My Stereotactic Biopsy Experience
Hi everyone. Yesterday I had stereotactic (meaning mammogram guided) core biopsies on both breasts to examine calcifications that showed up on a screening mammogram. I tried to read as much about this procedure in advance as possible so I would know what to expect (I was very nervous). Here is a description about how it went, trying to cover the details that I wanted to know when I was reading up on it. Since this is a long post, I am going to do a second one right afterwards with some “tips” that I found helpful.
My appt was at 3pm. I got there at 2:45 to do paperwork. I was having both breasts done, so my appointment was longer than average. I was done at 5:30.
I was able to keep on my clothes from the waist down and they gave me a gown to wear with the opening in front. They did not have slippers for me.
The procedure room was fairly small, there was my dr and two nurses / techs and me. They had me bring my purse in with me, so don’t bring a big bag. The lighting was bright and there was no music. It was kind of chilly and they gave me a nice soft blanket to wrap around my shoulders and kept it on me for the whole time.
My procedure was the vacuum assist core biopsy, and it was done laying face down on a table. There was a two step stair up to the table. Since I was on meds and am also blind without my glasses, they helped me up. So if you have mobility issues, just let them know.
The table is not particularly comfortable (and they told me this was their “new” softer table!). So don’t be expecting cushioning like a massage or physical therapy table. It wasn’t just plain metal, but the padding was thin. The hole in the middle is fairly big, I guess they have to make sure they can fit all shapes and sizes! I am a fairly small person, so the edge of the hole was pressed up against my rib cage and today I have bruises on both sides from that edge. It didn’t hurt at the time, it just wasn’t comfy. I do have a shoulder problem, so I was able to keep both my arms at my sides and not over my head. My head was turned to the right side.
I had told them I was nervous, so one woman was my “comforter “ and she did a great job of telling me what was happening every step of the way and checking in with me.
I’m on the cusp of menopause and so my periods only come about every 4-5 months and I have always had really bad PMS breast tenderness. So, totally bad timing and I started those darn PMS pains about 3 days ago! Argh.....! See more on this in my next post on tips.
Once I got positioned for my L breast, my nurse told me they were going to position me on the compression paddles so they could take some initial images. I was surprised at how much moving and pushing and pulling that involved. You can’t see anything that is happening under you, so these invisible hands moving you around were weird, but not painful.
Then they told me they were going to start the compression. Here’s what I have to say about this part, if the compression of a regular mammogram is something you can handle, then you won’t have any issues at all. Being hyper tender because of my PMS, this was difficult. But you can read my tips on this in my second post.
Once they got the compression set, they took two images. The only time that my nurse stepped away from me was when they did the images...then all 3 of them were back behind some shield in the corner. Then they said they were going to clean me off and do the lidocaine shots. I was nervous about this part. I had used EMLA on both breasts before my appointment (see my tips post) to get some topical numbing. I didn’t even feel the prick of the needle! I felt a burning sensation as the lidocaine went in, but it wasn’t bad at all (and I am not one of those people with a super high pain threshold, trust me). They did a second shot and I didn’t feel either the prick or the burning with that one.
They waited about 5 min to make sure that the lidocaine had time to take effect. Then they said they were going to make the little incision and insert the needle. I honestly did not feel a thing! Some ladies have said they felt “pressure” but other than the overall compression of the machine I did not feel any separate pressure from the needle. Then they said they were going to take some images again and they stepped away to do that.
When they came back they said everything looked good and they were ready to take the actual biopsies. I was expecting to hear some kind of suction noise (since it was a vacuum after all!), but all I heard was a little electronic humming. I did not feel a thing!
Then they said they needed to take an image of the samples to make sure that they got the calcifications they were looking for. They may also have taken another image of my breast to see if they could tell that the calcifications were gone at the same time. Then they came back and said everything looked good and they were going to put in the titanium marker. Didn’t feel a thing with that either!
Then they released the compression (hallelujah!), but the other nurse proceeded to put a lot of pressure on the site of the incision to keep it from bleeding. Not painful, but kind of felt a little like she was doing a push-up on me! But I didn’t bleed much, so all was good and I was done on that side.
Now, on to the R side. There were only a couple of differences worth mentioning....due to the location of my calcifications on the R side, right behind the nipple and fairly close to the surface. Apparently this is a very hard area to get with the core needle machine, if there is not enough thickness the needle can come out the other side, they can have issues with the vacuum, etc... so what this meant for me was (I) compression was much more uncomfortable (imagine them squeezing not your whole breast, but mostly just down on your nipple), (II) the lidocaine shots were right into my nipple (like on the L side I didn’t feel the prick at all, but the burning was more intense, but bearable) and (III) they had to try two different locations to get the right angle to get in there, so it took longer and I wound up with shots in two different places. But other than that, the R side was also painless for the actual procedure.
While I am totally glad that this is over, I can honestly say that the things I was worried about were totally manageable and my experience was ok. I do have some tips to share that helped me which I am putting into a second post right after this.
Anyone out there who is scared, you can do this! I am not one of those stoic, high pain tolerance kind of people ...and I was fine. You will be too
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Ok folks, here are my tips:
I had my dr prescribe EMLA, which is a topical numbing cream. I put it on 90 min before my appointment (I covered it with some gauze under my bra and wore the cream right up until I changed into my procedure gown) and it really helped. I honestly did not feel the pinch of the needle at all! I did ask my dr about which general area to put the cream on so I didn't have it completely covering me.I would not recommend doing this procedure while you have PMS tenderness. It just adds unnecessary discomfort which is completely avoidable.
Bring socks in case your facility doesn't have booties.
