Oct 10, 2017 03:19PM - edited Oct 10, 2017 03:42PM by leaf
When they did a core biopsy and found LCIS, there was some reason why they did that. Normally it was because there was something seen on a mammogram (such as microcalcifications), but they may have seen something on ultrasound or MRI or felt a lump.
As with almost everything else with LCIS, this too is controversial. But it seems like they've somewhat settled down to: they compare the imaging (or tactile feel of a lump) with the LCIS-revealing core biopsy. If there is ANY difference between the location found on imaging and the core biopsy location, they do an excision. Other people just recommend an excision in any event after they've found LCIS on a core biopsy.
What they do is they excise the area around the core biopsy. If the abnormality was seen on a mammogram, they often 'bracket' the lesion. They insert brackets (like fish hooks) into the breast to locate the lesion/core biopsy area. This is because obviously they can't do a mammogram while the surgeon is doing surgery. Then the surgeon excises the area between the brackets. I assume they would also do this if the lesion was found on MRI. (Since my lesion was seen on MRI in Aug 2017 showed ALH bordering on LCIS, I may be having a surgical excision in the next many months.)
I've never had an ultrasound excision, but I assume you could do that on the operating table (but I'm not sure).
On my initial LCIS diagnosis, my abnormal mammogram (due to microcalcifications) was done in late October, they tried to do an ultrasound biopsy in late November but couldn't see anything, they did a stereotactic mammogram core biopsy in early December, and I had the area excised in late January. If you look at studies, they differ with the study, but if the imaging and core biopsy locations do not match, about 20% of the time when they surgically excise the area they find DCIS or invasive cancer.
They took about 2 tablespoonfulls of tissue in my excision. (I have a B cup.) Its the decision of the breast surgeon how much to take. I did have a 'dent' for a few years, but it completely filled in over time, and by about 2 or 3 years, it was REALLY hard to see exactly where they did the excision. Your experience may differ; I've not seen any other women with breast excisions so I don't know what the 'average' dent or scar is like.
I had conscious sedation (midazolam (Versed) and propofol for my surgical excision, and once an anesthesiologist was involved (immediately before the surgical excision, after the brackets were inserted), it was totally fine (NO PAIN). This means that while sometimes I was conscious, I did NOT feel any pain. When I said 'Ohhhh', not in pain but more like asking what was going on, they gave me another slug of propofol, which put me out again.
However, before the excision, when they were inserting the brackets, I had a miserable time (pain 9/10 because I'm sure if they were pulling off my arm it would be more painful at 10/10), because they wouldn't let an RN be present so I couldn't have any opiate or anything by mouth because they were going to do surgery for the excision. Before they started the bracket insertion, they said I had to promise that I 'would not move a muscle' during the procedure. They did about 3 seconds with the equivalent of an ice cube, then inserted the bracket. It hurt so much, but I knew if I cried I would move, and would have to repeat the process. So I couldn't communicate with them how much it hurt. They saw my face and gave an injection of local lidocaine, which hurt as much as the bracket insertion, and didn't do a thing, then they hit the wrong place several times (you have several constant mammograms to make sure the bracket was at the calcifications), so had to pull out the fishhook brackets several times. Then, someone knocked at the door and asked if they could come in (I said yes because I didn't know what else to say), no one identified themselves, and about a dozen pair of feet walked in. (The room was adjoining the waiting room, so I had no idea if it was a family member of a patient who was looking for a bathroom.) I was dripping blood, and one person asked if I was in pain. Again, I knew if I said I was in pain I would cry, and if I cried I would move. There was the other issue of modesty since of course I was naked and had no idea who kept on entering and leaving the room; no one identified themselves. (I also work at that hospital, so some of these people could have known me professionally.) As one male co-worker later suggested, I felt like I was on display. I was so grateful for his understanding. (He is from a minority group, so I'm sure he understands being marginalized.) That understanding was healing for me. I wrote 2 letters to the radiologist, complete with Pubmed references and stories from bc.org on people who passed out during their procedure, or refused to get any mammograms for the next 10 years and subsequently got bc. That radiologist gave me a reply that 'he'd have to give sodium bicarbonate to everyone'. No apology. Sodium bicarbonate is 'supposed' to increase the effect of the lidocaine, but I've seen Pubmed papers that refute that. In any case, whatever he did did NOT NOT NOT NOT work for me.
I'm not sure how long the bracket insertion took, but it felt like about 1.5 hours. (I stole my mammograms, so I'm roughly estimating from the times listed on them. Now they do it all digitally, so you don't have to carry your mammograms around.) You are squished by the mammogram machine for about 90% of that time, not just momentarily as they do for routine mammograms.
I have a history of trauma, so I'm sure that upped my pain score a LOT. I did a survey here in about 2006, and most people rated their bracket insertion pain as a pain score of about 5/10 (not 9/10). When I had my last MRI-guided biopsy early last month (where obviously they inserted a needle to get the breast tissue), my pain score was more like 3/10.
Hope this helps,