An excisional breast biopsy was my first surgical experience outside the U.S. It’s been about a month since I had the procedure, and I learned a lot. Maybe my story will help someone else.
Surgery of any kind is difficult enough without having it done in a foreign country. My spouse and I do have high deductible health insurance inside the U.S., but I decided to have this procedure in Mexico based on two reasons other than cost.
The health care system is quite different in Mexico from the U.S. There are books that contrast differences, give medical tourism information, or act as general navigation guides through the Mexican medical system. This is not any of those. This is a personal account with generalized lessons I learned about having a relatively minor surgical procedure like this abroad.
Part one is about my decision to have this done in Puerto Escondido, which is not a tourist mecca, and it’s not a haven for expat retirees like other Mexican cities. I share the biopsy experience in part two. Part three is cost itemization for my excisional breast biopsy at a private clinic in Mexico with no traveler’s health insurance. Part four may be helpful for any expat, on any serious doctor visit, in any foreign country – it’s the top three lessons I learned about surgical care in another country.
The surgical oncologist said my breast will be sore for a few months, but he’s pleased with my healing. The scar isn’t too bad, my nipple isn’t deformed despite a large piece breast tissue taken out, and the memory of the procedure is not as stark as it was a month ago. I can easily live with all of that because thankfully — my results are benign.
Part One: My decision
My previous experiences with health care outside the U.S. before this procedure were all positive. I had parasites, a mosquito virus, and a urinary tract infection – all resolved with a simple doctor visit in different areas of Mexico for little money. I’ve also had preventative exams – a skin cancer screening, two dental cleanings, a mammogram last year. I even got new glasses at a stop along our travels. Again, all good experiences.
Then came this year’s mammography results.
Advice from other expats, and my yearly mammogram
I asked a few different women who live in Puerto Escondido where to have my annual mammogram. Each one recommended I go Clinica Angel del Mar and see the general doctor there who spoke English. So, I had my mammography this year in at that clinic. I had x-rays and also an ultrasound.
My results came back with a BI-RADS 4b rating, meaning the radiologist had an intermediate suspicion of cancer. It could not be determined if suspicious microcalcifcations were cancerous, precancerous, or benign, so the report recommended a biopsy as soon as possible. Likely an excisional, or surgical, biopsy based on the formation of the spots.
The doctor and radiologist assumed I would return to the U.S. for the procedure because I don’t live in Mexico – I was only a tourist on an extended visit. My husband Tedly and I are slow travelers in early retirement. I’m only 45 years old.
The hunt for medical opinions
We went to a second clinic in town for a second opinion. A gynecologist who spoke basic English examined me, the images, and asked about family history and lifestyle habits. His recommendation: a surgical biopsy as soon as possible. He also assumed I would return to the U.S.
I asked if I could have it at his clinic and he said sure – he could do it himself in a few days. He answered our other questions, gave us his cell number, and gave me a hug as we left. ‘I want to help you,’ he said.
I gave myself a crash course about biopsy procedures. It didn’t take long to see a surgical biopsy is not a procedure usually done by a gynecologist. So the second clinic was definitely out, as nice as that doctor was, hug and all. I then made another appointment with another gynecologist at the first clinic – Angel del Mar. I had to wait five days.
The third doctor also recommended a biopsy as soon as possible. He said a surgeon would have the final say on the type, but he felt it likely would be surgical. He asked when I was returning to the U.S. I said I hadn’t planned to, and asked if I could have the procedure at Clinica Angel del Mar. Yes. A surgical oncologist visits the clinic twice a month from Oaxaca City. I could wait for his next visit, or, I could travel to Oaxaca City. I said I’d wait to see him on his next visit.
The gynecologist called the oncologist on his cell while I was there in the room and laid out the situation. The oncologist agreed to see me first thing when he arrived to town.
I decided Tedly and I would ask the oncologist specific questions on the morning when we met him – just before the scheduled biopsy. If we didn’t like the answers, I wouldn’t go through with it. Going back to the U.S. was always an option, and so was going to a larger city in Mexico where expats had procedures like this more often.
A calculated risk and my final decision
With a BI-RADS 4B rating, there was roughly a 25 – 35% of malignancy. Every medical professional I talked to was concerned I was on the higher end of the scale because I meet big risk factors: family history of breast cancer on both sides, no children, former smoker, ex-problem drinker. But this also meant there was roughly a two-in-three chance – or possibly even a one-in-four chance – this was benign. The odds were in my favor that this was nothing.
