needles for targeted chemo treatments for breast cancer, but something similar exists for liver cancer, which my husband has (though he refused the treatment). It is called TACE, or transarterial chemoembolization. They have other targeted methods of treatment, too.

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Mar 6, 2009 08:22AM, edited Mar 6, 2009 08:23AM by leaf

"By the way, the needle placement done before the excisional biopsy to make sure of targeting the area of the calcifications was simple. (Just having the breast numbed while sitting in a chair and having a less-painful-than-usual mammogram done right there to make sure the needle was in the right place. I felt nothing and it was not scary.)"

I'm glad the needle placement turned out well for you.  The big majority of people have this same experience.  Most people find it is VERY do-able. (I did a poll here at bc.org.)

I'm sure my experience was influenced by the fact that I have (something like) PTSD, and didn't know it at the time.  But if I ever need to have another needle placement,my doctor and I will be having a conversation about communication about pain BEFORE the proceedure starts. If you are concerned about this, then I'd advise asking the doc how what he wants you to do in the UNLIKELY event you do have pain.

If you're going through hell, keep going-Winston Churchill

Dx 12/8/2005, LCIS, Stage 0, ER+/PR-Hormonal Therapy 07/15/2006 Tamoxifen
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Jul 20, 2011 03:00PM creativemultimedia wrote:

I had a titanium marker inserted post biopsy and would like more information. Actually, my boyfriend is a natural skeptic and he made me want to get a second opinion about safety concerns. My diagnosis is benign for both breast biopsies but now I've started to worry about the damn marker! I need to find reassurance that it is okay to leave in, as I don't need any other breast procedures done (other than a follow-up mammo) in Jan 2012. I'm thinking of calling around to different physicians outside of the place where my procedure was done to get more information.

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Jul 20, 2011 03:11PM Bren-2007 wrote:

Hi Creative,

I have lots of titanium markers left in my breast.  There is no cause for alarm.  The first time they were put in for my first biopsy, which was good, as they marked the spot when it was time for my second biopsy.

My surgeon also left them in to mark the area when I had my lumpectomy.  They really are very harmless left in.

Bren

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Sep 29, 2011 03:39AM spinnerfaster wrote:

I had a biopsy yesterday and was told a metal marker might be inserted if needed.  I asked of all the risk. They did insert and I am concerned.  I researched on line as soon as I could and found many people have the same complaints of pain an infection.  I am not only anxtiously awaiting the results of the biopsy today but had many concerns of this marker insertion. 

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Sep 29, 2011 05:08AM, edited Sep 29, 2011 05:18AM by somanywomen

.....Below is a copy of a post that I wrote in May 2010 that includes a photo that I took of the titanium clips left in my surgical area..I took the photo of what was on my film, could not believe they left these things in me without my knowledge...I am extremely allergic to so many things and I have tried to find out if they may be the cause of my soreness still 2 years  after surgery..My docs will not admit that this could be cause, I am just as sore as I was 6 months after surgery, they just tell me that some people heal slower...My surgeon told me these were used instead of stitches or glue to close off the bleeding....I believe this clump of clips are still in there irritating my tissue...I have another mammo/ultra next week and will ask if they are still seen in the area because of the soreness that has never gone away.....

 "I have complained of pain (although I feel like it is going through deaf ears) to all my docs for the last 7 months..My whole lump side (back to front, arm to under ribs)  is sore and I have strange ongoing irritation ( like a sandspur under my skin) at sn removal area...My left side looks healed so I get little sympathy....I still have not found a comfortable sleeping position, when I get out of bed my whole side feels like it weighs a hundred pounds and does not want to rise with the rest of my body..A type of numbness/tightness compresses the top of my arm and radiates down at times...

At my 6 mo mammo recheck, the below clump of 7 surgical clips showed up in film and I believe these things have a lot to do with my soreness/slow-healing..My surgeon does not think they have anything to do with my se's, he tells me to wait another 6 months...He discouraged any removal of these saying I may end up with more problems....He also said that my surgery has nothing to do with my numbness arm se's...I do not think he takes my soreness/pain/numbness seriously and wonder if it is just his ego that has closed his ears to my concerns....He suggests that the radiation might be the cause...

