March 2014 Surgery
Comments
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thank you so much Kitty! I will keep that in mind and try my best to rest. I have Super-Woman Syndrome (don't we all???) and I have been known to do that to myself on many occasions. looks like they might be lowering the snow amounts by me which will be a huge relief too.
Good luck to all of you too!
xo
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Blueberry, I have a pre-op appt with my surgeon on Tuesday and I will ask. In my case, I have 2 definite unidentified lumps on my "good" side plus an area of scar tissue from a 2009 excisional biopsy (I had calcifications and a radial scar back then). I don't want to risk lymphedema on my good side with an SNB but if they find cancer and have to take ALL my nodes, it is even more likely. It would be nice to have one good arm for needle sticks, blood pressure readings, etc.
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Hello Ladies,
I'm scheduled for my bilateral mastectomy on Monday, March 3rd. I'm having my SNB done 2 hrs prior to surgery. I was scheduled with another hospital in February and for various reasons cancelled that surgery to find another surgeon, oncologist, etc. The first hospital was going to do the SNB the day before. Is there any difference? Is one way better than another?
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Julie, I am right there with you. I don't want to risk lymphedema on my good side, but doing a less invasive procedure now may save us from a more invasive/risky one later. I don't think a SNB on my good side is an option for me since no lump has been detected, just super dense breast tissue. I'll just keep hoping that they don't find additional cancer. There is so much to consider, and, for the most part, I have no idea what I am talking about.
An update on the SNB I had on 2/12 for those that wanted to know what to expect. The incision is all the way healed and I have most of my range of motion back; I can pull and push things. Some of the feeling has come back to my upper arm, and it only aches a little. I found sleeping with a squishy pillow under my arm super helpful as I couldn't stand for my arm to touch my body. The most unexpected part was that the incision never hurt the pain was in my upper arm and down my side.
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This thread fell off my Favorites list for a few days, so I'm trying to catch up. I'll update the surgery date list next.
Melisden, first of all welcome to our group. Both hospitals sound like they do the sentinel node biopsy the same way, although the timing is different. Radioactive isotopes have to be injected at least two hours before your surgery, but last several days so some doctors prefer to do it the day before the surgery. Be sure to ask for EMLA cream. We had a good discussion of SNB's back on Feb 23-24-25 so go back and read the details there.
Blueberry, you really don't need to bring anything to the hospital. Check with your doctor, but they will give you a surgical bra of some sort...you'll probably wake up in it. There is a good thread elsewhere on the BCO forum about what to bring to the hospital. Search for it under Active Topics.
Stfne, I had a BMX with immediate placement of implants. There was no problem fitting 800cc rounds. My pec muscles were not loose...in fact, I had been a long-time fitness instructor so my pecs were in good shape. The implants fit under the pecs just fine. I also had gigantic FF breasts but since I did not go for nipple sparing surgery, I could have the immediate implants. Your PS will likely have to order your implants days before the surgery, so you need to have the size discussion before that. The surgeon usually brings in several sizes of implants because he cannot be sure what will fit. As you've read, they will also bring in tissue expanders. Sometimes the surgeon who does your mastectomies will remove tissue pretty close to the skin so when the plastic surgeon takes over, he might find that the tissue is too thin. It may not have enough blood supply or there might not be enough of it to cover an implant so the PS will opt for a tissue expander instead. There's no point going ahead with a procedure that is likely to fail, so if you wake up with one or both TE's, it's not a big deal. Your PS is just looking out for you. He/she will probably explain all this and have you sign a consent ahead of time.
The smoking issue is HUGE. Many PS will not operate on anyone who is smoking or has recently quit. The chance of failure is just too great.
Iwanna and the others worried about colds: an upper respiratory problem could mean your surgery will have to be delayed. The anesthesiologist has to maintain your airway during the surgery, so if you are having a problem, he might cancel. Best to check with your surgeon the day before rather than show up and have it cancelled that morning.
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Re: risk of lymphedema after SNB
The most recent info on the Susan G Komen breast cancer website says you have only a 5% risk of developing lymphedema after a sentinel node biopsy versus 35% if they do an axillary dissection. If you don't do the SNB at the time of the mastectomy, they can't do it afterwards so if pathology shows cancer has spread to any of your lymph nodes, you will have to go back to surgery for an axillary dissection.
