Should I have a SNB?

Dear 4casygirl,

I am so sorry that you are in this position faced with the decision about the SNB, which is a pretty standard procedure in most bc cases. Like the other drs said, you have not had any pathology done on any tissue, and it happens sometimes that there is IDC present that is missed. That to me would be an indicator to go to for the SNB. They take only a few nodes, and chances are that those will be negative, Then you can have complete peace of mind. If you don't have an SNB, you may always worry that something may have been missed. The SNB procedure was developed to spare women unnecesarry pain and trauma, and also to lessen the chance of lymphedema. Years ago women were basically butchered, all nodes were taken out and they just had to live with the consequences, but nowadays things are much different. It is important that you get the best breast surgeon available to you.

4casey, I don't have any expertise to say whether SNB or not, but I can tell you that one well-designed study showed that if you wait at least 7 days after your mastectomy/snb before lifting arms above the shoulder, you can reduce your LE risk.  It's common to have you start PT for arm/shoulder mobility right after surgery, and not so many breast surgeons seem to be up to date on the LE literature to know that delaying the PT or any 'wall walking' or other stretching upwards does not cause mobility problems, but it does reduce LE incidence.  So push back if you have SNB and anyone tells you to start stretches before one week has passed (some LE folks are saying to wait ten days as extra caution).  It doesn't mean you won't get LE, but it puts the odds a little more in your favor.

Here's a link, if you want to see the study abstract:  http://www.physiotherapyjournal.com/article/S0031-9406(08)00113-2/abstract

It's very smart of you to consider your LE risk with SNB.  I have LE after SNB--it happens, and the risk is quoted in a wide range, depending on the study one chooses to believe. I was told 1-3% but since then, I've seen studies that suggest the risk of LE after SNB is as high as 17%.  SNB does not mean losing just one node...up to 5 is not so rare.

There's no clear path to a decision here, is there?  Best of luck sorting it all out.

Carol

4Casey, the risk is there, although 'just' mastectomy poses less risk than mx combined with SNB or especially when combined with axillary node dissection, i.e. lots of nodes removed.  Vicini and Shah did a study of studies not long ago, looking at the research literature to see what the studies were finding regarding LE incidence with various breast cancer treatments.  Their review  found that mastectomy combined with SNB, but no radiation therapy,  yielded risk percentages ranging from 3-23% in various studies.  The problem with LE studies is that there is no common method of measuring to diagnose LE; no standard diagnostic criteria; and highly variable patient follow-up periods.  So the whopping huge range of 3% to 23% is probably explained by variation in study variables.  Here's the link to the abstract:  http://www.ncbi.nlm.nih.gov/pubmed/21945108  --but to get the value from this excellent article, you need to see the entire article.  I think your breast surgeon would be able to get access to it.  Can you send a note asking the office to try to get a copy? 

Carol