Lymphedema from a Biopsy?

MishaT

I am currently undiagnosed but have been scheduled for an excisional biopsy on Jan 31. I felt a palpable mass in my breast and u/s showed a lymph node that does not look concerning to the radiologist. Nonetheless, the breast surgeon thinks the safest thing to do is to remove it and have it biopsied.

I've been reading this board like mad and now am worried about lymphedema. Has anyone gotten lyphedema as a result of one node being removed? How concerned about this side effect should I be?

flannelette

From my experience not at all. I had 6 nodes removed during my mx in 2008, and 6 nodes removed from the other armpit last summer and no lymphedema at all. went swimming as soon as possible after the surgery this summer - I think using and extending your arms probably helps.

Binney4

Flannelette, I'm so happy to hear how well you're doing! The risk of lymphedema is on-going, though, for the rest of our lives, so you might want to check out some risk reduction guidelines here:
http://www.stepup-speakout.org/riskreduction_for_lymphedema.htm
Stay well!

Misha, knowledge gives you some control over the risk. Any surgery or other trauma to the area can put us at risk, even with no cancer present, but the risk does increase with number of nodes involved, so your risk would be low, but not non-existent.

You might ask any doctor on your team for a referral to a well-trained lymphedema therapist for baseline arm measurements, personalized risk reduction tips, learning a gentle lymph self-massage, and possibly fitting for a compression sleeve and glove or gauntlet (fingerless glove) to use for exercise and travel. After the biopsy, keep your arm below shoulder level (not stretching the axilla) for the first two weeks to allow for maximum healing and repair of the lymph vessels. Stay well hydrated, pause from time to time to do some deep abdominal breathing, and return to regular activities and exercise slowly and incrementally, rebuilding your strength gradually. Let us know how you're doing! It'll be good!
Gentle hugs,
Binney

dogsandjogs

I don't think you will have a problem. I had 17 nodes removed years ago and never got lymphedema. But I was a marathon runner and very active so I'm sure that helped as I started running as soon as possible after my mastectomy/reconstruction.

carol57

In round numbers, about 40% of women get lymphedema after breast cancer treatment, most within the first three years, but as Binney said, the risk remains for the rest of our lives.  So, why are some of us in the 40% club and others in the 60% LE-free zone?  Studies abound that show that some BC procedures and treatments put us at greater risk for LE than others.  

For example, and it only makes sense, if you have lots of nodes removed, and especially if many of them had malignant cells, you are at greater risk than if you had no nodes, or only one or two removed.  And yet there are lots of women who have 20+ nodes removed and never get LE.  

My own mother had just about every node removed with her radical mx nearly 45 years ago, and she also had a long course of radiation, which also heightens the LE risk.  But she never got lymphedema.  Me: sentinel node biopsy only, and I find myself in the 40% club. 

So, we CHEER for Flannelette and dogsandjogs and want them to never get LE, but those of us who have it really, really want everyone else to learn about their LE risk and take whatever steps they can to reduce it.  

Misha, The risk of LE after lumpectomy alone is quite small, about 3%, and losing one breast node would also seem to pose very little risk (I don't recall a study that mentions LE risk after loss of one node from breast tissue--I think that's what you're describing, not from the axilla). So, probably you won't get LE, but in this case, forewarned really is forearmed, and you can take simple steps to hedge your bets on staying in the 60% LE-free zone. Binney gave you some great ideas for risk reduction.   Keep us posted on how you do!

Carol

MishaT

Thank you all. Without this thread, I would never have even known about lymphedema. I will definitely talk about it with the breast surgeon and do everything I can to prevent it. The staying hydrated thing is something I am very bad at, so I am so glad to get the advice  as well as restricting range of motion in the arm post-surgery and even deep breathing. I don't know how I'm going to convince my two boys (8 and 6) to stop jumping all over me as I heal, but lymphedema sounds like a beast. So sorry for those of you dealing with it.

ktym

Misha, you could also see if there is a way they could needle biopsy the lymph node and not actually take it out.  They may or may not be able to but if it is possible it would help cut down your risk some.  I'm loving all the positive thoughts and encouragement here.  Just keep in mind if something like swimming or running post op was proven to help prevent lymphedema they would be recommending everyone do it.  But the encouragement is great and hopefully you'll be encouraging other people in the future about how you never got LE after your operation.  IMHO Binney gave great advice.

