Axillary dissection vs. sentinel node biopsy?

Kate,

I had a bilateral mastectomy with sentinol node biopsy (dissection) on April 30, 2009.  I had three lymph nodes removed.  Two of them were positive for cancer (one had microscopic amount, other had .27 mm amount of cancer cells).  My oncologist wanted at least six lymph nodes so that he could acurately stage the cancer.  Check with your oncologist to see what he wants.  I had to go back for an axillary node biopsy on May 26, 2009.  My surgeon did tell me that this might happen but he likes to take as little as possible when it comes to the lymph nodes.  If my sentinol biopsy had come back negative I would not had needed the axillary node biopsy.  Check with your oncologist and surgeon.  Axillary node biopsy will be tougher than sentinol node but it is doable.  It just takes a little longer to recover from axillary node biopsy because the surgeon has to go deeper into your armpit.  Good luck!   

                                                                    Ruth

Kate, I sent you a private message. I also noticed you posted about running. I'm really thinking you should push for the SNB now.

With an SNB, they do an injection around the tumor of blue dye or radioactive material to find which node(s) the area drains to first - that's the sentinel node. The issue for multi-focal may be that the different spots may have different sentinel nodes. They might have to do the injection twice and take out two spots of nodes to be accurate for multi-focal and perhaps that's not done.

But another advantage of an SNB is that the pathologist can concentrate on one or a few nodes that are most likely to have cancer cells if it has spread and examine them very carefully instead of having twenty some nodes to examine and not being as thorough with each one. It would be worth checking with another surgeon.

i had a bilateral mastectomy and sentinel node biopsy. i do have an incision below the armpit for the SNB. i had two nodes removed, both negative. i agree with the above comments about getting a second opinion.

I had one tumor that had 2 sentinel nodes identified with SNB. One was removed under armpit, one was an internal mammary node. Both were removed, and sent to pathology..so results were not immediate during surgery. 3 days later, I got results that both were positive. So, then unilateral mastectomy & AND were done. Just got home today.

Joni

momgovero~I had my SNB on Monday. I was terrified because I read horror story after horror story on these boards. I felt one pinch from the lidocaine & that was it. NOTHING!!!

Now, I am sure each hospital does it differently, ask your bs, I did & he told me I would be receiving an injection. Keep in mind I had just had a lumpectomy 5 days earlier and still had stitches in my nipple, my breast was already tender & swollen & painful.

2tzus~I had a mastectomy & I still have an incision below my armpit from my SNB. 

Your MD needs to be skilled in SNB so maybe he doesn't do them. I went to a breast cancer surgeon specialist and he told me upfront that there can be false negatives which would require more surgery. I had a tumor in each breast so had a SNB on both sides last july. I really don't remember it being too painful. The SNB on the right was + so he removed 15 lymph nodes and 5 were +. The left SNB was neg initially but pathology came back + days later. I went back in and had 9 nodes removed, 3+ in the sentinel node and 1 additional+. I later had radiation to both sides. At this time I am waiting for reconstruction exchange in Aug. I fortunately have had no lymphadema problems but did go to PT for a few months after surgery. They often don't remove a large amount of nodes like in years past. Talk with your MD and get more info. Good luck!!

Kate, I am facing this question too, with further surgery tentatively scheduled for 6/22. This is a very controversial area without a overall clear answer.

I had a simple mastectomy with SLNB on June 1st, and one node came back microscopically positive.  

There are many doctors convinced that this surgery is overdone, because there almost always turns out to be no more detectable disease in the other nodes (sentinel node biopsy is very accurate). And there are side effects that may matter most to women like you and me who highly value physical activity.

But there is a a large and influentional group of doctors who believe that not removing the lymph nodes once one is positive may leave undetectable disease that will one day be shown to be a major factor in recurrence.

 The  best advice I have for you -- the advice I am following myself -- is do NOT get all your information on this from a surgeon. Surgeons are biased to surgery, and doing this surgery is considered state of the art -- it's the decision to skip it that needs to be defended.

You need to sit with an oncology, get oncodx, and look at the totality of your risk and your overall treatment plan before deciding whether this surgery is the right individual choice for you.

If you can't get this done by 6/19, postpone your surgery.  You can always say yes later -- it's a short outpatient operation -- when you are clearer in your mind.

Again, this is my same situation, and my plan to handle it.

 Judith