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Old 12-30-2011, 01:54 PM   #136
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Biopsy: If you do have a suspicious mammogram or other imaging test result, your doctor will probably want you to have a biopsy. A biopsy involves taking out some or all of the abnormal-looking tissue for examination by a pathologist (a doctor trained to diagnose cancer from biopsy samples) under a microscope.

When possible, your doctor will usually use one of the quicker, less invasive approaches to biopsy:
Fine needle aspiration biopsy involves inserting a very small, hollow needle into the breast. A sample of cells is removed and examined under the microscope. This method leaves no scars.
Core needle biopsy inserts a larger needle into the breast to remove several cylinder-shaped samples of tissue from the area that looks suspicious. In order to get the core needle through the skin, the surgeon must make a tiny incision. This leaves a very tiny scar that is barely visible after a few weeks.

Here is a little more about that test:

core needle biopsy
Core needle biopsy uses a larger hollow needle than fine needle aspiration does. If you have this type of biopsy, you’ll be lying down. After numbing the breast with local anesthesia, the surgeon or radiologist uses the hollow needle to remove several cylinder-shaped samples of tissue from the suspicious area. In most cases, the needle is inserted about 3 to 6 times so that the doctor can get enough samples. Usually core needle biopsy does not leave a scar.

If the lesion cannot be felt through the skin, the surgeon or radiologist can use an image-guided technique such as ultrasound-guided biopsy or stereotactic needle biopsy. A small metal clip may be inserted into the breast to mark the site of biopsy in case the tissue proves to be cancerous and additional surgery is required. This clip is left inside the breast and is not harmful to the body. If the biopsy leads to more surgery, the clip will be removed at that time.

In addition to offering quick results without significant discomfort and scarring, both fine needle aspiration and core needle biopsy give you the opportunity to discuss treatment options with your doctor before having any surgery. In some cases, needle biopsy can be performed right in the doctor’s office, unless your doctor needs the help of imaging equipment to guide the biopsy. However, needle biopsy has a higher risk of a “false negative” result — a result suggesting that cancer is not present when it really is. This is likely because needle biopsy removes a smaller amount of tissue than surgical biopsy does and may not pick up the cancer cells. Your doctor may recommend a surgical biopsy in follow up to, or instead of, a needle biopsy. Together you can decide what is best for your situation.
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Old 12-30-2011, 01:58 PM   #137
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Thanks, ladies. It helps have someone to talk to. Only dh knows. I don't want to tell my mom and freak her out.

I thought about calling my OB/GYN. I never talked to her, only the nurse. I really don't have any info about anything, other than what I've looked up on the internet. Do you know why they'd order a core biopsy over a fine needle aspiration? I also have to wait until the 13th for the test. My maternity leave is over 2/2. I feel like I'll spend it crying rather than enjoying my time with the baby. I seriously can't stop imagining my children maotherless and the baby having no memory of me. I know it sounds dramatic, but I can't help it.
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Old 12-30-2011, 02:00 PM   #138
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Do you think the core biopsy will affect my breastfeeding? The lump it not near the nipple.
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Old 12-30-2011, 02:20 PM   #139
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I seriously can't stop imagining my children maotherless and the baby having no memory of me. I know it sounds dramatic, but I can't help it.
Don't worry, we know all about those thoughts around here. They stink. (I have to watch my "words" as I got in trouble recently for saying something bad! I normally would have used a different word after they, lol.)

I would see if you could try to get in for a biopsy sooner than that. (Although it's probably good they feel you can wait that long - when I found my lump they were like, "You need a biopsy right away - we have an opening tomorrow!" ) Even if you have to go somewhere else. That is an awful long time to wait and worry. It normally takes a few days to get results back as well, and if it's over a weekend, the waiting is excruciating.

I think the core and fine needle are basically the same, mainly different size needles. They take out several tissue samples to examine under a microscope looking for signs of abnormality in the cells. It's important to get enough tissue to sample, so they take it from several areas. Sometimes they take out the whole lump to examine it (excisional biopsy). All of my biopies have been needle core (3).

I believe the biggest issue for breastfeeding after the biopsy will be discomfort to you (This is where Ann usually chimes in about using a bag of frozen peas for pain relief!) but they will let you know. I can't remember if they inject lidocaine into the breast before the biopsy but that might be an issue if they do. Your team will let you know. It might be a pump and dump situation for a day or two if that were the case.
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Old 12-30-2011, 02:23 PM   #140
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I do not know if the biopsy will affect breastfeeding. Can you put in a call to the pediatrician. The timing is unfortunate with the whole New Year's eve thing this weekend, but I would speak to a doctor on call at the very least. Not sure if the pediatrician or the OBGYN would be the best doctor, I am kind of pushy, I would probably call both.
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Old 12-30-2011, 02:32 PM   #141
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Comparison of the two types of needle biopsies from the Mayo center website. Notice that is suggests at the end of the first paragraph to ask your doctor to explain why one is being recommended over the other.

