Surgery Monday....question

Personally I would have whatever test was available while I was there and undergoing surgery. I opted for a prophylactic removal of my right breast even though there was no evidence of disease after MRI's and biopsies. Some people questioned my decision but I did it for me. Post surgery showed that the rt breast was very busy and probably would have ended up cancerous. Better to be safe I say! Wishing you all the best!

Like Annette, my SNB incision caused the most discomfort, took a long time to heal, and is still sore five months later. I am still numb under my arm from my armpit halfway down to my elbow. After the SNB I learned of the risk of lymphedema and partly wished I hadn't done the SNB. I did have IDC found in the first biopsy, so it probably was a good idea to check my lymph nodes just in case. As others have said, you can always have it later and why put yourself through the discomfort and risks if you end up only having DCIS.

This was exactly my situation.  Dr. thought pure DCIS.  We discussed Sentinel node biopsy and she told me if there was no invasive cancer it was not necessary and that the incision was separate from the DCIS incision and would likely be more of troublesome than the DCIS incision.  My pathology returned the following week and microscopic invasion was found.  Yesterday, exactly two weeks after my lumpectomy I returned to the same surgery center for a Sentinel Node Biopsy because of the mirco-invasion. It has just been 24 hours since my SNB, and I would agree that this incision and procedure is more painful.  I'm still just sticking with Tylenol, but it is definitely a bit rougher.  I will also note that the SNB was down under general as opposed to twilight for the DCIS.  With all of this being said.  I would do it exactly the same way.  DCIS surgery than wait for pathology.  It is likely you will not need the biopsy.

The number of nodes taken depends on your anatomy ... this idea behind a sentinel node is that it is the first node that any cancerous cells would drain to, so if that is clear, then the likelihood of any cells having escaped is incredibly low.    To test it, they inject a radioactive dye into your breast near the tumor (or sometimes around the nipple), with the idea being that the first node to get hit with the dye will "light up".   If only one node "lights up" with the radioactive dye, then that is all that needs to be taken.   In some cases, more than one lights up so they don't know which one is the "sentinel" one, or they are too entangled to tease apart and are removed in a cluster.    I had 3 taken (they all "lit up"), but my mother (who had a mastectomy) only had one as that was all that lit up for her.

Sure hope that node is negative for you!

Yes, that's my understanding ... one way to think about it is as a chain (although that's not completely accurate as they do eventually branch, but it works for this).  If you remove the first link, then the next link become the first link.

Good luck on Monday, Lc! I'll be thinking of you and please come back and let us know how you are. 

I think that this discussion of lymph nodes may have solved a mystery to me of my mother's experience with cancer in 1978.  I have her journal that she kept while at the hospital before and after her surgery.  She went into surgery not knowing for sure whether she'd wake up having had a mastectomy.  Evidently, that's how they did things then - would check pathology and if the lump turned out to be invasive, they'd perform mastectomy and remove lymph nodes.  My mother had 12 nodes taken and was told later that 3 out of 12 had cancer cells.  There was some discussion with the tumor board as to whether she'd have radiation and chemo, radiation alone or nothing at all. One doctor voted for no treatment, but he was outvoted by the others who thought she should have radiation.

It was decided that she have five weeks of radiation, and at about week 5 she was entered into a clinical trial involving the injection of dye into the remaining lymph nodes and then a few hours later (after she and my Dad went out for lunch), going for an x-ray. She was only the sixth person in the trial, and was nervous about it but was told that it would be beneficial. 

I had always wondered why, if cancer had been detected in the nodes, that she wasn't given chemo in addition to the radiation.  But reading the above, I think that the trial must have been looking for the remaining nodes to "light up".  Perhaps if any had, she would have had another surgery and chemo added to her treatment.  I know that this possibility hadn't even been discussed with her.  After the procedure, she had another week added to her radiation treatments. And that was it.  I'm assuming now that nothing "lit up", so the doctors felt they had made the right call with surgery and treatment?  She was 60 then and lived for 33 more years! 

Lois-

  Just wanted to wish you good luck on Monday.  I had surgery a few weeks ago for DCIS and also had sentinel node testing done. It sounds like you have a good rapport with your surgeon and that is so important. He has the benefit of looking at all the standards for treatment plus the advantage of knowing your unique situation and history. In my case my surgeon recommended this due to family history, I have two sisters who had invasive ductal carcinoma in mid 40's and I was 43 at surgery. I talked to my sisters but also several good friends who work in different types of therapies with lymphedema patients but also knew the risk is low with this type of removal versus more radical techniques. My surgeon normally wouldn't do with every patient but felt like in my situation it was a good idea to guide care.