If I went back to the U.S., we’d have to find a place to live (the house is rented), I would have to start over, negotiate the in-network health care system at home, wait for appointments, have the biopsy, and then… what? Ok, if it’s cancer, start treatment. If it’s not, resume travel.
Or – I could simply have the biopsy in Puerto Escondido and know as soon as possible. All of that waiting so far was already a drag on my soul.
Factor one in my decision – I wanted to know yesterday.
Other women in Puerto Escondido rely on that clinic for breast cancer diagnoses, so why shouldn’t I? If the results came back as malignant, I could then determine my next step — if it even got to that point. If results were benign, I could have some time to begin healing before the next stop on our world tour (Guatemala). Also, as any doctor will tell you, early detection is key. I absolutely wanted to know yesterday.
Factor two in my decision – this is how other women got their health care, so it should be good enough for me.
I was ready to have it with the visiting surgical oncologist — as long I liked the answers to a list of questions just for him.
I had blood work at the clinic’s lab and got the all-clear for minor surgery, if that’s what the oncologist thought was needed when we finally met face to face.
Part Two: Biopsy Day
The surgical oncologist at Clinica Angel del Mar either flies in or drives in from Oaxaca City twice a month. He’s a known advocate for early detection. He’s quoted in news articles lamenting women wait too long to get a mammogram, and often by the time they see him, it’s too late for him to save their lives.
Meeting the surgical oncologist, and final questions
The specialist was kind and concerned. He took a long time to study all of my information. He patiently answered all our questions. He didn’t speak any English. The clinic had a bi-lingual staff manager who acted as our translator.
The oncologist said it had to be an excisional biopsy. He needed to remove a good-sized chunk, and used his hands to illustrate the size. Tedly asked if there was there better equipment in Oaxaca at his other clinic that would better help him with my procedure, because we could easily travel there. He said no, all he needed was there at that clinic. And on it went – a Q & A with specific questions saved up for that moment with this expert.
In the end, I was comfortable with having it there – as comfortable as a woman can be about this kind of thing. Ten minutes later I was in the operating room.
The biopsy experience
The surgical room was not as white and gleaming as other rooms in my limited minor surgical experiences back in the U.S. – a kidney stone removal, for example. This room was more of a yellowish cream color. I had negative thoughts and worries about its cleanliness from the start.
But my only real problem: I was not sedated – the surgery itself was difficult for me. I didn’t feel any physical pain – my breast was numbed. It was the tugging feeling I had on my body, and the sound of the cutting, that I will never forget. Most of the time in the U.S., women are given an IV sedative, not general anesthesia. How did this happen? How was I not sedated? Something had been lost in the translation before the procedure.
At one point, the doctor asked the nurse a question I didn’t understand, but I knew he didn’t like the answer. He left the room – kicking the door out with his gloved hands in the air.
He returned with a long string of thin flexible plastic. That was what he would eventually use for stitches. I felt panic edging in. Hopefully the doctor hadn’t touched anything with his gloves that would infect me. That’s all I could think about – infection.
More cutting. More tugging.
When I was on the verge of a freak out, the doctor told the nurse to get the translator. She came back with him. He wasn’t wearing gloves or a mask. I was now even closer to a freak out – all I could think about was germs and contamination of the hole in my breast a few feet from his unmasked mouth. I was borderline hysterical. Speaking of the incision site, it was not blocked from my view. I had to keep my head turned away, and my neck was stiffening up.
After a few moments, the nurse placed a mask over the translator’s face and gave him gloves. He explained what was happening to me. In English, finally, I heard English. I could see his eyes watching the doctor work on my breast. He is stitching the inside, and next will come stitches on the outside – try not to move, he said.
It was eventually done. The translator left. The nurse helped me sit up. My gown was drenched with my blood on the back. My knees were weak. The nurse helped me stand. I turned around to look at the doctor.
He was holding what he had just taken out of my body with some instrument that looked like salad tongs. A huge chunk of flesh. I nearly fainted. It was as if he was proud of the tissue he took from my breast he held it up for my inspection. For my approval. The room spun.
The doctor later showed the same chunk of flesh to Tedly – in some kind of preservative cup.
After the biopsy
In the doctor’s office I sat with Tedly, the oncologist, the translator. I was detached. It felt surreal. My breast still felt numb. The oncologist gave me orders for recuperation. No running. No swimming. No creams, only soap. Gauze, tape, antibiotics, ibuprofen, acetaminophen, rest. The specimen would be sent immediately to an affiliate lab in Oaxaca City. Results in a week, maybe more. More waiting.