There are several breast biopsy procedures used to obtain a tissue sample from the breast. Your doctor may recommend a particular procedure based on the size, location and other characteristics of the breast abnormality. If it's not clear why you're having one type of biopsy instead of another, ask your doctor to explain the reasons in more detail.

Types of breast biopsy include:

Fine-needle aspiration biopsy. This is the simplest type of breast biopsy and may be used to evaluate a lump that can be felt during a clinical breast exam. For the procedure, you lie on a table. While steadying the lump with one hand, your doctor uses the other hand to direct a very fine needle — one more slender than that used to obtain a blood sample — into the lump. The needle is attached to a syringe that can collect a sample of cells or fluid from the lump. Fine-needle aspiration is a quick method to distinguish between a fluid-filled cyst and a solid mass and, possibly, to avoid a more invasive biopsy procedure. If, however, no fluid can be withdrawn and the mass doesn't resolve on its own, you may need further evaluation with a diagnostic mammogram or ultrasound or surgery to remove it.
Core needle biopsy. This type of breast biopsy may be used to assess a breast lump that's visible on a mammogram or ultrasound or that your doctor feels (palpates) during a clinical breast exam. A radiologist or surgeon uses a thin, hollow needle — but not quite as thin as the needle used in fine-needle aspiration — to remove tissue samples from the breast mass. Several samples, each about the size of a grain of rice, are collected and analyzed to identify features indicating the presence of disease. Imaging techniques, such as mammography, ultrasound or MRI, are often used to guide the positioning of the needle used in a core needle biopsy.
Stereotactic biopsy. This type of biopsy uses mammograms to pinpoint the location of suspicious areas within the breast. For this procedure, you generally lie facedown on a padded biopsy table with one of your breasts positioned in a hole in the table. You may need to remain in this position for 30 minutes to one hour. The table is raised several feet. The equipment used by the radiologist is positioned beneath the table. Your breast is firmly compressed between two plates while mammograms are taken to show the radiologist the exact location of the area for biopsy. A small incision — about 1/4-inch long (about 6 millimeters) — is made into your breast. The radiologist inserts either a needle or a vacuum-powered probe and removes several samples of tissue. The samples are sent to a laboratory for analysis.
Ultrasound-guided core needle biopsy. This type of core needle biopsy involves ultrasound — an imaging method that uses high-frequency sound waves to produce precise images of structures within your body. During this procedure, you lie on your back on an ultrasound table. Using ultrasound, the radiologist locates the mass within your breast, makes a small incision to insert the needle and takes several core samples of tissue to be sent to a laboratory for analysis.
MRI-guided core needle biopsy. This type of core needle biopsy is done under guidance of MRI — an imaging technique that captures multiple cross-sectional images of your breast and combines them, using a computer, to generate detailed, 3-D pictures. During this procedure you lie facedown on a padded scanning table. Your breasts fit into a hollow depression in the table. The MRI machine provides images that help determine the exact location for the biopsy. A small incision of about 1/4-inch long (about 6 millimeters) is made to allow the core needle to be inserted. Several samples of tissue are taken and sent to a laboratory for analysis.
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Old 12-30-2011, 02:38 PM   #142
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I found a couple of articles for you, paintnolish, that I think you'll find helpful.

http://www.mothering.com/community/t...-breastfeeding

http://www.lalecheleague.org/llleade...jan03p136.html

I never heard of a lactating adenoma before. Hey, you learn something every day.