My facility said it was ok to wear deodorant (even though you're not supposed to for a regular mammogram). That made me more comfortable, as I knew I was going to be sweaty and nervous but didn't want to be smelly too!
If you are nervous, ask if you can bring in earphones and an iPod. I preferred to hear them tell me what was going on, but you might like the distraction of music.
Get two ice packs (I have four, two for each side). That way you will always have one cold when you have to swap them out.
Bring chapstick. My room was chilly and dry and my appointment was very long. I put extra chapstick on my lips when we switched sides halfway through and that helped me be more comfortable.
Don't wear a bra that you like to your appt. Either buy a new cheap sports or supportive bra or bring something old that you don't care about. When I left the facility I was packed with ice and had some minor bleeding. The bra I am using will be totally stretched out from the ice packs and will be going right into the trash.
Bring an old button or zip front top to wear home. It will be easier to get on yourself than something over your head. Are since you can't shower for 24 hours, you might just wind up wearing that same top to bed...so make it something comfy!
Don't wear jeans or any other kind of bottom that has any raised seams or a zipper or anything on the front (I would even avoid pockets) there is little padding on the table and having anything poking into your hips or tummy won't be comfortable. I wore old yoga pants.
If your neck is uncomfortable turning one way versus another, ask if it matters which way your head faces. I was able to switch my position when we switched breasts, and that definitely helped me from getting too stiff.
Please talk to your dr about any fears you have! My dr was great and she answered many questions for me and we had an agreement in advance that i would tell her if I was having pain and that she would make sure I had enough lidocaine and that if I asked her to stop at any time, she would stop. That made me feel like I had some control over things and really helped.
If you have really bad anxiety, talk to you dr about that too. I did wind up taking an Ativan an hour before my appointment. But if I had to choose between that and the EMLA, I might pick the EMLA.
Make sure you have Tylenol or Advil or whatever your dr says is ok to take the day after your biopsy in the house. I was achy in the middle of the night and was glad that I didn't have to run out to the 24 hour pharmacy!
You can do this ladies! I hope these tips help you feel more prepared and less stressed out.
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ok all, I am two days out and doing great (minimal discomfort - the bruising I can see beneath the steri-strips looks awful, but is not painful at all).
One tip I forgot to add- make sure to take a shower, bath, do your hair, whatever bath/beauty routine you like right before you go for your biopsy. You won’t be able to take a shower or get the site wet for some time afterwards (24 hours for me) or take a bath or swim (5 days for me). I just had my first shower after the biopsies and feel sooooo much better about everything!
Good luck to all
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hello alll ,, I am Arsen,, new member
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Great summary and tips, would have loved this before my biopsy. One thing I will mention is that I have neck problems and regularly take Aleve. They wanted me off it for 7 days before biopsy and no way was I waiting that long. I took my chances and ended up with a large hematoma. It didn't hurt too bad but was ugly for quite some time
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hi arsen, your message was very short, so maybe it got cut off? Let us know how you are and what’s going on for your you
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Thank you so much for this. I don’t have the EMLA - dangit- but have an Ativan I get to take after I sign consent. I am also taking Tylenol when I wake (not Ibuprofen), as the nurse said it would be ok.
Mine is tomorrow morning and my knees are almost shaking already. I’m so anxious. Sucks so bad
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I had my stereotactic biopsy this morning. We arrived 45 min early so that I could give consent and take an Ativan. Well I didn't get called back until 8:15, a full hour after we arrived. That's because as I was sitting there I saw my physician walk in at 8:04. I finally get back there, they give me warm blankets in a nice lazy boy and I sign consent. I take the Ativan and do stomach breathing and hand wringing until the Ativan kicks in. I also count how many images (10) are in a row on their curtain over and over, and recite the Lords Prayer about four times. Check Instagram for posts to make me laugh (mostly cats and dogs).
Then I walk across the hall to the procedure room. Very nice technicians, three, get me up into the machine and I lay face down with my breast in that hole. I got as comfortable as I could and really there were nice soft pieces for where my chest/chin laid and where my hips laid. I got to keep my left arm up by my face and my right arm stayed down by my side. I got a good chuckle to myself that this setup is like milking a cow.
They positioned my right breast in for the compression and tightened it up. Again hands are pulling the boob down and into the compression (ever feel like thy are utters, anyone?). This doesn't bother me at all (I nursed 2 babies for a year each, also just started my period today, and mammograms have never hurt me). The lidocaine was like at the dentist- just stung a bit. She went further in and I could feel a bit more of the needle but it wasn't that bad. Then they painlessly cut a slit in my skin so the needle could be placed. I truly don't think I felt the needle going in. When it started to sample a bit, I said ouch and they applied more lidocaine. Towards the end of the sampling I said ouch again and they stopped and applied more lidocaine. It didn't take but 5 or 10 minutes between actual cutting of my skin to the last sample. Best of all was the helpful tech who let me squeeze her hand and talked me through all of it.
I found having a good layer of chapstick on, comfy yoga paints and socks and sneakers was helpful.
Be firm but demanding with your needs. I didn't advocate for myself until well after I had kids. It was natural to advocate for them. I have no problem explaining the reasons I have for anxiety - familial genetics, and actual anxiety-invoking traumatic events- and I told the whole team what I need and why.
If you are knees-knocking anxious as I am, I probably would get a nighttime Ativan. I had a long rough night last night and a good cry with my husband who never panics and was reassuring.Then I felt some better and settled down for bed after a lot of tossing and turning.
Overall, if like me you are cruising every site to find info on stereotactic biopsy, feel better knowing that I felt very little discomfort (not a 10 on the scale) and the pain was handled within a second. They actually left the room to get me more lidocaine and didn't budge the needle until more was in place. I was not in pain waiting for more lidocaine.
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