The doctor said he tried to stitch me in a way that would minimize the scar. Another doctor would take the stitches out in eight days. He wanted to see how it healed. He would be back at the clinic in two weeks. The results surely would be ready by then. Try to relax, he said. Enjoy the view at the beach.
We tried to enjoy the moment as much as possible. Some beach outings and visits with fellow expats helped me.
The results came a week later – when I had the stitches removed. Benign. Another English-speaking doctor read the results again- yes, this is good. It’s benign.
He gave me the pathology report, which was in Spanish. It described in great detail the 5.3 by 5.4 centimeter chunk of tissue removed from my breast.
The greatest detail: benign.
Part Three: Cost breakdown
Prices are based on 19 pesos to the dollar. Everything except one doctor’s opinion was at Clinica Angel del Mar.
Mammogram, ultrasound, results with a doctor: $91
Doctor’s opinion, breast exam (not at Angel del Mar): $30
Doctor’s opinion, breast exam: $10
Blood test before the biopsy: $36
Excisional breast biopsy by visiting surgical oncologist: $384
Pathology examination of specimen: $70
Guaze, tape: $7 (estimate)
Pathology results translated by English-speaking doctor: No charge
Stitches removed: No charge
Part four: Top three lessons on medical care abroad
Would I have another surgical procedure in a foreign country? Yes. With my learned lessons as guides. I’ll share the top three that could apply to anyone.
First, and, most importantly: any language barrier must be overcome.
This seems obvious – but I’m also talking about the nuances of language. Sometimes things are lost in translation, or, never make it to direct translation, or the translator makes assumptions. Remember the sedation thing? Somehow, that got lost in translation. I assumed, based on what the translator was saying, that I would be sedated in some way – but I wasn’t. That cost me in a big price in anxiety.
Second: it’s difficult to research doctors in Mexico online (and likely in other countries, as well). Ask others who live in an area about a doctor’s reputation.
In places like California, the state has a Medical Board. The board will list reprimands, fines, or any other actions taken against medical doctors. No such thing in Mexico, and likely not in other foreign countries where we will find ourselves.
Side note about internet research. I found a gynecologist in Puerto Escondido who was recommended on the Tomzap site – a website frequently used by tourists. I was planning to see her for a second opinion. However, upon trying to track her down, I found a news story from a few years ago that said she was arrested and charged with murder, if the news story is to be believed.
I emailed the contact at the Tomzap site and sent along a link to the news story to see if they knew about the murder charges, but I never heard back. I have no idea if the woman was cleared of charges – I could find no recent reports.
Third: keep fear in check. I prayed for strength, but admittedly I still had some prejudice against going through with this.
In hindsight, I had a lot of fear because I compared the doctors and health care from home to the Clinica Angel del Mar. That fear was unnecessary, and, frankly, it was elitist. Women in Puerto Escondido rely on that clinic and its lab in Oaxaca to detect cancer. I’m just another woman, and there is no reason to think detection can only be done in the U.S.
I also was worried about the appearance of cleanliness. Again, unnecessary. I didn’t get an infection during or after the procedure.
The bottom line is: every single person I met throughout this whole thing was professional and helpful – from the receptionists at the scheduling desks to the translators, to the doctors who spoke English and didn’t speak English. I’m grateful for all of their kindness towards this uptight gringa.
This experience is yet another reminder for me to let it go and let it be, while I do whatever footwork I can to help myself – and others – as best I can.
When I say others, in this case I mean my husband. I had a trillion thoughts as I waited for the biopsy, and then the biopsy results. I thanked God and the Universe many times over that this was happening to me, and not to Tedly. Hypothetically assuming the worst, I also easily decided I would be grateful to deal with cancer rather than see him deal with it.
That I can have a true partnership with another human being and feel this kind of love — it’s simply a miracle.
Tedly was stressed out so much over this – and that is a whole other story I’m sure he’d rather tell in person to anyone interested. Today, he might chuckle about it, because my results are benign. We are both way more relaxed now that we are in a quiet, somewhat secluded area on Lake Atitlan in Guatemala for several weeks. This is the perfect place for me to finish healing, and for Tedly to relax.
If you’ve read this far, it’s likely you are facing a surgical breast biopsy as an expat woman living or traveling in Mexico. Or, you are a person facing some kind of similar surgical procedure. If there’s any way I can help, or if you need clarification on anything I’ve experienced, please reach out. I would be happy to help, if I can.
Note, Ellen had another biopsy one year later in Croatia. Those results came back positive for early stage breast cancer. Read about that journey, here.