The National Institute of Health in a publication from April 2013 says: Sentinel node biopsy
For patients with breast cancer, sentinel lymph node dissection
has gained favor over axillary lymph node dissection for the axillary staging of
early disease because of decreased morbidity and because of the questionable
survival benefits of axillary lymph node dissection, as shown in a phase III
randomized study (ACOSOG-Z0011)
of axillary lymph node dissection in women who had stage I or IIA breast cancer
and a positive sentinel node.[18][Level
of evidence: I] Several studies have shown that lymphedema is more prevalent
in breast cancer patients who undergo axillary lymph node dissection than in
those who undergo sentinel lymph node biopsy.[19][Level
of evidence: II] One study evaluated 30 patients with unilateral invasive
breast carcinoma who underwent sentinel lymph node biopsy and 30 patients who
underwent axillary lymph node dissection. This study found a 20% rate of
developing lymphedema in the axillary lymph node dissection group compared with
none in the sentinel lymph node biopsy group.[19]
Rates of lymphedema among women who undergo sentinel lymph node biopsy have been
reported to be between 5% and 17%, depending on the diagnostic threshold and
length of follow-up.[20-22] The majority of diagnosed lymphedema is mild.[21][Level
of evidence: II]A July 2013 publication by Memorial Sloan Kettering is next.
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From Sloan Kettering hospital: (Sorry for the big font in the third paragraph)
Lymphedema is an abnormal swelling that can develop in the arm, hand, breast, or torso on the side where your lymph nodes were removed. This is called the affected side. Lymphedema develops when the arm’s lymph vessels are no longer able to carry all the fluid out of the arm.
During a sentinel lymph node biopsy, between one and a few lymph nodes are removed to check for cancer. Studies show that the risk of developing lymphedema is very low in people who have had a sentinel lymph node biopsy.
During an axillary lymph node dissection, a wider incision is made and more lymph nodes are removed from the armpit. This is done to remove additional lymph nodes that may have cancer. Studies show that the risk of developing lymphedema is higher in people who have had an axillary lymph node dissection than in those who had a sentinel node biopsy. This is because removing axillary lymph nodes changes the way fluid in your arm circulates.
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Linda505, you said your doctor said you had separate cancers. What did he mean. You have IDC in both breasts, right? Let me know what kind of reconstruction you are going to have so I can add it to the list.
Do I have everyone on the surgery list now?
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The stuff Sandra posted is all really good info.
I had my snb same day as bmx, few hours before. I think I'd rather, as a get it all over with in one day kind of situation.
I brought my drain belt to the hospital but didnt use it. Was in a surgical kind of wrap and the drains were pinned. Actually my ps said I didnt need any kind of garment, I just felt weird going without something right then. When I got home I started using the drain belt, it was awesome. Used it for over 2 weeks til second drain was out. Bring comfy loose clothes to go home in. Button shirt for sure. Maybe a tablet or book, but I didnt feel like reading or watching tv.
I was in for 2 days. By then my hair was gross. I jokingly asked nurse if they didnt have something- and they did! A 'shower cap' hair cleaning thing- she put it on, rubbed my head a few minutes, took it off, no water, and voila my hair was clean. It felt great. Ask about it.
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Sandra is certainly a kind and thoughtful host, isn't she? And we have aviva! Aviva, I asked for those showercap things in the hospital. It did feel good at the time. But truly -- since I had so many infections, and then the flu -- my hair was an extreme dirty mess.
I for one am sweating bullets for Wednesday. My chest is a mess right now. They are supposed to be fixing it. But I have heard that they will not be doing the job I'd hoped for. It seems the PAs at the PSs office are trying to prep me for it. And this new development, which happened yesterday, has sent me spiraling out of control.
Don't know if I can bear how it's going to look after. Really. So I'm not going into sx with much confidence.
Melissa and faerywings -- thinking of you two. You're up first! You are going to be great. XXXXX
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Welcome, Melisden!
Best of luck to you on Monday!
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blueberry - they inject around the nipple, not around the mass, so as long as you have breast tissue they can do a SNB - they can't do one after the breast has been removed. If they do the dye/tracer injections on the right before your surgery, then refrain from looking at the nodes unless something shows up in pathology - the nodes will still be blue later (essentially the Pink Lotus method mentioned above). I would ask your nurse navigator if you will be dressed in a garment of some kind in the OR - I had a mastectomy camisole on when I woke up, and it had drain pockets. I did not wear it long and used a clean shoelace to string the drains on for taking a shower. I had read about another great idea for showering. Use a piece of plastic wrap long enough to wear like a necklace (the JP drains have loops) when rolled up. That way you can throw it away and get a new piece for every shower. You can also use large safety pins to pin the drains to the inside of your clothes, or find a lightweight sweatshirt with inside pockets - or wear a one inside out and use the kangaroo pocket as a pouch. I had my drains less than a week, which is somewhat unusual, but since you are around the house mostly I am not sure investing in special bras and belts is worth it.
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March 10 for me: BMX with TE. 1 night over and hubby gets to stay in my room with me. Microinvasive ILC in gigundouus fibroadenoma.
