Dr. Jenn (Jenn) Simmons explains the purpose and safety of surgical/titanium biopsy clips used in breast procedures. She distinguishes clips placed at minimally invasive biopsies (small ~3 mm markers, usually removed at excision if benign or removed when lesion excised) from clips placed at cancer surgery to mark margins (~7 mm) and clips used universally for hemostasis. She reports that literature mentions two rare problems — hypersensitivity to titanium/surgical steel (itching, redness, inflammation) and clip migration — but that in her extensive clinical experience these complications are exceedingly rare and she considers the clips safe short- and long-term.
Questions this video answers
Approximately 3 millimeters in length.
Approximately 7 millimeters in length.
Hypersensitivity to titanium/surgical steel (itching, redness, inflammation) and clip migration (movement into adjacent tissues).
Chapters
Hi there, it's Dr. Jen. You asked and I answered. Today we are talking about the surgical biopsy clips, the titanium clips. I've been getting so many questions about whether or not they're safe. I have reviewed the literature. I'm going to talk to you about what is reported in the literature, and then I'm going to tell you about my personal experience. And I want you to know that we are talking about two separate instances. Now, first of all, whenever anyone has a minimally invasive biopsy, a needle biopsy, a cord biopsy, a stereotactic biopsy of the breast, this is usually done with imaging assistance. It's usually done when a lesion is not palpable. And the reason that we place a clip at the time of that biopsy is because, first of all, if it's not something that can be felt, if it's not palpable, and this does turn out to be cancer, we want to know exactly where it is to be able to localize it and remove it at a later date. Also, if this is something that is benign, we want a marker in there so that for subsequent imaging, for subsequent issues when, when something comes up. If you have a clip inside of a lesion, that is the universal sign that I've been biopsied and I'm okay. So that is the reason why clips are put in at the time of minimally invasive biopsy. Now, those clips at the time of surgery are always removed. They are tiny, tiny, tiny, 3 millimeter in length, and I don't even know what the depth is. It's, it's minuscule. These clips are put in at the time of biopsy, but then they're removed at the time of excision. So that clip that is used to mark the lesion, that is removed. But if you go to the operating room for removal of a lesion, that is cancer, not the benign stuff, the benign stuff, we put that clip in to mark it and then we remove it at the time of surgery. If you choose to have like a fibroadenoma removed or a radial scar removed or something like that, that, that clip that is placed in the lesion is removed. So you don't have any remaining titanium in your body. If you have a breast cancer surgery, then the borders of that excision, if you're having a, a lumpectomy or a partial mastectomy, the borders of that excision are then marked with 7 millimeter titanium clips. So that if you're going to go on to have radiation, the radiation doctors can know exactly where to focus their treatment, because they know exactly where the tumor was. Or this is the radiologist, not a radiation oncologist. The radiologist's ability to follow that area, because if the cancer is going to come back, it is most likely going to come back where it was before. So it gives the radiologist the ability to follow that area closely. So that is why clips are placed at the time of surgery for breast cancer. Now, I also want you to know that if you have a mastectomy, while those clips are not placed for the purposes of marking the area, if you have a mastectomy or are lots of blood vessels that are involved, and the same exact clips are used to tie off blood vessels. So almost everyone that had surgery has these clips placed. Almost everyone. These clips are used for hemostasis, to divide blood vessels and to stop them from bleeding. And they're used universally in all different kinds of surgery. And if you've had any kind of surgery, you almost certainly have these clips in. So I don't want you to think that these titanium clips are solely used for the purposes of biopsies. They are used universally in surgery. Now, who has a problem with these clips, and what are the problems? If you are allergic to titanium or surgical steel, then you will react to these clips. And it can be an allergic kind of response, itching, redness, that kind of thing, inflammation. This is extremely, exceedingly rare. And in the thousands and thousands, I don't even know how many thousands of women that I operated on, I never saw it. I never saw a sensitivity response to cold clips, to surgical clips. The other thing that is discussed in the literature, that I never saw myself, is migration of these clips. So I guess technically they can migrate. And when we think about migration, we think about adjacent tissues. So it can migrate from the breast to into the tissues of the chest wall, from the breast into the axilla. And I guess if it does that, it can cause some pain. But more than likely, the pain that anyone has after breast surgery or axillary surgery is more likely due to disturbance of the tissues, disturbance to the nerves of that area. Technically, you can put a clip on a nerve if someone confused it with a blood vessel, and that will be painful. And the only cure for that is to go surgically back in and remove that clip. And I guess that that would be determined by EMG mapping along those lines. But those are the two things that are reported in the literature. Hypersensitivity response to the metal or migration of the clip. Again, I want to tell you that these things are exceedingly rare. And I personally have no concerns about leaving these clips in. They are not only used for breast surgery and they are not exclusively used for cancer. They are used in almost every surgery. People use clips for hemostasis, for, to stop bleeding, to divide blood vessels, to divide tissue that is very vascular. They are universally used, very commonly used. And I believe that they are safe, safe in both the short term and the long term. So I hope this helps to comfort anyone who has concerns about the clips that they, they have inside. And if you've had a lumpectomy, you certainly have these clips inside. But it, but I do not think that there are any long term complications associated with having these clips. And what your body generally does and what I've seen time and time again is that it kind of isolates them, it forms a barrier around them, a capsule around them. And I have not seen any long term complications of having a clip. I don't want to take anything away from anyone who's ever had that. I know that there are reports in their literature of people having hypersensitivity reactions and of people having clip migration. I fortunately never saw that. And again, I hope that that is of comfort to you and anyone who is not having problems. I don't think that you should anticipate any. It's Dr. Jen, bye for now.