Photo of 6 mo mammo clips at sn area...I can see 7 and wonder if there are more....

Surgical clips...ouch!!

“There must be some way out of here,” said the joker to the thief, “There’s too much confusion, I can’t get no relief."....All Along the Watchtower..Bob Dylan

Dx 9/28/2009, IDC, 1cm, Stage I, Grade 2, 0/2 nodes, ER+/PR+
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Jan 10, 2012 07:26PM Boops wrote:

I know so very little about all of this, but I, too have concerns about the titanium markers.  I noticed that no one has mentioned that it is considered a heavy metal and typically, heavy metals are toxic to the body.  It's hard to say if it's the clips or the recovery from radiation causing you problems, but I would seriously consider switching doctors and getting a second opinion.  Get someone who listens to you and sets their ego aside.  I prefer women, but go with what your gut instinct tells you.  Dump that doc!

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Jan 10, 2012 08:09PM marie5890 wrote:

Boops, you are confusing two differnt things

Somanywomen was talking about surgical clips...More like stitiches/sutures to close the wound

 ".My surgeon told me these were used instead of stitches or glue to close off the bleeding."

Biopsy markers are different..the identify within the breast where the biopsy samples came from

"Breast Biopsy Marker Clip

Marker clips used for breast biopsies are made of titanium or surgical stainless steel and are about 2 millimeters in size.  When the radiologist or surgeon feels a marker should be used, they are inserted at the end of breast core or needle biopsy procedures to mark the site of the biopsy for later reference.  This is an important step to take since most abnormalities biopsied are small or subtle and can become extremely difficult or impossible to identify after a core biopsy procedure. 

DO NOT READ ANYTHING INTO THE TECH'S EXPRESSION OR WHAT THE TECH SAYS. Jan '11 Biopsy Dx-ed a PASH tumor (rare, but benign tumor)....All I ask is for peace and serenity to the depths of my soul. Makes the rest of life more live-able.

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Jan 10, 2012 08:10PM exbrnxgrl wrote:

Somanywomen,
Are you referring to surgical clips/staples or the titanium marker used to mark a biopsy?The OP is asking about the titanium biopsy marker which is not a replacement for stitches or to stop bleeding. I am sorry that you have been in pain for so long. As for the biopsy marker, see leaf's original posting that provides reference to adverse reaction being very rare.
Caryn

Bilateral mx 9/7/11 with one step ns reconstruction. As of 11/21/11, 2cm met to upper left femur

Dx 7/8/2011, IDC, 4cm, Stage IV, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2-Surgery 09/07/2011 Mastectomy (Both); Lymph Node Removal (Left); Reconstruction: Breast implants (permanent) (Both)Radiation Therapy 11/15/2011 ExternalHormonal Therapy 11/21/2011 Arimidex
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Jan 10, 2012 08:34PM cycle-path wrote:

Boops, titanium is NOT a heavy metal or a toxic metal. It's completely safe and inert in the human body. It's completely nontoxic to animal and plant life, even in huge quantities, and is used in many medical situations. 

Titanium isn't magnetic, so it's ok to get an MRI if you have titanium in your body. It's used in dental implants and in most surgeries in which bones are repaired. If you know someone who injured a bone and had a "pin" put in, that was titanium.

Truly, nothing could be safer.  

I am an Uppity Woman. Don't like my posts? Put me on IGNORE.

Dx 12/10/2010, DCIS, 1cm, Stage 0, Grade 2, 0/2 nodes, ER+/PR+
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Jan 11, 2012 04:43AM leaf wrote:

Being 'devil's advocate': They often use titanium in joint replacements and teeth, where it can withstand a lot of force.  But, being good scientists, it sounds like they are developing methods to actually detect the amount of titanium in the blood.  They did find higher, though still very, very low, levels of titanium in people that had titanium implants in joints/teeth that withstood a lot of force versus controls.  www.sciencedaily.com/releases/... Even the controls (who had no titanium in their body) had some level of titanium in their blood.  The people that had implants in places that withstood a lot of force had higher levels (though still very low) of titanium in their blood. They undoubtedly  will use a method like this to monitor titanium levels.  Note I have NOT found any studies that find titanium toxicity in people that have sesame-seed  sized pieces of titanium (besides the VERY RARE people who are allergic to titanium.) If gobs of people were getting a theoretical titanium toxicity, it would have been a lot earlier than 2011 to find a blood test for titanium.

