Supporting women whose lives have been touched by breast cancer

Day-case guide wire excision with sentinel node biopsy

By bl

The letter from the hospital’s Day Surgery Unit told me to arrive at 2.00 pm for my surgery. It explained that my surgery may not be until later in the afternoon. I was told not to eat or drink anything for 6 hours before the appointment. I had pre-op assessment and a sentinel node scan the day before, which was when the dye for the sentinel node biopsy was injected. I had already been told that the surgeon would use a probe to locate the sentinel node and he would inject a blue dye into the breast tissue that would stain the skin for several weeks.

At 9.30 am on the morning of my operation I received a call from the new cancer wing of the hospital. Apparently I should have received a letter from them telling me to be at the hospital at 9.00 am for the guide wire to be inserted. They said it was not the first time this had happened and they would have to telephone patients in future to ensure they received their notification in time. I had planned a busy morning to keep my mind off the impending surgery, but said I could be there in half an hour; they suggested I bring everything with me as it would be better to remain in the hospital with the guide wire in place and they would contact the Day Surgery Unit to let them know I would be arriving early.

My husband dropped me off at the door; we could see people queuing for parking spaces and it seemed pointless for him to come in with me when he would only be sitting around outside in the waiting room, so I told him to go home. I knew he would only get restless and stressed and I felt I could do without that.

After booking in at reception I had to wait a couple of minutes until the radiographer came to take me through. I was told to take off all my clothes above the waist and put the gown on with the opening at the front, after which I was taken through to the ultrasound room. The radiologist was the same one who had carried out the biopsy the previous week and explained it would be a similar experience for me, the only difference being that instead of taking a sample they were putting the wire in. The lesion was located by ultrasound and a local anaesthetic injected into my breast. There was the usual sharp scratch and a mild stinging sensation as the anaesthetic went in. I was asked if I could feel anything sharp, which I couldn’t, and the wire was inserted. I didn’t feel the wire being put into place. They explained that the wire had a hook on it and should be quite securely held in place, but just to be careful not to ‘yank’ on it. (Did they really think I was going to mess around with it?). I was surprised by the length of wire that was left outside my breast, but this was coiled up and a dressing put over it. I then had to have a mammogram to ensure it was in the right place.

For most people this would have been quite straightforward, but unfortunately for me, the mammogram detected a second suspicious lesion in another area of the breast (invasive lobular cancer does not create lumps at first and the change in cells is called a lesion) not too far away from the guide wire. I had to go back to the ultrasound for the radiologist to confirm that the wire was in the right place and in the area that had been biopsied. The new lesion did not show up on the ultrasound, but was definitely on the mammogram so it was decided to insert another guide wire into the new area under mammogram this time. They explained that because the mammogram takes two-dimensional pictures the second area could have been thought to be part of the first lesion on the original mammogram results, but with the guide wire inserted they could see quite clearly the two different areas.

Because of the location of the second lesion (very low and close to the edge of the breast) it was impossible to insert the guide wire standing up, so I was taken to another mammogram machine where I had to lie on my right side on a wheelchair with the back support flat and the leg supports in place and was literally wheeled in to the mammogram and my right breast put into position. The radiographer had to crawl on all fours underneath the mammogram to administer the local anaesthetic. It took 2 injections before the area was numb and then the guide wire was inserted. It took quite a while because of the position of the lesion, but eventually it was in the right place and further mammograms were taken. They told me how patient and tolerant I was, but what’s the point in being anything else? I knew they were only doing their best for me and at that point I did not realise the significance of the second lesion.

Both wires were coiled and taped to my chest and I was told I could get dressed, but it might be best to leave my bra off. There was no way I was going to attempt pulling a tee shirt over my head in case I dislodged the wires, so I decided to leave my hospital gown on and just put my coat on over the top for the walk to the Day Surgery Unit. (I suggest wearing something you can button up if you have to have this done.)

I had to wait while they contacted the consultant and wrote up the report (3 pages). The radiologist came to tell me that the consultant was coming over shortly to go through the mammograms and ultrasound pictures and would see me before surgery. The notes were placed in my folder and one of the radiographers walked with me to the Day Surgery Unit. It was 12.10 pm when we arrived at the Day Surgery Unit. The radiographer handed the receptionist my notes; I was told to take a seat and someone would be out shortly to take me through.

