Struggling with a decision

lmanalo

I met with my general surgeon on thursday. Before the consult I was set on a lumpectomy/radiation and sentinal node biopsy. I do have one node with minimal involvement (that they know of). While meeting with the dr I decided to have a mx and auxillary node disection. I was certain when I left the office that I wanted a mx, uncertain about the auxillary node disection. I've read so much about the possible side effects that it scares me more than the mx.

Now, I'm not so sure about either decision. The mx is a worry because I want immediate reconstruction. The problem is I'm rather large busted (DDD) and am worried they are going to want to go the route of the expander - I just have no interest in being lopsided for several months. Not to mention the pain of expansion. I haven't been to see the PS yet, guess I'll have to find out my options before making that decision.

 The axillary node disection is the most bothersome. I keep reading about all the problems women on this forum are having after it. I just hate to think that if I have the sentinal and it shows issues I'll have to have yet another surgery. I know I'll at the least have to have the one involved node removed.I just can't decide what to do.The dr told me I can change my mind at any point up until the night before the surgery in March. 

Anybody else face this decision - what did you do? is a auxillary node disection really that bad?

pejkug3

I had a lumpectomy on Thursday 1/27/11.

Initially, I was supposed to have a SNB.  But my nodes were all bigger than my surgeon had anticipated so I ended up with an axillary dissection of level 1 and 2 lymph nodes.

The frozen dissection of the Sentinel Node was benign, I guess he took all the others as a precaution.

I'm just a few days out from surgery and it's painful, but tolerable.  I definitely know when I'm due for pain medication though.

I cannot speak to LE issues but my surgeon kept reassuring me that most women have no problem with it.

bevin

Hi There - I would encourage you to get a couple of consults with other surgeons if you can - this may help with your decisions. I chose to have a lumpectomy. I didnt want more invasive surgery than I needed.  The doctor said, they can always go back and do that if I change my mind, but since I was unsure, to do the lumpectomy.  Lumpectomy with rads and tamoxifen have the same cure rate as mastectomy according to NCCN guidelines. I also had an SNB where they removed 5 nodes, all were clear. I had slight LE and followed the excercise plan and stretches, and that went away within 3 mos of surgery.

Good luck on your decision. I am sure others will weigh in soon who went the mx route and can offer more insight to that tx.

Fearless_One

If it helps, I can tell you I had no issues with my lumpectomy and axillary node dissection.   And I also had rads in that area.  

The only reason I have opted for a BLMX, is because I have dense breasts.

lago

LE is a lifetime risk. I was told I had a 3% risk, probably less because I'm thin. I knew in my gut I would get it. I had level 1 (10 nodes) removed. Here is a picture of my arms when I was first diagnosed. It never gets worse than this.

Granted my LE is not that serious of a case. I'm between a stage 0 & 1. I have a feeling that when I get this chemo out of my system (less than 2 weeks from my 6th and last chemo) the LE will be less of an issue. I am seeing an LE therapist. I'm doing exercises and massage. Really not too bad. I do feel this will be managed and just have occasional flair ups in the future. The trick with LE is initially prevention and if you get it to treat it early.

I understand why my BS took level 1 nodes. My risk of having micromets with my diagnosis (agressive large tumor) was about 70%. Everyone was surprised and happy that my nodes where clear. Am I mad, no. I'm grateful that it wasn't in my nodes. I don't think I would have been happy if they found a micromets after surgery and I had to go back under the knife/anesthesia again.

Also remember there is still risk LE with even having a breast removed as well as sentinel node biopsy.

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As far as reconstruction you really need to discuss this with a PS. You might not even be a candidate for implants. I wasn't a candidate Latissimus Dorsi flap, TRAM flap or  DIEP flap because I'm too thin. I could to TUG or GAP flaps but that was much to invasive and involved micro surgery. All I could think is what if it fails. But with all these flap options you will be using our own body tissue and might be a better option for a larger breasted woman like yourself. I was an A/small B cup and plan to stay that size.

This site might give you some information so when you do discuss with your PS you won't be over whelmed with information. I highly recommend you see more than one. Make sure that they do other breast reconstruction procedures other than implants. http://www.breastreconstruction.org/