Sentinel node dissection for prophlactic mastectomy?

lemonadehk · January 2016

Hi all, I was diagnosed with IDC in my right breast last January. Had mastectomy and anxillary lymph node dissection. Later on I was tested positives for BRCA2. So I decided to have prophlactic mastectomy on the left side to be safe. The surgery will be next week.

My surgeon suggested that I consider sentinel node dissection. She said there is a small possibility of false negative for MRI and mammogram imaging tests. If it turns out that there is cancer, then I would need an anxillary dissection. And since I had anxillary dissection on my right already, it would not be good if I have to have anxillary dissection on the left as well.

Has anyone had prophylactic mastectomy? Did you have sentinel node dissection? I would appreciate any thoughts/input.

BethL · January 2016

I had bmx in Dec. The right was prophylactic and I did not have a node dissection or boops on that side. Only on the side with cancer, but I am not BRCA +. I'm no expert, but I thought they I inject the dye near the tumor and then map it to the nodes associated with that area. Not sure how they woukd do a sentinel node biopsy without a tumor. Hopefully someone else can give some more information.

besa · January 2016

I had a prophylactic mastectomy on my non-cancer side four years after my initial bc diagnosis. I am BRCA mutation negative but do have a family history of bc. (I am considered high risk but not as high as someone with a BRCA mutation.) I did not have sentinel node biopsy on my prophylactic side. I had a negative breast MRI and mammogram. That being said I was aware of the risk that I would face axillary dissection if cancer was discovered during pathology.

NCCN guidelines version 2.2015 "Breast Cancer Risk Reduction" (see page BRISK-5) under foot note "bb" (foot note is on page BRISK-6) states that "axillary node assessment has limited indication at the time of risk reduction surgery"

I have heard of some doctors injecting isotope and then mark the sentinel nodes with clips before prophylactic surgery so that they can go back later after mastectomy and remove the marked nodes if pathology warranted it. I think that some women who have had mastectomy & reconstruction at NOLA have talked about this. If you are interested it might be worth a post on Dr. DellaCroce's "ask the doctor web site"

http://members.boardhost.com/plastic/

BethL - mapping the sentinel node can easily be done in a prophylactic setting. There is no need for a tumor to be present. The isotope is injected near the nipple and they locate the main nodes that are drained using a probe that detects radioactivity. The radioactivity can be injected the day before surgery or the day of surgery. I think the dye can be done in addition to isotope and is usually done at the time of surgery.

lemonadehk- I was under the impression that the exposure to radiation from lymphoscintigraphy was much lower - see conclusion section in link below - which talks about exposure equal to from 1 to 5 chest x-ray exposures

http://www.birpublications.org/doi/pdf/10.1259/bjr...

tanyarocks30 · January 2016

I am having BMX/DIEP Feb 18 and have been diagnosed with atypical hyperplasia with high risk of DCIS. Strong family history. I am having a sentinel node injection on the afternoon prior to surgery. Since they will be in there, they are taking and testing. So, technically I do not have a tumor and they are still testing.

grammakathy · January 2016

I had sentinel node surgery on my cancer side by my BS during my mastectomy. Five months later I had a prophylactic mastectomy along with TE placement and those were done by my PS. No sentinel node biopsy was done because there was no cancer detected by mammogram. In fact, the fact that I could skip the sentinel node was a reason I opted for the prophylactic Mx. That was the hardest and most disfiguring part of my first surgery.

Tanya - I was diagnosed with atypical hyperplasia in December 1999. In 2013, that same spot was diagnosed as IDC and was a 2.0 cm tumor, grade 2.

farmerlucy · January 2016

I had a pbm and invasive was found despite negative screening. I did not have nodes taken initially but my BS was able to do a snb after waiting three weeks to heal. I have only heard of this a couple times on these boards and only found one small study which concluded it could be done but was only about 60% successful. If I had to do it again I would insist on doing the dye and maybe placing a clip next to the node but not taking the node. Angelina Jolie had it done that way.

tanyarocks30 · January 2016

I just figure that since they are in there the may as well check.

Grammakathy....exactly why I am doing this now. My mom was diagnosed at 40 and passed away at 50.

Everything about this ordeal is beyond words. I find everyone on these forums fantastic and real. Nothing is off limits. Thank you everyone. I feel like everyone here is holding each others hands. 💙

inks · January 2016

I am BRCA1+ and at the time of my bilateral mastectomies they did the sentinel node biopsy on both sides. BRCA mutation raises the risk of contralateral BC by 40% so in my opinion this is very different from your regular average run of the mill prophylactic mastectomy. There were studies about BRCA+ prophylactic mastectomies and weather the sentinel node biopsy was beneficial and the recommendation for prophylactic (no prior cancer history) mastectomies in BRCA carries was that sentinel node biopsy is not necessary. However I was not able to find any conclusive info about BRCA and the need of sentinel node biopsy in the non cancer breast. In my own case the sentinel node biopsy on my prophylactic side gave me cording and the scar is way longer on that side. This area has very little research and the decision is going to be hard for you.

tanyarocks30 · January 2016

Definitely going to do some more research

besa · January 2016

For information specific to women who are very high risk and prophylactic mastectomy you could try the FORCE web site:

www.facingourrisk.org

A quick search turned up the info below concerning sentinel node biopsy. Hopefully there is more info to be found.

http://www.facingourrisk.org/understanding-brca-an...

In the study above 4 out of 143 women had invasive bc found during prophylactic mastectomy. Two of the four had positive sentinel nodes....

lemonadehk · January 2016

Besa, thank you for sharing your experience. And you are right. I was wrong about the radiation dosage. It's much small. In fact, even pregnant women can take it. I have edited my original post so that it is not misleading.

lemonadehk · January 2016

Thank you all for sharing your experience and thoughts. Went to talk to my breast surgeon today again. She said I could go either way: the chance of having IDC is small and the chance of having lymphadema from sentinel node dissection is also very small. I need to think a bit more about it.

lemonadehk · January 2016

hi Ingrid, it's been a while. How are you?

I am scheduled to have prophylactic mastectomy and total hysterectomy with ovary and tubes removal this Friday. Quite nervous. Have you removed your ovary yet

inks · January 2016

I'm well , thank you. I have been without ovaries for a year now. The laparoscopic surgery was very easy. The hot flashes were bad for a while but I don't know if its from lack of estrogen or AIs. The oophorectomy part should be easy and you already have experience about mastectomy. I have my fingers crossed everything will go well on Friday!

Melgirl · January 2016

I'm currently trying to make this decision too. I won't know my genetic status before surgery and am having a BMX. The surgeon is leaving it up to me if I want to check the sentinel nodes on my right side. I'm very torn.

lemonadehk · January 2016

hi Melgirl, it's a difficult decision. I just had the surgery with sentinel node taken out. Frozen section shows it's clean, but I have no regret.

Sentinel node dissection for prophlactic mastectomy?

Comments

Categories