Sentinel node injections and pre-op bracketing: what to know before you go

Ignorance is NOT bliss, hence why I am writing this post. It would have been scarier yes, but also (and paradoxically) easier to understand going into these procedures what they were actually going to do to me.

What is a sentinel node injection?

In my case, the first lumpectomy did not show clean margins. Before my breast had even had a chance to heal itself, already badly bruised and tender from the biopsy that led to the initial diagnosis, and then further inflammation and soreness from the first lumpectomy, we were back in surgery.

Woman in doctor's office

My doctor prudently recommended that we also include a sentinel node biopsy at this time. We needed to determine if any cancer cells had moved to the lymph nodes, which would inform both staging and treatment.

I was already going to be under anesthesia, so it just made sense to do it then.

The day before that second surgery, I showed up for pre-op labs, paperwork, and what (up until then at least) had been the most uncomfortable part of all this so far.

Since the sentinel nodes are among the first few lymph nodes into which a tumor drains (source: Mayo Clinic), a biopsy of the lymph nodes in that area is one of the best ways to determine if a tumor has begun invading the lymphatic system.

Just like when you have an MRI with contrast, this procedure requires a pre-procedure injection of a tracer material. It helps the physician find the sentinel nodes during surgery.

What I didn’t fully understand was that this would involve, count ’em, 1, 2, 3, 4! needles to the already badly offended (see second paragraph) and super sensitive nipple, in clock-wise fashion while I lay on a table, allegedly numbed “a little bit.”

God bless her, I’m not sure how the nurse didn’t fall flat out on the floor from me squeezing the ever-loving everything out of her hand. Thank goodness it was over quickly. And the doctor, for all that he lacked in personality (I’d have rather watched paint dry) was skilled at his task, respectful, and efficient.

I managed to whisper out a quiet “thank you” before he left the room, leaving me lying on the table to get dressed. As I slipped back on the hospital-issued robe, preparing for a 45-minute wait to make sure the tracer material took as it should, tears puddled in my eyes.

When the 45 minutes were up, I was too overwhelmed to do anything more than quietly pad about the room and say “Yes ma’am” or “No ma’am” as the nurse instructed me on where to stand for images. So it was only in my head that I shouted out a bit of “fluent sailor with a trucker accent,” as my friend Traci would say.

What is bracketing?

I got a little horsy with my breast surgeon about this one. Granted, it wasn’t until after the procedure because I had no clue how painful it would be until I did it. And she apologized. But I also knew she was right:

It’s one of those necessary evils to help the surgeons find exactly where the breast tissue is located that needs to be removed.

If they used lidocaine before they ran the wires (the day after the four needle nipple fun), I couldn’t tell. So if this is going to be part of your procedure, make sure you know who is doing the wire guided localization (which radiologist), which nurse will be assisting, and what type(s) of numbing medicine they can/will use. If you can meet them before and establish some level of rapport prior, so much the better (I had no such luxury).

It’s certainly not this woman’s fault, but I had a very green, very eager to put the patient at ease nurse who helped that morning. When my bravery melted into downright painful wails, it certainly hadn’t helped matters that she’d flat out lied to me when I asked her if it would hurt worse than my biopsy, which was a doozie.

Maybe – probably – it was unfair for me to even ask her that. But I’d had to leave Rett way down the hall in the pre-op area, I was in this big, scary room with two total strangers and I was about to undergo something involving a lot of equipment while a radiologist stood 10 feet away with his back toward me the whole time.

Much as tried to put on the proverbial big girl panties, it felt like someone plunging a sharp object into a fresh wound for 20 off-and-on minutes, with the need to pause and hold still on my side(ish), with my breast hanging off the table and being smooshed into a mammography machine, and then having to wait, wait, recalibrate until they got the exact images they needed.

Move over, sentinel node injection. This is the actual worst so far.

One more tip – if you know that bracketing will be part of your deal, make sure you have someone who can sit with you while they look at the final sets of images outside the room. I was left in there alone for a good 20 minutes and I just bawled.

My breast felt like someone had violently beaten it with a blunt instrument. I’d been told to “wait for a few minutes” until someone came to get me. Surgery was (supposedly) going to happen soon. My husband was nowhere near me. All I knew at that point was that it was more than Stage 0, currently “stage undetermined,” and it may or may not be in other parts of my body. I also felt weirdly violated.

Such a sensitive, private part of me had been repeatedly exposed and poked and prodded; it was bruised and swollen beyond all recognition. In that particular moment, I felt scared shitless.

It was then that I noticed a chair about 15 feet away, in the corner of the room. Empty of course (remember, I’m in there all by my lonesome), but I felt what I was praying for in that moment – a little God-given courage, and maybe, just maybe, a bit of His presence too.

When 20 long minutes had passed, I finally opened the door, and walked gingerly out into the hall (wires hanging out of me and all) to figure out when in Heaven’s name we might be getting this show on the road. I’m sure they just love when patients do that, but for Pete’s freaking sake, don’t leave people in physical agony and without enough information to know what the flip is happening next.

I was told something to the effect of, “Almost done. Be there in just a few.” So I shuffled back, bawling long gone and now just full on irritated as all get out. Thank God for that teeny little speck of Heaven-sent patience, as it was just enough to while away the last few minutes in a reasonably calm state before they wheeled me back to pre-op.

If you’re potentially or definitely facing one or both of these procedures, don’t fear them. But don’t be na├»ve either. Learn as much as you can about what to expect, who will be doing what, who will be allowed to be with you (even if no family is allowed, which clinician can be your support person, ’cause you’re gonna want one).

And then go in fully prepared like the resolute soul that you are.

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