Friends, countrymen, lend me your boobs [biopsy]

November 26, 2023 4:43 PM

I need clear information on the breast biopsy [stereo something] process/procedure.

I'm getting one for micro-calcification or calcification (not sure which) this week.
All I understand is that this is the 21st century and they're going to cut into me. Not happy.

I do much better when I know exactly what is going to happen and in what order. I joined an online group but all they do is dance around the question, i.e.,"hope you feel better" "sending you energy" I'm opposed to none of these, but need much less nebulousness and ambigiousness.

am also concerned about the pain, although I understand they're going to inject me with numbing solution (and my GP has given me some sort of benzo). Th apin worries me -- this most recent one itself hurt like the dickens (Not talking about "being uncomfortable" and it never hurt like that before (I've had lots of them).

So, tell me like I'm five, and please don't omit any steps. Also, procedure is Wed afternoon. Should I plan on taking Thursday off?

posted by Rumi'sLeftSock to Health & Fitness (15 answers total)

Good news; this is actually not too arduous a process.

You disrobe, put the little nipple stickers on, sit at a mammography machine; they inject a numbing agent into the breast, take some readings to locate the calcifications, extract a small sample, take another few readings, put a marker into the biopsy bed for future reference (no, you won't set off a metal detector), pop a little bandage on it, give you a wee ice pack to tuck into your bra, you're done. You'll probably spend more time waiting than in the procedure.

You shouldn't feel anything during, except if they need to flatten non-numbed tissue to get the reading (no different than the diagnostic mammo you presumably had to get this ordered). Afterwards, a little to some soreness and bruising. You should be fine to work the next day.

Try to get clarity on when they will call you with the results. There seems to be a concerted effort at more high-end places to get the results within 2 business days, but I bet a week or more is still common.

Honestly, the waiting for the results is more painful than the procedure, by at least an order of magnitude. But...for the minority of microcalcifications that are actually problematic, the vast majority of those are ductal carcinoma in situ ("stage 0"), which is rarely treated with chemo or radiation now and in ten years or so they may not even be doing lumpectomies for (long-term trials underway comparing monitoring and surgery outcomes), so unclear is it whether it actually needs to be treated as cancer. There's a certain segment of the population that has a kind of breast cancer hysteria; try not to get caught up in that, especially at this point.
posted by praemunire at 5:06 PM on November 26, 2023 [7 favorites]

If it’s a stereotactic biopsy I had one, and I had a separate core needle one too. The stereotactic one is like having a long mammogram with a bonus needle. I didn’t feel the needle but the compression part was as uncomfortable as the original mammogram.

For both, the ice pack was good and I was really sore for maybe 24 hours and sore for a couple of days - longer than I thought I would be, but perfectly manageable with just over the counter pain meds.

For mine I wouldn’t have characterized it as “cutting in” - more like a worse version of the Covid shot.

I had a longish scare (see two biopsies, above) and I am under fairly strict follow up but all was very well.
posted by warriorqueen at 5:12 PM on November 26, 2023 [3 favorites]

University of California, San Francisco: Stereotactic (Mammogram-Guided) Breast Biopsy -- slight alternate to the first response, but may apply depending on the area of your breast being biopsied:

"Biopsy is defined as small amount of tissue that is removed from the breast to be studied under the microscope. During the biopsy, the patient will be lying on their belly with the breast positioned through the table. You will feel pressure and possibly mild pain, but if you feel severe or sharp pain let your doctor know. The table will be elevated so the radiologist will work on your breast beneath the table. Mammography images will identify the target area in the breast. They will insert biopsy needle at the target area, while taking multiple images to ensure the needle is on the right track. They will place a marker at the site as it is important to know the location of biopsy if any further intervention is needed."

This is an excerpt at the UCSF page; if you click on this link there's also a 3.5 minute video showing a patient meeting their doctor, signing paperwork, being positioned on the exam table, with the doctor kneeling at the table and the radiologist at a monitoring screen; at 0.16 and 2.08 there are non-gory computer animations of a breast biopsy.

(If you can take Thursday off without great penalty, I think you should; rest up and use an ice pack if you're sore. Best wishes, OP.)
posted by Iris Gambol at 5:13 PM on November 26, 2023 [2 favorites]

Yes, sometimes the positioning of the patient can vary. Should've said that. Honestly, lying down might be easier, just in terms of keeping still.
posted by praemunire at 5:19 PM on November 26, 2023

This really depends on several things, including how much tissue they take, where on your breast it is, & how deeply they need to cut. I had this done a few months ago and I wish I'd been better prepared for how much recovery and self-care I needed. For example I had to send my partner to the drugstore that night to get supplies I wished I'd known to have -- wound closure strips and gauze. I had to put sanitary pads inside my bra for 2 days because I was bleeding quite a bit more heavily than I thought I would. I was very bruised and sore.
The biopsy itself isn't painful after the first needle that goes in to anesthetize you -- and that's pretty much on par with getting novocain at the dentist.
Good luck! Benign wishes.
posted by ojocaliente at 5:23 PM on November 26, 2023 [1 favorite]