  I had my sentinel node testing and wire placement done at an outpatient facility in the morning and then went to hospital for surgery-got to love insurance companies and I am an RN in this hospital! Not sure if that is the case for you- I hope not- but if it is, I have to tell you it was a piece of cake and I was more nervous about this than surgery. Sentinel node study was just pinch and slight burn followed by scans. Totally awake no sedation and it was fine. Wire placement-my DCIS was not visible or palpable-just caught on baseline (1st) MRI so clips were placed with MRI biopsy and they basically place a wire to  the spot clip is in so surgeon goes to the right area. Not everyone needs this but if you do this wasn't bad either. Basically lay on stomach like MRI and have a few lidocaine injections to numb and it was over before I even knew it started. (I am not superwoman and found the MRI biopsy pretty uncomfortable so after that every thing has been uphill.) Couple of gentle mammograms shots to confirm placement and wire just covered with gauze and taped to chest. My husband and I laughed when I came out because I had visions of having to get into the car and having some long wire out an open window but in reality just couple inches long. I had surgery like 3 hours later and was completely comfortable in waiting room.  I told my surgeon if surgery was as easy as first two things we would be good.

 Long story short, I ended up with two lymph nodes removed during surgery and very happy they were negative. Yes, it was sore afterwards-more than lumpectomy site- but what helped me was sleeping with a small pillow-a decorative one from comforter set-under my arm. Made a big difference. You also have to remember in the OR they place us with arms kind of up and over head at times so some discomfort post op can be from that as well. I had fair amount bruising in arm pit. Ultimately knowing those nodes were negative helped me and my surgeon decide on next step when 4 of 6 margins were still positive in pathology report. I opted for second more involved but still breast conserving surgery one week after first surgery. Nothing invasive and nodes being negative makes me feel more confident in decision.

I wish you luck and want to add, I just returned to work this Wednesday night-three weeks from first surgery. I work in a neonatal intensive care so I was lifting little babies during night and really felt good. No issues with arm pit or arm now just a little sore at incision from last surgery. My advice- really take it easy after surgery and follow rules for lifting-only time I was really uncomfortable was lifting my little one too early. Try the pillow under your arm-my husband's idea and it really helped. Sorry this is so long but thought it might help the hear a recent experience with this. I will think of you and your family Monday.

Lois-

Glad to reassure you. Our experiences can be a little different but I think the caveat is finding a team to care for you that you trust, respects your decision, are open to any (sometimes many) questions we may have. My surgeon has been open to second opinions or going to teaching facility if that is what I chose at any point. That means a lot. It sounds like everything located close together in your area so you should do well. I was next door to hospital I work at but had surgery in main campus downtown. It was kind of a long day and yes, I was hungry by surgery time. Started first procedure at 10am and surgery at 330 pm. Not sure it made any difference but I was worried about being thirsty and knew I had afternoon OR time so I drank couple bottles of water between 930 and 11pm night before w little light snack. I didn't find myself thirsty though I did envy my husband's coffee. One other thing if you are prone to nausea with medications please let the anesthesiologist know. They can pick certain medications, premedicate you, or give you something in postop. I even got patch preop which I left on couple days after both surgeries, helped with nausea for couple days pain meds and I had general anesthesia both times.

Thank you for the advice on something for sedation with MRI biopsy. I didn't have anything before first MRI and struggled with feeling claustrophobic. I am a light weight with any pain medication and I have never taken  Xanax or Valium so I just went for it. After the first MRI I told the tech- Ok, I am never having this test again, little did I know! Couple months later I have had MRI biopsy once, second aborted MRI biopsy on opposite breast but will have follow up MRI for that in three months. I do try to just relax and take my self somewhere else in my mind. It does help but I think maybe I will try something to take the edge off and get a ride. I am having radiation for 6 weeks starting 4/7. Waiting a little over three weeks since last surgery to heal a bit more. Good luck Monday!

Megan

What a good way to think of it, motherofone.  My mother's little journal rode in my purse for each day of my treatment.  I almost felt I had her with me.

Good luck tomorrow Lois! I will be thinking healing thoughts for you:)

With my lumpectomy and SNB I asked for a spinal block and a sediative rather than general anesthesia. I believe this helped with recovery. The anethesiologist thought it was a good idea and that it may be a better option for lumpectomies.

Lois!  Yipee!  Great news, now time to heal!

Lois, I'm so happy and relieved for you!