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Aug 13, 2020 11:22AM
From October 2020 to the Present-STILL NO ANSWERS (so sorry...long post)
Hello...newby here. I have been on a roller coaster ride since October and still have no answers. Wanna ride with me? Summary of all the bumps below:
Summary of Mammary Concerns:
04/0 6/2019-Blunt trauma to chest with seat belt/airbag. (car accident) 4 fx ribs and dark purple, swollen, "hard as a rock" rt breast. Over time the bruises cleared and the hardness went away except for one lump. In October of 2019, I had a breast exam performed by Dr. Gray who ordered a Mammogram and Ultrasound. (She told me that she did not think the area was of serious concern, so she ordered a Screening Mammogram.) However, when I attempted to schedule this an order was obtained from my PCP for a Diagnostic Mammogram and Ultrasound.
1. Right breast 10:00 4 cm from the nipple 2 cm hypoechoic shadowing region corresponding to that seen mammographically. This may represent sequelae from the patient's recent traumatic event, however, ultrasound guided core biopsy is recommended for definitive tissue diagnosis.
2. Palpable region of concern right 4:00 breast corresponds to a 1.3 cm heterogeneous hypoechoic oblong structure region suggestive of a resolving hematoma. Recommend a 3-4 month follow-up ultrasound to ensure stability. At that time, the other hypoechoic structures in the right breast should also be reassessed likely representing developing oil cysts/complicated cyst.
3. No definite suspicious sonographic findings in the scanned left retroareolar breast. Recommend left routine mammography in one year unless clinical symptoms dictate otherwise.
RECOMMEND: Ultrasound-guided core biopsy right breast 10:00
10/28/2019-Biopsy Report- Granulomatous inflammation and fibrosis. No malignancy seen. BI-RADS Category 3 Probably Benign Finding
04/20/2020-Irregular mass corresponding to a previous benign biopsy site, may be concordant with Granulomatous Mastitis, lobular carcinoma cannot be excluded.
04/29/2020-Breast Surgical Consult: Dr-didn't believe it is Granulomatous Mastitis, didn't believe another biopsy was necessary, said there isn't anything on the Ultrasound of 04/20 that she is "worried about" but suggested an MRI to get a closer look at a "dark" area on the Ultrasound. She said she didn't see that there was "blood flow" in that area, "which is a good thing." (her words)
The MRI was done on 05/14/2020
05/20/2020- Breast Surgeon Dr. called me to discuss the MRI. Now she is saying possibly Granulomatous Mastitis, there might be activity indicating "blood flow". (I have absolutely NO SYMTOMS of Granulomatous Mastitis)
MRI Report: Summary/Impression
There is no axillary or internal mammary lymphadenopathy on either side. There is no skin thickening or tethering and the nipples are not inverted.
IMPRESSION: 3 areas in the right breast with suspicious imaging characteristics. Unfortunately differentiating carcinoma from fat necrosis cannot be made based on MR imaging as their appearances can be indistinguishable.
BI-RADS Category 4 suspicious findings.
She STRONGLY recommends an MRI Guided Biopsy. I told her I needed to think about it. She did not like that answer and I felt "pressed" to schedule it. I told her I was not sure and wanted to think about it. She said she didn't want her staff to waste hours of time to get this all arranged and then I decide I don't want to have it done. She said her staff would call me on Friday the 22nd for my decision. When I asked her what she thought this could be, she said she has no idea. I have not heard from her office again.
I have decided NOT to have another MRI, first of all being in the prone position was very uncomfortable for me (pressure on area of fx ribs) and it was difficult for me to breath. If another biopsy is really necessary, I will agree to an Ultrasound Guided Biopsy.
I requested and was granted a 2nd opinion Breast Surgeon of my choice
*To date: I have not seen any change whatsoever in my right breast. I can palpate several "lumps". One of them the first Breast Surgeon consulted has labeled in the diagram on her written report: Fat Necrosis
*Before I obtained the above report, I had asked Breast Surgeon #1 if the "suspicious areas" could be Fat Necrosis and she said emphatically…"oh, no! Not after all this time. (I looked it up and found that after traumatic injury, sometimes Fat Necrosis can become evident a year or more later.) hmm…why, despite her denial, did she label one of them Fat Necrosis???? I will not return to her!
07/23/2020-Consultation with Breast Surgeon #2. She believes this all could be Fat Necrosis, from the trauma but suggests a 2nd Look Ultrasound to try to pin-point the areas of "suspicion" from the MRI with possibly an Ultrasound Guided Biopsy in the future depending on the results of the Ultrasound. Sounded like a reasonable plan.
08/10/2020-2nd Look Ultrasound done. The radiologist said the Ultrasound was unable to "get close enough" to the 3 suspicious areas seen on the MRI. Her recommendation was to have an MRI-guided Biopsy but to discuss this with the Breast Surgeon on 08/13/2020.