It was 2.10 pm when my name was finally called. Now, I’m quite a relaxed person and very patient, but if I had been stressed or anxious, this wait would have been very difficult. There was another woman with a hospital gown under her coat and she was pacing up and down. I would have gone over to have a chat, but her husband was with her and I didn’t like to interfere. I could see that the morning patients were being discharged and guessed they were making up new beds. Having been awake since 2.00 am I could have done with a nap, but carried on trying to read my book and resting my head on the back of the chair. Patients arriving after me were taken through, but I guessed they were probably scheduled for earlier operations. Eventually it was my turn and I was shown to my cubicle. It consisted of a trolley, an armchair, a bedside locker and was surrounded by curtains. I was told to take everything off and put the hospital gown on with the opening at the front.

The consultant came to see me and advised that the second lesion was most likely another cancer. They grade what they see on mammogram and ultrasound from 1 to 5, the higher the number the greater likelihood of cancer. My first lesion had been a grade 5 and this was a grade 4. Rather than just take a small sample for biopsy, he was going to attempt to remove it with a clear margin at the same time, but he said I should think of this as a staging operation and would have to wait for the pathology results, which may indicate a mastectomy is in order. I was third on his list that day he explained and he would see me in theatre later.

The nurse came back to see me, put my name tag round my wrist and took by blood pressure. I was amazed it hadn’t gone up, but I don’t think the news had really sunk in and I felt quite calm and accepting of what was happening to me. Next the anaesthetist came to see me; he introduced himself and made himself familiar with my notes including all the details that had been filled in when I had my pre-op assessment.

At 4.00 pm I was asked to get on to the trolley and at 4.10 pm was wheeled into theatre. They helped me take my right arm out of the gown, a needle inserted into the back of my left hand for the cannula (a bit like a syringe that the anaesthetic and any other drugs can be administered through) and I was told I would shortly feel drowsy. One minute I was wide awake and the next someone was calling my name and I was back in the Day Surgery Unit; it was all over. I felt a little groggy and they asked me if wanted a cup of tea, but I wasn’t really with it at that point. They left me with a glass of water and suggested I try and drink it as soon as I could. It took me a while to properly wake up during which time my blood pressure and pulse was taken a couple of times. I wasn’t in any pain and managed to sit up and sneak a look inside my hospital gown. There was an enormous dressing across my chest extending from the inside of my left breast, across my right breast and under my arm. I found out later that this was a pressure dressing. The nurse brought me a cup of tea and some biscuits and said they had just called my husband. It was 6.30 pm. I was given some painkillers to take home together with a sheet explaining when I needed to remove my dressings, what to expect post-operatively and numbers to call if I had any questions or problems.

It was when my husband arrived and I had to tell him about the second lesion that it hit me and I was a little weepy, but told myself it was better that they found it before my surgery than after. The nurse helped me off the trolley, I got dressed, the cannula was removed and home I went.

Once the anaesthetic wore off, I was sore rather than in pain. I took a couple of the painkillers just before I went to bed for the first 2 nights and once during the day, but otherwise didn’t feel I needed them. The area under the arm where the sentinel node biopsy was carried out was the tenderest site and the morning after the operation I had to go to the GP for the nurse to replace a small dressing that had rolled back on itself and was uncomfortable and making the area a little sore.

Taking the pressure dressing off after 36 hours wasn’t as bad as I thought it would be. Underneath it were 2 small transparent dressings: one covered the excision round the nipple and the other was under the breast where the first guide wire had been. I had been told I could remove these at the same time, but as they were the same as the dressings I had on when I had the biopsy I knew I would be able to shower with them on (there was nothing cowardly about my wanting to leave them in place!) so left them until I saw the consultant for my results and he took them off for me.

The biggest disadvantage with having these procedures as a Day-case was the hanging around between the guide wire insertion and the admission to the ward. If I had arrived at the hospital at 9.00 am and only needed one wire, I probably would have been hanging around from 10.00 am onwards, not an ideal situation. Originally I was to have been booked in for an overnight stay and I can only think that they could not find a bed on the ward for me so rather than delay surgery they went for this option. I can only be grateful that they fitted me in so quickly; I can’t fault the care I received. Unfortunately, the second lesion was another invasive lobular cancer and I am currently waiting for a mastectomy, but it’s better this way than having a lumpectomy and radiotherapy only to find out later about the second lesion.