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Hello all I am new to this group, though I have had my surgery date for about a month. I was diagnosed Jan 8th with multicentric IDC. So it's a mx for me on March 10th. (Julie, we share our date!) Although the very early days when I didn't know much and had no plan I think were more difficult, my anxiety is growing each day as the surgery approaches....on the other hand I really want to get moving after all the tests and discussions with docs. The information on the SNB has been illuminating. I asked what seemed like hundreds of questions of the BS,PS and MO, but still find great information here on things I didn't cover.
Sandra, thank you for keeping we March Dates together and your thoughtful posts..Aviva, your shower-cap shampoo sounds very handy! Have any of you been started on Arimidex of Tamoxifen? I was started the middle of January.
Melisiden and faerywings very best wishes for a good outcome on Monday.
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Luppie,
Welcome! I started Anastrozole a little over a month ago. Side effects ( achy joints, flulike aches and sudden depression) started about 2 weeks ago for me. SE aren't everyday, so that helps make it tolerable. Have you started on a hormone inhibitor?
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Kitty, thank you for the welcome. Yep,I started on Anastrozole January 16th. I have had trouble with sleeping , I think it's caused by the MAMMOTH hot flashes that wake me, then I have problems returning to sleep. I've tried Ambien with not much success. I also have had a few days of sudden depression-that's your very good description-it comes and goes from out of nowhere. I have minor aches and pains but strangely, they seem to occur on the days I don't workout .So far the SE's are tolerable for me too. Fingers crossed they stay that way for both of us.
Aaisaandjoel, Tarot, Blueberry, jbdayton and Juliecc we all share the same surgery date, wow. Not long now....
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There are 24 of us now. March 10th is the most popular surgery date...5 of our group will be in the hospital that day.
Re: drains
SpecialK is right, there's not much point spending money on something to hold your drains when you won't have them for long. Several things worked great for me. One was a l-o-n-g piece of dental floss that I made into a loop to go around my neck. Then used big safety pins to attach the drain bulb loops. Perfect in the shower. Another was an equally long piece of flat 1/2" elastic with the bulbs pinned to certain places on the elastic depending on what I was wearing. Idea three is to take a pair of tube socks, cut off about three or four inches at the toe to make pockets. Pin them to the bottom of a surgical bra, sports bra, Genie bra, or sleep bra.
As for garments, you will probably wake up with some kind of surgical bra, camisole, or maybe even an ace bandage. Some doctors have you in bandages and tape instead. Mine was a surgical bra that zipped up the front. It was tight so the first time the doctors came for rounds and unzipped it, I POPPED out and it hurt. After that either I did the unzipping myself or held on to the outsides of the bra while the doc unzipped. Some bras have hooks and the same thing can happen. My bra had little pockets to hold the drain bulbs. They were attached to the bra band with Velcro. Quite handy. I used my homemade sock drain pockets when the fancy ones were in the laundry.
Careful: drains can have very long tubing. Sometimes you get focused on pinning the bulbs to your bra that you forget the tubes. You will only pull down your pants along with the tubes ONCE...ouch! If they hang down past your waist it's an accident waiting to happen. I sat on one in the hospital, then tried to scoot to the side of the bed and MAN, did that hurt! The tube pulls on the suture that is holding the drain in place. It stings! You can loop the tubes up and pin them separately until you see the doctor again. Then ask him to cut the tubing to a manageable length.
Make sure that your pajamas don't come up too high under your arms. It will rub and make you crazy! Nightgowns are a bad idea. Don't take one to the hospital. Get several pair of cheap Walmart pj's a size too big to make sure nothing is touching or rubbing.
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On the subject of drains I also found that it helped to tape the tubing to my skin just below the exit from the body with paper tape to prevent an unplanned tug.
Sandra - you can add me for Mar. 7
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Good tip, Special. What do you want me to put down in the description of your March 7th procedure?
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Here is a link to an excellent video on rehab after breast surgery.
http://breastcancerrehabilitation.com/Rehabilitation.html
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Thank you all so much for the good thoughts and I am sending them al back to you for the entire month.
xoxox!
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There is so much great advice here! I met with my plastic surgeon for a pre-op last Thursday and it was very rushed. I was able to speed through my questions but I thought we could spend more time talking about expanders and implants. Hopefully my pre-op with the regular surgeon on Tuesday is better. I have Kaiser and you can email doctors online. My regular surgeon is bad about writing back. Over the last month I sent 3 questions and 2 went unanswered. Boo.
About mastectomy bras. I have an appointment 2 days before surgery to get fitted for 2 mastectomy bras. (One to wash and one to wear.) I think I bring one of those to the hospital and I'll wake up in one.
