removing chest wall fascia for close margin

1965sally

removing chest wall fascia for close margin

1965sally

I had a partial mastectomy with unacceptable margins and am getting mastectomy next week.  One margin was less than 1mm from the chest wall, and a radiation oncologist said he wanted to see the path report after mastectomy and then decide if radiation needed.  (I had a high Van Nuys score and other factors making them want to treat my DCIS aggressively.)  My new breast surgeon pooh-poohs the idea of radiation after mastectomy for DCIS and said instead he might remove some of the chest wall fascia in that area.  Has anyone else heard of this?  And what are the consequences or side effects of removing fascia?

12954

I had a mast ( skipped the lumpectomy as I am small enough that it would not have been all that different) My margin at chest wall was <5 mm.  I did the radiation ( bummer as the decision for the mastecomy was to avoid radiation).  I also had type 1,2, and 3. The chance of recurrence was high and with type 3 -50% chance as  dcis ( which the radiologist says comes backs as skin lesions) 50% invasive. Never discussed more surgery or removing fascia

trish

smerf

I also had a partial mastectomy, and the fascia was removed at that time. I had a 1mm margin, and that was the fascia. My cancer was invasive, and I'm triple negative. Because of the tumor being so close to the chest wall, the most agressive tx included rads whether I had a mastectomy or not. I have no se's because of the missing fascia. In fact, I wouldn't know it was missing if I didn't read the operative report.

Wishing you all the best.

twirlgirl

I had a lumpectomy for a large mass (7cm phyllodes sarcoma, a rare BC, with a 1.5cm DCIS mass inside) and it was growing all the way down to the chest wall, so in order to get the clear margin, my surgeon had to take the fascia. You don't really need it and won't miss it. Even my massage therapist, who really knows her stuff said it would be fine long term.

After surgery, my chest muscle was very sore and I think just "grumpy" at being disturbed, but that healed in about a month or so.

best wishes~sending healing thoughts your way~ 

mbordo

I believe my surgeon mentioned this at my surgical follow-up following my re-excision.  He wanted to be sure we got the margin this time, and mentioned taking the "thin layer that covers the chest wall muscle - like the membrane in a piece of steak..."  I'm guessing that is a reference to the fascia?  We got an acceptable margin there (but ended up w/o a clear anterior margin - at that point I went for mastectomy).  The fascia issue never came up as impacting my treatment course...

Mary

1965sally

Thank you all, this is reassuring.  I also talked to one of my doctors yesterday who thought taking the fascia was a good idea.  I'm especially glad a massage therapist agreed it was fine - I used to go to a good one every week and that's where I even learned what fascia is (yes, that thin membrane).

Dottie123

Yes, I had a similar situation. After lumpectomy I had a 1mm margin at the chest wall (even though surgeon took the fascia) and at the inferior.   It was recommended that I have radiation, do another wider re-excision, or have a mastectomy.  The radiologist mentioned the possibility of radiating the chest wall even after a mastectomy depending on the path report.  I made the decision to have a mastectomy (done 4/7/08) and fortunately the path report came back clean.  No radiation, No tamoxifen recommended.  The surgeon said she went back and "shaved" the muscle on the chest wall.  It sounds awful, but honestly I never felt any tightness or soreness and have full range of motion.  Wishing you the very best.    

1965sally

Thanks for posting, Dottie, that is really good to know.  Now I found out (or supposedly was reminded but I don't remember it) that another margin was even closer and more unusual - in my armpit.  I'm going to post another conversation to ask if anyone's had that before.

rockstar22

I had a BMX 8/2011 and my surgeon didn't remove the fascia because it wasn't "clinically indicated" even though it was considered deep according to the initial biopsy and MRI report. Now I have margins and will need radiation. Doc said removing the fascia wouldn't have made a diference. I'm not so sure. Any one have any info on this? I have TE and have already started expansion so I'm seriously bummed about this

1965sally

As I understand things (very incompletely), radiating the chest wall is just done because the cancer was invasive.  Removing fascia wouldn't have prevented that.

That's definitely a bummer though.

coraleliz

I had a BMX with the muscle fascia removed. I only know this because I read it in my surgical report. I had ICD & DCIS. My tumors were close to the "wall" but margins were good & fascia was clean. I was hoping to avoid radiation but with lympatic vascular invasion on one side & lymph node involvement on the other.....off to RADs I went. I didn't know to discuss this with the BS prior to BMX. Not sure if this helps?

mom3band1g

I did not have my fascia removed....we didn't know how widespread my DCIS was until after the mast.  I did have several less than 1mm margins on the chest wall and a 1 mm margin on the anterior.  I was strongly advised to do rads.  I did and don't regret it.  I feel good in that I did all I could to prevent it from coming back.  I did not want to to have a recurrence and kick myself for not dealing with it the first time.  Honestly, after a mast rads is a walk in the park!

happyraccoon

hey ladies. i can't figure out WHY my chest hurts so bad! my bmx was 3.5 weeks ago and the pain is still BAD. i've been back to the surgeon twice, my onc twice, and a general practicioner twice. they all say im healing perfectly. but why does it HURT?

BLinthedesert

Sally, I had fascia removed during my lumpectomy (it was a large area, so techincally it could be classified as partial mast) - my RO said I would have radiation with either MX or lumpectomy, even though mine was all DCIS.  Removing fascia does result in a little more chest wall scarring (closer to a MX in this regard) - and for me, radiation exacerbated the problem.  Furthermore, many BS "move things around" to obtain better cosmetic results - this also causes a lot of scar tissue, and increases possible truncal lymphedema -- just swelling of the chest wall lymph system.    So -- it is important to be vigalent about stretching after surgery (and during radiation).  Also, asking for a prescription for PT or finding a good massage therapist will really help.

happyracoon, you have had a major surgery to your chest wall, it is going to take a while for it to heal.  If after 6 weeks the pain has not gotten ANY better, then you might need to ask them to evaluate you for some sort of infection; but at this point, it is, unfortunately, normal to hurt.  I am sorry. 

1965sally

Hi, yes, I did not stretch enough after surgery and regretted that!  But I can do everything I need to do.  Anyone reading this, please don't neglect the stretching.

 Happyraccoon, I hope you feel better soon.  I think it was about 4 or 5 weeks when I started feeling better, if I can remember that far back.  Do you have your drains out?  They make things much worse.  Watch out for any red streaks that weren't there before, and take your temperature, to be on guard for infection.  Good luck.