http://breast-cancer.ca/type/lactating-adenoma.htm
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Old 12-30-2011, 04:42 PM   #143
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I also learned new stuff today, thanks Linda for posting those links.
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Old 12-30-2011, 05:06 PM   #144
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excuse the lowercase. holding the baby.
i called the place where i had the tests. at first the recptionist was not helpful. she said they could not discuss results when i asked what it was about the mammo that warranted biopsy. she also said there were no sooner openings for the test. i was crying and told her i did not know how i would make it until the 13th, which btw us fri. the 13th. she said the tech from yesterday would call.
the tech said the mammo couldn't definitively rule out anything and the only sure way would be to do a biopsy. in fancy terminology she said the mammo showed that part of the nodule appeared cyst-like and part appeared solid. it was also oval in shape. she also said they could get me in for the biopsy on tues. and didn't want me worrying any longer than necessary. results will take 1-2 days and the numbing stuff will be out of my body in 4-6 hours so not to nurse then. she didn't know if i had to pump and dump. i think i'll call the lactation consultant at the hospital.
thanks for the advice and ifo, ladies. it is good to see that 80% are ok and also to see what it could be besides cancer. without you i probably would not have called and would be waiting for the 13th.
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Old 12-30-2011, 05:12 PM   #145
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excuse the lowercase. holding the baby.
i called the place where i had the tests. at first the recptionist was not helpful. she said they could not discuss results when i asked what it was about the mammo that warranted biopsy. she also said there were no sooner openings for the test. i was crying and told her i did not know how i would make it until the 13th, which btw us fri. the 13th. she said the tech from yesterday would call.
the tech said the mammo couldn't definitively rule out anything and the only sure way would be to do a biopsy. in fancy terminology she said the mammo showed that part of the nodule appeared cyst-like and part appeared solid. it was also oval in shape. she also said they could get me in for the biopsy on tues. and didn't want me worrying any longer than necessary. results will take 1-2 days and the numbing stuff will be out of my body in 4-6 hours so not to nurse then. she didn't know if i had to pump and dump. i think i'll call the lactation consultant at the hospital.
thanks for the advice and ifo, ladies. it is good to see that 80% are ok and also to see what it could be besides cancer. without you i probably would not have called and would be waiting for the 13th.
Yay for Tuesday! And oval is great. Cancers are not nicely oval shaped, they're irregular and ugly. I had a nice jelly bean shaped spot early on that I wanted biopsied (rather than waiting and worrying for 6 months which was the recommendation). It came back as a benign fibroadenoma. (And later I developed cancer in a different spot.) I would hold on to those good thoughts!
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Old 12-30-2011, 05:39 PM   #146
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Benign Fibroadenoma - oval



Cancer - irregular



Microcalcifications/DCIS - speckled

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Old 12-30-2011, 05:44 PM   #147
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Glad you got moved to Tuesday! It pays to insist, and tears don't hurt either. Really that was way too long to wait.

Kiss that babino for us!
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Old 12-30-2011, 10:44 PM   #148
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Thanks again, ladies. You've helped me become a little more informed and that has mad me feel better. I haven't cried in the last few hours and spent time watching tv with older ds while holding the baby. I also busted out the pump and pumped a few ounces. The baby hasn't had a bottle yet, so I need to ready him for Tuesday.
Dh is going with to the biopsy on Tuesday and I have a friend watching the kids. Dh is really bad around needles and blood, but if he passes out or vomits it will at least provide comic relief!
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Old 12-30-2011, 11:53 PM   #149
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Boy, that MRI was helpful in your decision making, huh? That's good!

If you look back to page 5 here, someone else asked about mastectomies and got answers there. Ask if you have more specific questions. Also www.breastcancer.org and www.susanlove.org are good informational websites.

Are you by any chance on Fantasy in April? I might say postpone but I know how much prices have jumped up. Is it just your immediate family or are you going with a group? That's a tough one. We still don't know if you'll be doing chemo yet, do we? If you are, that will be in the midst of that, and in that case I might wait until I was feeling better. If no chemo, then maybe. There can often be little annoying problems that crop up after any surgery that might make it difficult to be out of the country and such, though. Tough choice.
I will take a look at page 5, thank you. I started reading up on breastcancer.org last night and was getting a little wigged out so I stopped. My cruise is on one of the Norwegian Cruiseline ships to the Western Carribean. I have been told I won't need radiation but nobody has mentioned either way about chemo. This leads to my other question. Do they wait to analyze the tissue that is removed before making that decision? My hunch tells me that is the case in which case I could find out after the surgery that there is more work to be done.

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Mer mom, thanks for the update. I am glad you will be able to just worry about one side, not two.

As for the mastectomy, it takes several months for the wound to heal, especially with reconstruction. The main area of pain as far as the breast goes, is the underarm area if nodes are removed, which dissipates over time. You will have exercises to do to make sure you regain mobility in the arm.

What kind of reconstruction are you thinking about, tissue transfer of implants? That would change how I would look at this, IF you are not facing chemo.

Tissue transfer is big surgery, actually much more involved than the mastectomy, as you have multiple incisions, could have three if you have the unaffected breast lifted or reduced.

I went nowhere for a month after the free tram flap done two years post mastectomy. And I healed real well. Biggest problem was the stomach incision, hurt a good bit even with the binder to give it support. Three months is longer but I think a six month interval would be preferable.

That is a big decision and one I would address to both of your doctors. My reconstruction was five years ago, and I am sure there have been improvements in flap surgery if that is the way you are going. The Diep method is especially said to be easier to recoup from since the muscle in the abdomen is not cut in that procedure. There was no one in my location who was doing DiEPs in 2006.

I would definitely discuss as I am sure you intend to your planned trip with both surgeons and get their input.