Jolly

I don't think there is a predictable answer for this. One more data point: I had two lymph nodes removed, no chemo or radiation, and I have lymphedema. I don't think I had good advice on immediate post surgery movement and exercise. I also think I had a previously undiagnosed primary lymphedema in my foot. I wish I had spoken to an expert in the field beforehand. Now I manage it with swimming, MLD and visits to a well trained PT.

MishaT

This is all very good advice. Thank you so much.

I was going crazy about all of this and made an appointment to have a consult with my GYN just to talk through all my various test results. She seems to think I am low risk for LE because they won't be removing an entire node, just a 1 cm part of one. Crossing my fingers that she's right.

In any case, I'm going to contact a LE therapist in my city and do all the preventative stuff. My surgery is late next week, so I have a little bit of time.

Beesie

Misha, I saw this thread earlier and didn't comment, but I just saw your most recent post where you mentioned that your film images were rated BIRADs 3. You've made the decision to have an excisional biopsy rather than go through the "watchful waiting" that is often recommended for a BIRADs 3.  I understand the reasons for that, but a BIRADs 3 means that there should be no more than a 2% chance that cancer will be found. With such a low risk of a breast cancer diagnosis, this certainly puts into question why your surgeon is recommendating the removal of a lymph node (or part of a node), particularly since the radiologist does not think the lymph node looks concerning.  

If you were going into an excisional biopsy with a BIRADs 5 or a BIRADs 4C, I could understand a recommendation to get the nodes checked at the same time. But I'll honestly say that I don't think I've ever heard of a situation where someone had a node removed during a BIRADs 3 biopsy.  Remember too that if you do unfortunately turn out to be one of the 2% and cancer is found during this biopsy, a sentinel node biopsy can always be done afterwards.  

If you weren't so concerned about LE I don't think I'd be saying anything, but given your concern (which is certainly a legitimate concern), should you be probing your surgeon more about why he/she feels it's necessary to remove the node (or part of the node - not sure how only part of a node is removed??) when it's so unlikely that cancer will be found?

MishaT

Good questions, Beesie. I've been going back and forth on all of this myself. I have found this process very frustrating. the communication process is awful.

The BS recommended surgery for peace of mind and because he just couldn't confirm the radiologist's finding (that it's a lymph node) through touch. It was seen on u/s but not mammogram but it is palpable. I have been having pain for months, I have family history, and I'm scared. The BS never mentioned lymphedema to me either, I only learned about it here. You are right that I need to discuss this with him STAT.

lemon68

Hi

I have a similiar question. I had SNB on 1/24, he though he got 4 but he said they were so huge ended up taking only 2. He did tell my hub he had to move some nerve/vein in the way and dig alittle. My incision is horizontal about 4 inches. Looks as though it is healing fine but I feel like I have a washcloth rolled up under my arm at all time, that is the swelling. The pain has been bad, bad enough that I am still taking the pain killers. Today the pain in radiating down my inner arm to elbow. I have no idea if this is normal or not? I feel like it is so swollen around incision and above it almost feel like it could be drained. Do they ever need to drain this area after a SNB? Monday seems far off to go in and get it checked, any advice or opinions is appreciated.

Thank you so much for having these threads, boards are literally a life saver!

carol57

lemon, I am only guessing here, but it sounds like you might have developed a seroma, which is a pocket of fluid. 

IF it is indeed a seroma, here's some information you might pass along to your surgeon, from the following site:

http://www.stepup-speakout.org/essential%20informat%20for%20healthcare%20providers.htm

--Treat seromas promptly: from San Antonio Breast Conference 2010, “Seroma usually leads to prolonged wound healing, tissue inflammation and subsequent fibrosis and necrosis. It has been hypothesized that seroma formation is one of the main risk factors for post-breast cancer lymphedema.”   Seroma Formation Is Associated with Lymphedema-Related Symptoms. 
http://www.abstracts2view.com/sabcs10/view.php?nu=SABCS10L_478

In any case, you should really get it checked, and best wishes for a simple answer that can be addressed promptly!

Carol

lemon68

Thanks Carol, I think you are correct. I looked it up and even found a picture and its looking very similiar. My hub said earlier it looks like a water balloon exactely what one of the articles said.. hmm, lovely. Thank you so much for your knowledge I will be calling my BS in the morning to have him take a look. Seems like it has gone down since yesterday so hoping for it to continue.