How Do SNB if Didn't Happen in Lumpectomy?

Girl53

All: Just got call that my MRI and mammogram didn't find additional spots of ILC...yay!

But question: After my initial talk with BS, and discussion of possible PBM, I don't understand how/when SNB fits into process. I asked scheduler whether this was next step, and she said I should coordinate with plastic surgeon. I told her I hadn't decided yet on this treatment.

When/how is SN check done in cases like mine in which you've already had your lumpectomy (doctor got lesion out with clean margins during excisional biopsy), and you're deciding between mastectomy or radiation/chemopreventive? Aren't SNB results part of what would drive the decision? In other words, how do they do SNB if it's not part of an already-scheduled surgery? I think I'm missing something! Thanks.

SummerAngel

A SNB can be done by itself if necessary. I had my left-side tumor surgically removed, thinking it was benign (biopsy came back as a fibroadenoma), but when pathology was done on the entire mass they found cancer in it. I did not have clean margins, though, and wasn't eligible for rads (connective tissue disease), so I had to have a mastectomy. I was concerned that the sentinel nodes wouldn't be able to be found because the lump had been removed, but that's not the case. The radioactive substance (and later blue dye) were injected in another part of my breast and the sentinel nodes were found without an issue. As long as you have breast tissue they can usually successfully perform a SNB.

Holeinone

girl,

I had a punch biopsy on the sentinel node during the biopsy on the tumor. It was full of Cancer.

Call your surgeon, talk to his nurse. They seem to have more time & willing to explain what is protocol, or that particular surgeons preference.

If you can avoid having the node surgery, I would. It is much more invasive than removing a small tumor. They cut through nerves & muscles. Your arm is never the same. Weird numbness & weakness. That was my experience.

Girl53

Summer and Holeinone: Thanks for helping me understand. Just talked to doctor, and she said we could do SNB before I consult onc re: treatment plan, or after...but also said it would be better to avoid multiple surgeries and we could check SN if I chose mastectomy. I'm going to see oncologist soon and talk with her about risk and about treatment options.

When I asked surgeon, "Did you say PBM not unreasonable option for me because of my clinical profile, or my personal risk aversion?" She didn't answer my question. She just said, "It's a personal choice." She also said that, even with ALH, LCIS, dense tissue, and strong family history, risk on my contralateral side "wasn't that high..." 20 percent. I thought my risk was higher. ??

SummerAngel

Holeinone, where did you find the information that muscles are cut during a SNB? I've never seen that before.

Also, my arms are fine, and I had SNB on both sides.

There is a small risk of developing lymphedema from a SNB, but it's typically a necessary procedure in order to correctly stage the cancer.

SummerAngel

From what I've read, many women with BC on one side overestimate the risk of getting it on the other side. There are statistics about this, but I haven't looked them up. I would think your MO is most likely correct.

Girl53

Summer: BS told me she'd have her coordinator get first-available appointment with MO. The woman I will see has excellent reputation and is also very knowledgeable about genetics. Hoping she can clarify for me what, approximately, my recurrence and contralateral risks are, given my BC type, fam history, tissue density, ALH and LCIS, etc.

BS said last week that, now that I have actual BC dx, the LCIS was "off the table," kind of moot. Is this correct? I've read that there's disagreement about clinical significance of LCIS (is it a marker or a precursor?), and that its presence does make a difference to ongoing risk. Two sources:

http://www.cancer.gov/types/breast/risk-reducing-surgery-fact-sheet#q3

http://www.webmd.com/breast-cancer/guide/preventive-mastectomy?page=2#1

This point could make a huge difference for me in treatment decision. This is confusing.

SummerAngel

I'm not surprised your BS said that. They focus on the "actual cancer". In my case, my "extensive LCIS" was noted on final pathology but not expanded on at all. I have no idea what "extensive" means to them, and when I asked no one could say because it was considered "incidental". Same thing for the isolated tumor cells found in one of my nodes. My MO actually called that "meaningless".

Girl53

Summer: Thank you for good insight. I haven't read your whole history/all your posts here, but wonder if you have been basically happy with your mastectomy choice. It doesn't sound easy, but it sure does sound like it dramatically reduces risk. And my impression is also that doc is focusing on "cancer right in front of us," and not future. But with my personal trauma history and situation with desperately ill late husband, peace of mind is a high priority. This is so hard.

Just talked to family member last night who had PBM years ago due to high risk. She lives in Longmont!

SummerAngel

Funny that you have family in my town! I'm completely at peace with my mastectomy, but I do think that for me, personally, it was better that I didn't really have a choice. I couldn't have radiation due to connective tissue disease and I had bilateral cancer. So, that was that! When I first found out the left side had cancer I contemplated just leaving it alone (I had assumed I had DCIS because the BS told me they found "a little bit of cancer" in the lump). Then I realized I couldn't keep the breast because of the IDC and no rads, so I thought I would have a single mastectomy. Then they did an MRI and found the right-side tumor, and the entire tumor board at the hospital recommended BMX. The radiologist who did my second biopsy pulled me aside after and told me that if I had second thoughts about a BMX I shouldn't. He said he had rarely seen so many areas of concern in both sides and if I decided against BMX I would have to have a minimum of 4 more biopsies.

All that being said, if I could have spared at least one breast, I would have. It's a totally personal thing, though.

Holeinone

Summer Angels,

You are correct, no muscles being cut. My axillary node dissection was/is painfull & numb. I had a lot of Cancer in the nodes. Also extranodal extension.

Had I known that, I probably would of wanted a BMX. But got a lumpie, easy compared to the reconstruction of a BMX