Should I choose axillary dissection during my surgery?

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MoonBlue
MoonBlue Member Posts: 12
edited October 2016 in Surgery - Before, During, and After

Hi, all,

I had 1 positive lymph node (1.4cm) before I started my chemo and after chemo, it seems all the lumps are gone, including the main one in my breast (2.9cm originally). Now I am going to prepare for my surgery which I chose to have a mastectomy because my breast is small plus I want to remove it as clean as possible.

Now my main concern is lymph nodes and how many should I have them removed. I visited 3 surgeons and all of them told me the standard way is: check 3 nodes, most likely sentinel nodes. If all of them are negative, then no more nodes will be removed. If any of them is still positive, then axillary dissection will be performed which will remove all level 1 and level 2 nodes.

But for me, I know I had one, and a fairly big one before chemo. If now they pick 3 and all of them are negative, they will remove no more. Will that put me on a big risk of recurrence? Of course I want to do everything I can to minimize the chance of recurrence and I don't want one day, If I have local recurrence, I would regret I did not do enough this time. So if I choose to do axillary dissection no matter what, will that be a good, or wise decision?


Thanks a lot!

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Comments

  • LisaAlissa
    LisaAlissa Member Posts: 1,092
    edited April 2016

    Hi MoonBlue (great user name)!

    When the surgeons told you the "standard" way, were they talking about standard after neoadjuvent chemo? or standard when there is no neoadjuvent chemo? If you're not sure, I'd ask them...I'd also ask the MO who prescribed the neoadjuvent chemo.

    Removing lymph nodes, expecially as many as all of the 1st & 2nd level nodes, is no picnic (not that any of this is). You increase your chances of lymphedema and the potential loss of range of motion dramatically. You may want to post your question on the Lymphedema board to get more information there.

    If it's needed, it's needed, but it's not a decision to make lightly. Hopefully others with more (and better) information will be along.

    LisaAlissa

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  • MoonBlue
    MoonBlue Member Posts: 12
    edited April 2016

    Thanks, Lisa. I believe the standard means standards after neoadjuvant chemo. I know the big impact of removing level 1 & 2 nodes, that is why I feel so difficult to make the call. I will try the other board and see if someone has similar experiences. Thanks.

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  • Kathy044
    Kathy044 Member Posts: 433
    edited April 2016

    Hi MoonBlue, I saw your post in the Lymphedema forum but as axillary dissection is surgery thought it better to respond here.

    My case is different than yours of course. I did not have neo adjuvant chemo. I knew that I had at least one positive node by fnb before surgery (1.5 cm) and so knew that I would need to have axillary dissection. As it turned out out of 15 nodes removed that was the only one positive. It is so good to know exactly how things stand, better than an oncotype test, which I did not have, IMO. I was age 65 at dx, I could care less about a local recurrence, with cancer in the nodes it was distant recurrence that I was worried about. I have absolutely no regrets.

    I chose to have a lumpectomy + rads over mastectomy. Rads can increase risk of Lymphedema, but then so can mastectomy. Will you be having radiation of the axillary area after mastectomy? That might relay some of your concern. it's complicated isn't it?

    Kathy

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  • MoonBlue
    MoonBlue Member Posts: 12
    edited April 2016

    Thank you, Kathy.

    My Dr told me whether I need radiation is based on my final pathology report after surgery. Because I choose to have mastectomy without reconstruction, so I don't know if I will have radiation or not.

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  • Rainy213
    Rainy213 Member Posts: 9
    edited September 2016

    hi Moon!

    Just wondering what you decided on as far as your lymph nodes as i am currently facing the exact same predicament! Thank you for your insight.

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  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited September 2016

    From the reading I've done it seems that the trend is moving away from full axillary dissection when there are positive nodes, whether known prior to surgery or found during sentinel node sampling. Without knowing your pathology it's hard to offer much insight. However, I would stress the importance of speaking frankly with the surgeons about both the risks and benefits of ALND (not that most surgeons are very open about the risks). Perhaps it would help to talk with a physical therapist who works with lymphedema patients to get her insights as well.

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  • Smurfette26
    Smurfette26 Member Posts: 730
    edited September 2016

    My surgeon is not in favour of axillary node clearance at all.

    He said in the past it was standard practice but now he feels it just creates problems. He said most often the vast majority of cleared nodes came back negative and in some cases women were left with terrible problems with lymphodema. He said every day he feels more confident that the best practice is to monitor closely. In all of his patients he has treated this way in the past, only 2 have required further surgery for more cancerous nodes and their outcomes were no different to those women who didn't need further surgery.

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  • ElaineTherese
    ElaineTherese Member Posts: 3,328
    edited September 2016

    Hi!

    Did your radiologist insert a surgical clip in your compromised node?

    I was in a similar situation to you. I did neoadjuvant chemo, and afterwards, an MRI and PET scan showed that chemo had cleared out all the active cancer in my breast and compromised node.

    My MO wanted the surgeon to just remove that node and a few of its neighbors. But, my radiologist had not marked my affected node! No one knew which one it was. So, my surgeon took out all of my Levels 1 and 2 lymph nodes -- 20 in all. They were all clean. Fortunately, I did not get lymphedema, but I was kind-of annoyed.

    My RO says that with neoadjuvant chemo, treatment doesn't necessarily change because a few scans show the cancer gone. I was diagnosed at Stage IIIA, so I got Stage IIIA treatment.

    Sigh.

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  • Rainy213
    Rainy213 Member Posts: 9
    edited September 2016

    Hi Elaine

    I had a clip placed in one node but prechemo imaging showed three involved nodes so there will be no way to find the other two which makes me nervous. Obviously i prefer the biopsy but just dont know if its a safe decision!

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  • Houston2016
    Houston2016 Member Posts: 317
    edited October 2016

    Hello all, I am in somewhat of same dilemma but in case it involved positive margin after MX. I received neoadjuvant chemo (AC+Taxol) from April to Sept 01, 2016. I had initial biopsied with one positive lymph node. After chemo tumor was shrunk from 3.3-2.5, not much, so BS thinks MX on my left breast. He also took out 3 sentinel lymph nodes. Surgery was 10/5 and pathology came back negative nodes but one tiny cancer cell positive underneath the skin. BS said RE-excision after MX is rare but he didn't take this to the tumor board. He wants to go in and cut more skin. I'm scheduled for radiation and hormone treatment as well. However, I'm worried if the second pathology show positive again? How could it be with s MX? I don't want additional surgery and more recovery time which delay the rads and hormone treatment. Any suggestions or anyone with similar situation?




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