You may not have the pathology from the mastectomy back before your final payment on the cruise. Do you think you could request more time from the cruise line, due to the circumstances, or are there deadlines set in stone?

Worth an inquiry.

I did not have chemo so can't add much to discussion on whether you would be ready for a cruise three months after embarking on chemo. Heck, I do no know how long chemo treatment takes, but I know that varies greatly, and can be drawn out if you have a reaction.

Breastcancer.org is an excellent resource.

Glad your daughter took things so well. It is wonderful that she will have someone to talk about your diagnosis with. Be sure she understands that each case is different, and how much results vary from one woman to another.

Would love for you to keep us updated.
I have a choice of implants or a tissue transplant. I am strongly considering a tissue transplant but understand the recovery is much more difficult. It is helpful to hear from someone who actually has been through it. When all this is done, will my clothes still fit or will they fit differently? Will I still have feeling in the reconstructed breast? I meet with the plastic surgeon in mid-January. I keep wondering how I won't end up lopsided if he doesn't do work on both sides. I have visions of one girl looking new and perky and the other looking 51 and, well............not perky. I know these are vain questions and I am supposed to focus on my health but I don't want to end up deformed looking. I know, that probably sounds bad in the big scheme of things.

I did suggest to my husband that we explain to the cruiseline what is going on. In fact, I think I took out travel insurance. I should probably check. We already have purchased airline tickets, as well, and will have to talk to the airline to see about a refund. If they won't refund, we do have a timeshare in Kissimmee and perhaps a vacation lounging around the pool would be workable. I don't know. At least it wouldn't be as active as a cruise. My gut is telling me we may just want to put this off until school is out and we can rebook then when things are getting back (hopefully) to normal.

The people on this thread are truly helpful. Thank you for being there.

Paintnolish - I am so sorry to read what you are going through. I can't even imagine going through any of this with a new baby.
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Old 12-31-2011, 12:36 AM   #150
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Paintnolish, I doubt your husband would be allowed into the room where you have the biopsy. But it is good for him to be with you beforehand in the waiting room, and then afterwards when you are done with the procedure. I think it was good thinking to start with the bottle. Were you able to reach the lactation specialist?

Mermom, the size of the invasive component of your tumor (if any) and whether or not there is any cancer detected in lymph nodes will help the doctors know if you need chemo. Radiation more depends on whether there are clean margins found.

As far as clothes fitting, my experience was different in that my reconstruction was delayed two years. I had to wait for a few months to be fitted with a prothesis since I needed a large one to match the unaffected side, and my incision had to heal before it could handle the weight. So I used a light weight form that really looked fake, along with some soft shoulder pads from shirts I used to wear years ago. With reconstruction they give you a soft bra that has velcro that you tuck bandages in until it heals. After healing you can get a real bra. You can discuss size with the plastic surgeon.

I imagine usually the unaffected side gets the lift and reduction for women of a certain age. It really helps for fitting bras and being symmetrical. I saw three plastic surgeons and all three recommended the work on the unaffected side. I don't think it is a vain thing, it is important for your back, neck and shoulders, and your overall posture for that matter for you to be balanced.

My mom was 78 when she was diagnosed in 2008, at that age only the implant was recommended. She opted not to have the unaffected side worked on when she had her mastectomy and immediate reconstruction to reduce the amount of surgery. I think she would have been better off having the other side modified back then as well. She never has had the saline implant traded off for the permanent silicone one, and at this point I doubt she will. Probably isn't the wisest path for her to have anesthesia now unless medically necessary, since she has been having other health issues for awhile.

I wish i could offer you more feedback on taking the cruise. It might be fine, you never know. It really depends on how your body deals with this much surgery, and if you have any complications. Although it is major surgery, it isn't like heart surgery, or lung surgery, no vital organs are involved. But infections do occur.

The critical time for flap surgery is during the first day or two when the blood supply to the flap is being established. Once that blood flow is robust, you are past worrying about losing the flap. The stomach will hurt, they will give lots of pain meds, but the healing takes time. The drains are a bit of pain to deal with, and when they are removed you will start feeling like yourself again. I needed my husband with me 24/7 for 8 days. After that I started enjoying my independence again.

There are a couple of steps with the reconstruction, so it is an ongoing process. Expect to see the plastic surgeon for about a year, if you want all the trimmings so to speak. Feel free to pm me if you need more info on some of this. My plastic surgeon had a book of pictures of patients with result from both the tissue flap and implant surgery, before surgery, about 1 month out, and then further on down the line. I found that helpful.

No, you will not have any feeling in the reconstructed breast. A mastectomy requires the cutting of the nerves, so while their is no feeling, there is also no pain. There is numbness under the arm where the nodes are removed, and I have numbness in my stomach where the flap was removed.

It is not pins and needles numbness, however, so not bothersome.
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