But there should be NO force on a titanium clip in one's breast. So one's titanium level should be quite small.

The particle size may play a difference.  There is some concern and controversy whether titanium in nanoparticles could be toxic to some animals. (It sounds like this is controversial.) www.ncbi.nlm.nih.gov/pubmed/22... But a breast titanium clip is certainly NOT a nanoparticle - its about the size of a sesame seed.

The first modern titanium dental implant was in the 1950s per this website, and they've done millions since then. www.londondentalimplants.com/H...

If you do end up having some sort of breast cancer or a condition that puts you at higher risk for breast cancer, then they usually remove the clip during an excision or mastectomy.  If they are interested in doing a biopsy, then your risk of having something bad happen to you due to your breast lesion is a lot bigger than your risk of something bad happening due to titanium.

If you're going through hell, keep going-Winston Churchill

Dx 12/8/2005, LCIS, Stage 0, ER+/PR-Hormonal Therapy 07/15/2006 Tamoxifen
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Jan 11, 2012 05:21PM, edited Jan 11, 2012 05:23PM by besa

This Post was deleted by besa.
Dx 2007, IDC, 2cm, Stage IIa, Grade 1, 0/1 nodes, ER+/PR+, HER2-
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Apr 18, 2012 07:09AM 4whitey wrote:

I had this procedure to insert titanium marker inserted yesteday.  I never heard of this. When did this start to happen? I also am very worried about something being put in my body.  My husband had medical mesh used to repair a hernia and he has had over two years of hell and 4 surgeries to attempt to correct, but the mesh if still in there. In fact, surgeon put a larger piece in to "correct" the first one that got intertwined with his small intestines.  So I am definintely worried about the titanium marker.  I don't have a diagnosis yet.

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Sep 15, 2012 06:18PM alleygirl wrote:

Well... I have been going nuts for 3 days now. Had my breast biopsy 5 days ago. And YES, two days later... Itching like crazy and have a red spot and heat right over the cyst/lump area. I am so glad I found this site!
I see a few others are itching like crazy and yes, I too am allergic to costume jewelry too and only wear 14K Gold earrings!
Guess I'll be calling the on-call Dr tomorrow, since today is Saturday. Grrr!
At least I'm not crazy!! Unbelievable we are all going through this!

I also gained 2 lbs this week. When the Dr aspirated, no fluid came out, so he backed out to do a biopsy. When he pulled out.. the cyst filled with a fluid.. he thought perhaps to be blood. So I was thinking maybe it's filling up and might pop or internal bleeding with all this heat and redness. Didn't call the Dr sooner.... because I figured I'd wait and give it time to 'heal'. Yeah, right. NOT! Ughhh... so annoyed and (itchy) right now, (LOL)!

I noticed...I didn't see anybody post how they got their breast biospy flagger removed. HELP!

Good Luck to everybody!

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Sep 16, 2012 06:28AM SuzyQ2012 wrote:

I am having a stereo biopsy next week. I have been assured by multiple people that the marker is safe.
I never thought about allergies. Although, it hasn't been officially diagnosed, I was told that I probably have an allergy to nickel, as my skin usually gets irritated by jewelry- mostly earrings and rings. I will mention this before the biopsy, however, if it's pure titanium, I guess I'll be ok.

Fulloflife- please get the biopsy done. It's the only way to know for sure what's going on. Talk to your doctor about your fears. Hopefully, you can be reassured. I was told that the markers are necessary because they will know in the future the exact spot of the biopsy. This will save you from unnecessary testing in the future.
Wishing you the best!!!

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Sep 16, 2012 06:42PM KatMJ wrote:

I had one in for 3 years...then taken out with the lump.  For me...it wasn't an issue at all.

