What has to be done before surgery when there is suspicion of breast cancer?
The early case history shows that errors had been made:
waiting to long for a clarification of the microcalcifications - postponing too long to get an appropriate mammogram of the hardening - a biopsy with tissue sample from outside the lump and therefore a false diagnosis. I then decided to find on my own a better address for further examinations. A breast center seemed to be the right place.
January 5th, 2004: I brought the mammograms including diagnosis of November 11th, 2003 (no proof of a carcinoma), to the breast-center and asked, if it would be possible to remove the same day the lump in the gland tissue. In the meantime I had therefore gotten a bad feeling, the lump had become larger again. Perhaps it was not so good-natured as I had assumed according to the available diagnosis.
The physician thought that in my case and in view of the mammography pictures, he would prefer a usual tissue sample/biopsy, but I insisted on a complete excision of the lump due to the presented "good" diagnosis.
A compression bandage during 48 hours around the torso within the chest range should prevent blood from accumulating in the cave which had resulted from the lump excision. Unfortunately already during the first night the bandage slipped down, so an effusion of blood could form around the place of the former lump. This was worse looking (see picture), as it was.
The different colored spots became lighter, between the incision part and nipple, however, a swelling (hematoma) occured.
The lump in the left breast was in fact a breast cancer.
Now the microcalcifications in the right breast were examined again more exactly, tissue samples should give information. This happened outpatient under local anesthesia.
the core biopsy (Trucut®) of the microcalcifications
in the right breast and
the core biopsy (Trucut®) of the axillary lymphnode
at the left side
Also of an enlarged lymphnode in the left axilla a tissue sample had to be taken, also outpatient and under local anesthesia.
Here it is important to know, whether the axillary lymphnodes are already cancerous. If yes, these would have to be removed also during the surgery.
If without metastases, a Sentinel Node Biopsy could be made during surgery so that the side effects can be avoided, which mostly arise after the usual dissection of the axillary lymphnodes.
The Hematoma
Three weeks after the removal of the lump the skin over the hematoma (a localized swelling filled with blood resulting from a break in a blood vessel) had become very firm. It felt, as if under it a half cooked egg was stored. The blood in the cavity of the wound had thickened.
My desire to get the whole lump removed, instead of just a tissue sample, was therefore not very good.
The diagnosis of the microcalcifications at the right was not completely clear,
...and a Mammotome® biopsy of the microcalcifications at the right should give clarity here.
Under x-ray control the stereotactic vacuum-assisted biopsy (removal of the microcalcifications, see accompanying drawing) was made outpatient and under local anesthesia.