Response by poster: I don't know why this bothers me so much, after all I had numbing needles stuck IN MY EYE last summer for the retina procedure. Also that was a very annoying doctor. It just really helps me if I know ahead of time, no surprises, and I'm grateful for your replies.
posted by Rumi'sLeftSock at 5:24 PM on November 26, 2023 [1 favorite]

Just be *sure* they wait at LEAST five minutes before the needle biopsy. I had one a couple of years ago, and they didn’t wait long enough - I literally passed out from the pain.
I don’t say this to scare you, but because there are a) busy clinics, and b) insensitive and/or new doctors, both of which can contribute to rushing the procedure.
The aftercare wasn’t bad for me (get an extra wee ice pack if you can), but that really varies depending on the site of the calcification.
posted by dbmcd at 5:30 PM on November 26, 2023

I had one of these recently. You take off your shirt and bra and they give you a little robe. Then you lie facedown on a table with a hole in it. The boob in question goes through the hole and kinda hangs down. The other boob is squished uncomfortably on the table (I have large boobs), and I had to sort of hold it to keep it smooshing though the hole too. They tried to keep the rest of the robe over my back, presumably so I wasn’t cold. Then they elevate the whole table and the doctor goes underneath and does their thing, which fortunately you can’t see. The numbing agent hurt only a little - less then novocaine. The biopsy didn’t hurt, but I did feel this weird sort of pulling sensation when they vacuumed bits out. They place the chip, bandage you up, and do a follow up mammogram to make sure the chip was placed ok. Boob was sore and bruised, but I bruise easily, so…As others have stated, the worst part by far was waiting for the results. Mine was fine, and I hope yours is too.
posted by les34 at 5:30 PM on November 26, 2023

Just to mention, sometimes you lie down, sometimes not. Positioning depends on various things. I was sitting up, with both feet on the floor, and the surgeon and nurses knelt beside me. The positioning aspect was exactly like a mammogram but seated.
posted by ojocaliente at 5:37 PM on November 26, 2023 [1 favorite]

Also!! make sure you have a wireless sports type bra, and not too loose.
posted by ojocaliente at 6:02 PM on November 26, 2023

I don't know why this bothers me so much, after all I had numbing needles stuck IN MY EYE last summer for the retina procedure.

I had a stereotactic core biopsy done in October, and I read a lot of descriptions in advance, and I watched a lot of videos, and the idea of it filled me with sheer body horror. Something about being hoisted up like a car at the mechanic's, with your boob in a hole? Or about having your boob squeezed WHILE stabbed?

Ultimately, though, it was totally easy and fine. I didn't even have to remove my pants and socks/shoes for the procedure, which was kind of weird/comforting, and I wished I known that would be the case, in advance. The only pain I felt at all was from the initial numbing shots. After the shots, it took about 6 minutes total for them to extract the sample, then check that they'd gotten all the calcifications (which they could do using a fancy camera in the exam room, which may not be terribly common – it was brand new, and they were excited about how much faster it made everything go), and then insert the chip and bandage me up. *All* of that took 6 minutes.

It was easy to get home because my boob was still numb. After I got home, I rotated out bags of frozen peas in my jogging bra, and I alternated advil/tylenol (mostly out of paranoia), and there was no pain whatsoever. I did realize that I was allergic to the adhesive used in the bandage covering the biopsy site, so that was annoying and itchy. Also, they kind of make it sound like the bandage is needed for structural reasons (so the wound doesn't gape), so I was worried about removing it, but it turned out that the puncture was actually quite small (like 4mm by 1mm), and gaping wasn't an issue.
posted by unknowncommand at 7:05 PM on November 26, 2023 [1 favorite]

Oh, they also did a "gentle" mammogram immediately after I got off the table, to check placement of the chip. That involved going to a different room, and the mammogram was easy and didn't hurt either (because they don't have to squeeze you as much as usual, but also my boob was still numb).
posted by unknowncommand at 7:16 PM on November 26, 2023

Yeah I had this done a couple years ago and concur with the above - it's mildly annoying and uncomfortable but not at all excruciating, and I was sore for about two days but the level of soreness of a pretty solid bruise. If I hadn't been working at a job that required me to carry big boxes against my chest, I wouldn't have noticed much at all.
posted by restless_nomad at 5:54 AM on November 27, 2023

Mods can take this down if it's not appropriate here, but all women might like to know about this test for radiation therapy decisions for stage zero (in situ) breast cancer/dcis. I think this should be a known part of womens health care.
posted by ojocaliente at 7:32 AM on November 27, 2023

I had this done as well, but I sat upright at a mammogram machine. There was no pain past the initial jab of the anesthetic. If you get to sit up, prepare yourself to see blood when you’re finished. There was blood on the plastic mammogram parts and blood on the side of my face. (Made me feel like a badass.)

I did not take the next day off because I work from home. The soreness was tolerable but my breast looked pretty gnarly for a week because I bruise easily and because my skin was irritated by the bandage adhesive.

Fingers crossed for no significant findings.
posted by kimberussell at 4:37 PM on November 27, 2023