SNB - At 3:00 the day before surgery, I go to get injected. My surgery is the next morning. I have no idea if they are injecting the radioactive stuff, blue dye, or both. I have so many questions on the list for my surgeon.
What meds have you been subscribed? I already have my post op meds: Keflex (an antibiotic), Diazepam (muscle relaxer?), Zofran (for nausea), and hydrocodone-acetaminophen (for pain).
At the end of surgery, the PS injects this stuff called Exparel in the surgical sites that is supposed to give 3 days of pain relief. I hope it works so I can take less narcotics.
I am the first surgery in the morning and I am released the same day to go home unless there are problems. The surgeons said it is better to go home because of germs.
Good luck, Everyone!
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Sandra - I am having a procedure to re-mesh with a different, and hopefully superior, product called TIGR mesh - the dermal matrix used to make a sling to support the implants. I am having failure on the underside of the breast (bi-laterally), and I have abnormally thin pectoral muscles, so this is presenting a problem. I would call it a repair/revision of dermal matrix.
Julie - be careful with Zofran, it can cause a wicked headache. The kind of mastectomy bra you purchased probably is not the same type as what you may wake up in. Those are surgical bras and usually somewhat compressive.
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Good to know about zofran. I'll ask the surgeon about the bras. The "breast cancer coordinator" is the one who sent the bra order to a specialty shop. I guess they sell bething suits, breast forms, and also sorts of things there.
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Julie, did they talk to you about Emrel Cream before the SNB injections? That's one thing I am definitely finding out about. Sounds like they are taking good care of you though. I hope I get referred for some special bras for the healing process. I have bought a couple and my daughter is sending me the ones she used. What a thing to get to share huh? But, I am sure hers will be too small. She is a tiny little thing and obviously much younger than me so she hasn't gained those menopausal pounds that I have!
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Honestly, I never wore any special bras - the Ah bra or Genie bras work fine. The issue is that once they begin fills these bras may not fit, so something stretchy works throughout the process. I did not get regular bras until after exchange. Mastectomy bras are made for those not having recon - they are made to hold a prosthetic.
KLJ - the cream you are referring to is EMLA - or lidocaine cream. You need to check with your individual docs on this - some don't like to use it because they feel it may have an adverse effect on the injections. I have used it for chemo port access, but did not have it for bi-lat SNB.
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The emla cream for SNB is on my list of the tons of questions I have for my surgeon :-) I see him for a pre-op on Tuesday.
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Thanks SpecialK! I knew I would get the name of that cream wrong. I'm going to ask about it and then I need to let it go. I think I am overthinking the pain that I have read about from the injection for SNB. That's the problem with having to wait so long in between diagnosis and surgery. Too much thinking time! But, I have stayed away from Google and only researched here and on the picture forum. I did get Genie Bras so I think I will stop over thinking that one too. If I could just shut my brain off and let the next 2 weeks pass right on by and get this overwith
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klj - lol! I know it is easier said than done! As I said, I didn't have Emla for my bi-lat SNB and the injections do sting, but after that it was quickly forgotten. In hindsight, I would not have needed it. Don't worry too much about the bra thing too - soft is good - remember you will be dealing with drains and incisions so too structured a bra might not be comfortable. Remember that you are not trying to hold up breasts with the bra! I also had quite a bit of time from diagnosis to surgery - I knew on Sept. 9th what was going on and did not have surgery until Nov. 1st - lots of time to wonder and worry!
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I agree that there has been WAY too much thinking time! I too have only researched here and have purchased the Genie Bra. I also bought ear plugs and a sleep mask. I bought a couple of comfortable button down shirts and zip up hoodies and tank tops that can be stepped into to wear under the zip up hoodies when I get home.I will be bringing my iphone to listen to music and plan on making a "happy" playlist.
Friday was my last day of work until I recover. I plan on cleaning closets and drawers while I wait for Thursday. I have had so many friends and family offering to help out with the kids and house that I am starting to worry about them thinking that I am a slob. I tend to throw everything into closets and drawers to pick up the house before cleaning. I will be sending the kids to daycare this week and getting everything settled for them. I am also planning on getting a massage and a pedi on Wednesday. The nurse said I can have polish on my toes!
I'm calling the PS tomorrow to ask some questions and make sure that we are on the same page.
Trying to stay positive and not freak out. Music is helping. I'm gonna go down load that song "I'm happy" and dance with my kids in the kitchen. Maybe hubby will join us. He must be stressed too because he went out and bought me flowers today. That is not typical!
I think I am rambling.
Wishing a speedy painless recovery to all!
Faerywings and melisden I will be thinking of you! Hugs
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