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Sep 16, 2012 07:57PM awb wrote:

I was told the titanium markers pose no problem and can remain in the breast indefinitely. (mine was removed during my lumpectomy.) The radiologist explained to me that the same kind of markers are used commonly during cardiac and other surgeries and are tolerated well.

anne 

"I don't know what the future holds, but I know who holds the future"

Dx 9/5/2003, LCIS, Stage 0, 0/0 nodesSurgery 09/16/2003 Lumpectomy (Right)Hormonal Therapy 10/30/2003 TamoxifenSurgery 04/05/2005 Prophylactic Ovary Removal (Both)Hormonal Therapy 02/28/2009 Evista
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Sep 18, 2012 02:13PM, edited Sep 18, 2012 02:16PM by leaf

I certainly have had itchy incisions that have *not* involved the insertion of anything.  For example, I had several moles removed and the incision area itched - sometimes years later.  When you have an incision, nerves get cut .  Maybe this is associated with 'phantom pain'?  I don't know if the itching sensation is due to an error in the brain or spinal cord, or if its an error with what the nerve is detecting.  But there could be other causes of itching besides a titanium allergy.  (I have an allergy to ?nickel, surgical steel (when wearing earrings.)  They used a titanium clip in several biopsies on me and I've never had any problems.  One was removed on lumpectomy, but I still have other(s) from other breast biopsy(ies).)

However, everyone is different.

If you're going through hell, keep going-Winston Churchill

Dx 12/8/2005, LCIS, Stage 0, ER+/PR-Hormonal Therapy 07/15/2006 Tamoxifen
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Sep 18, 2012 07:08PM SuzyQ2012 wrote:

Thanks for the info, Leaf. Sounds like we have the same type of allergy. Glad to know that I should be ok with the markers.

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Sep 20, 2012 08:11PM alleygirl wrote:

Update... I had the aspiration/biopsy done on a Monday, started to get a red spot on my skin where the titanium was places, along with ithcing and heat. By Sunday, I was very lucky, it all calmed down! Haven't had any issues since then. Been a week. GOt biopsy results back and it was not malignant, but Dr wants another mammogram in 6 months:-(
As for the aspiration, that was slighly painful. Dr didn't get any fluid, so he had to do biopsy. When the Dr pulled out to do the biopsy, the 'thing' filled with what the Dr thought was probably blood. I asked for more local and pretty much felt nothing but an awkward pressure when he did the biopsy and that was not an easy feat with dense tissue, took him a bit to reach it, during aspiration and biopsy!
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Sep 25, 2012 05:40AM lukefrancis1 wrote:

hi, it was explained to me that the marker...mine was radioactic minut lead like a small beebe was removed when located with a giger counter and removed with as much as the lesion and area when the excisional proceedure was done.

I still have the so call clip from another stereotactic (where lesion as missed) in me! they assured me no problem! hope this helps.....Again prayers for all big day for me hopefully results of last proceedure.!

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Dec 6, 2012 03:26PM IrisM2900 wrote:

Double check with at least two sources at your hospital on whether your marker is titanium or stainless steel. My breast surgeon's assistant told me she "thought" it was titanium; I confirmed with the Radiologist's office that it was actually stainless steel. Since I am highly allergic to nickel (an alloy in stainless steel), this answered the question of why I had a major auto-immune response (high white blood cell count, pain, discomfort, hives, muscle weakness, fatigue).

So, if you're allergic to nickel, or other metals used in stainless steel, you can refuse to let the doctors/technicians implant stainless markers. like another poster, I was also not told that a marker would be implanted until AFTER the procedure. I did not sign any consent forms for the marker either (I checked the paperwork).

Btw, my hospital (a teaching university in the Bay Area) jumped the gun on ordering a FNAB of my underarm. I didn't have pre-existing breast cancer, and they still did the FNAB before any mamograms were performed. There was only ONE enlarged lymph node in my armpit (that was the reason they ordered the FNAB). After a lot of research, I realized that with my situation it would have been better to re-Ultrasound the area in a few months. Now, I have a scar, pain, and illness all due to an excessive invasive procedure. (Every case is different, so obviously, if you have cancer or other abnormal lumps, you may want to go with the procedures and implanted markers).

Btw, it was a benign lymph node.

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