Inclusion Criteria:  greater than or equal to 18 years of age biopsy proven breast cancer standard radiotracer injection (intradermal injection in the upper outer quadrant of the involved breast) radiotracer injection occurs on the same day as sentinel lymph node surgery  Exclusion Criteria:  males pregnancy  local anesthetic allergy or active use of the following medications:  Abametapir (risk X) Conivaptan (risk X) Fusidic Acid (risk X) Idelalisib (risk X) Mifepristone (risk D) Stiripentol (risk D) Amiodarone (risk C) Dofetilide (risk C) Dronedarone (risk C) Ibutilide (risk C) Sotalol (risk C) Vernakalant (risk C) Non-English speaking/reading Unable to provide informed consent Unable to participate with surveys  Undergoing radiotracer injection the day prior to surgery or intra-operatively at the time of initial surgical scheduling  If patients are initially scheduled for same-day preoperative injection, complete all enrollment procedures (including randomization), and surgery is re-scheduled for a day prior to surgery or for intra-operative injection, they will be excluded if:  randomized to a lidocaine patch arm (Arms C or D) re-scheduled for an intra-operative injection • Planned non-standard radiotracer injection site