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What is a wire localization?
Wire localization is a procedure in which a wire is placed in the breast by a radiologist prior to your surgery. The purpose of this is to mark the location of the abnormality your surgeon would like to remove. This is necessary, as many lesions cannot be palpated (felt), and can only be seen by mammography or ultrasound. This procedure is performed the day of your surgery – usually a few hours before your scheduled operation.
How is it done?
There are two methods of doing a hook wire localization - ultrasound guided or mammography guided. If it is microcalcifications that are being removed, you most likely will have the mammography guided wire localization.
What can I expect with ultrasound guided localization?
- The technologist will explain the procedure, followed by an ultrasound of your breast to mark the location of the lesion for the radiologist. The radiologist will answer any questions you may have and obtain your consent.
- The radiologist will clean your skin with an antiseptic solution and administer some local anaesthetic (freezing). He/she will confirm the location of the lesion, then, while scanning, guide a needle to the lesion.
- When the needle is in place, the radiologist will thread a very fine wire through the needle and remove the needle from your breast. All that will remain will be the wire that has a hook at the end of it. This hook helps prevent the wire from being easily pulled out or from migrating in further.
- Immediately following the placement of the wire, a mammogram will be taken to document the placement of the wire in relation to the lesion. These final images will be available to your surgeon in the operating room to use as a guide during surgery.
- The remainder of the wire will be taped flat to your skin and covered with a bandage so that it will be protected when you put your gown or clothes on.
What can I expect with mammography guided localization?
- The radiologist will explain the procedure, answer any questions and obtain your consent.
- Often with a mammography guided localization, you can be given local anaesthetic (freezing). Occasionally this is not possible, as it may make it difficult to visualize the lesion.
- The technologist will position you as for a mammogram, but you will be sitting rather than standing. The compression paddle has an opening in it wherein the technologist will position the lesion. The compression will be firm, but not as tight as for a regular mammogram.
- After the initial exposure, the compression will stay on your breast. It is very important for you to hold still as any movement may affect the accuracy of the localization.
- The radiologist will clean your skin with an antiseptic solution, and then place the needle to where the lesion is seen. Another image is taken to check the placement. If the radiologist is satisfied with the position of the needle, the compression is released and an image is taken from a 90° angle. This is to confirm the depth and to check if any
adjustments need to be made. The wire is then inserted through the needle and the needle is removed.
- Two final images are taken to confirm the placement of the wire. These images will be available to your surgeon in the operating room to use as a guide during surgery.
- The remainder of the wire will be taped flat to your skin and covered with a bandage so that you may put your gown or clothes back on.
Will it be painful?
If your localization is ultrasound guided, you will be given some local anaesthetic. Other than the pinch from the needle used for the freezing, you will probably not have much discomfort. There will be some compression used for the post procedure mammogram; however, the compression is not as tight as for a regular mammogram.
If your localization is mammography guided, you may have some discomfort from the compression as you will be in it for a longer period of time. As mentioned earlier, the compression will not be as tight as for a regular mammogram, but snug enough so that there will be no movement during the procedure. If it is not possible to use freezing, you may feel the needle as it is inserted, but the compression helps numb the sensation. Most women find it tolerable.
How long does the procedure take?
You can expect the procedure to take 20-30 minutes, depending on the location of the abnormality within your breast and how easily it is visualized.
Do I have to worry about the wire falling out?
The portion of the wire within your breast has a hook at the end of it. This hook helps to keep the wire anchored, however if the wire is pushed or pulled, its position may change. For this reason the end of wire is carefully taped to your skin and covered with a bandage. We ask that you try not to move your arm too much especially lifting it up too high on the side of the breast with the wire in.
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