Mastectomy - anyone not have Sentinel Node Biopsy?

I did not have any lymph nodes biopsied when I had DCIS. I did when I had IDC (just one--no LE problems at all).

HopeWins, your question was specific to having a MX for DCIS, and that is an important distinction.

Lumpectomies and mastectomies are very different when it comes to doing a sentinel node biopsy. An SNB requires that injections be made into the breast. After a lumpectomy, obviously the breast still remains, so an SNB can be done afterwards. With a MX, the breast is removed, so if an SNB is to be done, then it has to be done before or at the same time as the MX.

For someone with DCIS, this is a significant difference. A SNB is not indicted when the diagnosis from the biopsy is thought to be pure DCIS. But should some invasive cancer be found mixed in with the DCIS in the final surgical pathology, then it becomes necessary to check the nodes. For those who had a lumpectomy, this can easily be done. For those who had a MX, not so much. This is why it is generally recommended that women who are having a MX for DCIS do have an SNB. The exceptions tends to be if the area of DCIS is very small and low grade, but even then, an SNB is often recommended if the patient opts to have a MX. Certainly an SNB is highly recommended if the DCIS appears to be widespread and high grade, since the risk of finding an invasive component is greater under these conditions.

One option - which I don't think is done by many facilities - is to do the SNB injection into the breast at the time of the MX surgery, but not remove any nodes. Then if the breast pathology is available quickly, the patient can be taken back into surgery for the SNB. I don't know the window of time in which the nodes will retain the injection. Certainly it's at least 24 hours (some facilities choose to do SNB injections the day before operating) but I don't think much longer than 48 hours. This methodology was invented by Pink Lotus when they did the PBMX on Angelina Jolie, so you might find out more if you check their website.

As for the risk of lymphedema from an SNB, it's a long time since I dug around in the data, but my recollection is that the risk is in the range of 5% - 10%.

Hi HopeWins, here is an article that may be helpful: How Many Lymph Nodes Are Removed? as well as this: Sentinel Lymph Node Dissection.

Thanks, for the comprehensive answers here!

1LifetoLive, we welcome you warmly, and thank you for sharing your experience.

Hi, HopeWins -- I developed lymphedema with only 2 nodes removed initially. It's an issue I'll have to deal with the rest of my life and very annoying. I developed cellulitis last year after a trifecta of sunburn, lifting something heavy and swimming in a river. A quick round of antibiotics took care of it but it is a concerning development. I wish I'd known about sentinel node marking before my BMX.

Make sure your MRI is done at the appropriate time in your menstrual cycle or you could have a higher risk of false positive results on the MRI. This happened to me and influenced my decision to have BMX. Nothing was found in the contralateral breast.

Oy--sorry! I forget so much these days!!

Hope,

It seems as if the procedures prior to an SNB can be somewhat different from place to place. My surgery was scheduled for very early in the morning, so I had the injection into the nipple the evening before. The blue dye injection took place while I was under general anesthesia. I bet you’ll have responses where these things went differently. All the best