decision of axillary node dissection

ME. But I had neoadjuvant chemo, and my surgeon took 4 nodes *after* chemo. 2 had dead cancer. Two were clean. I did not do the ALND, just the rads.

brcm - interesting in Australia the decision would be surgical.

age, your size, co morbidities - spec heavy smoker or diabetes make healing longer and may affect your chance of lymphoedema - so does the experience of the surgeon - less discussed but important as less women have this done these days - so cooked but not overdone;)

there are probably almost similar rates of recurrence between dissection and radiation (at least by study numbers, although because I work in a surgical enviroment I can say a good surgeon is magic) - with radiation you have to be specific in what is radiated - chest wall, axillae, supraclavicular area, internal mammary nodes ( again very rare) - how many sessions, left or right ( heart) and using breath holding if left to protect heart

yes the combination of radiation therapy and surgery to the same area makes lymphoedema higher risk.

there are other risk factors for lymphoedema so you need a specific assessment for you

with two positives nodes you will need some breast radiation if you follow Lancet's work irrespective of your surgery

https://www.thelancet.com/journals/lancet/article/...(14)60192-6/fulltext

there are three levels of axillary surgical dissection

https://www.breastcancer.org/treatment/surgery/lym...

level 1 - refers to 2-4 nodes - mostly addressing sentinel nodes - sounds like you had that

level 2 - usually 8-15 nodes

level 3 almost never done these days

i had by choice and on my request mastectomy and axillary clearance on what was initially thought to be a 2-3cm with no nodes needing only a lumpectomy - ha ...when out 4plus cm with one node - I then had chemo plus 25 sessions of rads - I dont have lymphoedema, healed well - I am 50, dont smoke and have good health aside from BC. I also had my uterus and ovaries out as I was wildly HR + ve. Its probably an overkill for many - but I am a single mother of a now 9 (then 6) yo so I threw the kitchen sink at it. Not sure whether it will make a difference but...we do the best we can with the information we have at one point in time.

I may have made different choices at 60 or 70 - I can not tell you that.

Wishing you well whatever you decide.

🙂🐣🌷

brcm,

ok - so with the clear distinction that I had IDC and you have a diagnosis of ILC - we are about the same size and node positiveness and age at diagnosis

the work on rads versus surgery is newish ( so not everyone will think it) but the numbers are supportive of RO opinion - however keep in mind that numbers are an average, and new work still needs the test of time - plus the prognosis for each individual depends ALL their risk factors versus treatment options.

The Mods suggestion is safe and great - still by enlarge surgeons operate... RO do rads and so on.

I am not sure what I would have done if I wasnt so intent on the kitchen sink - so I am no real help. I can tell you I dont regret my decision but I kinda blocked out side effects ( my MO felt obliged to list them in writing - never looked at them - I mean really... I was get whatever it was and treat them as I went along, but keep in mind that I was generically familiar with them) so not necessarily wise well thought out plan - went with my gut despite a fair bit of knowledge on this - I must sound mad and usually I am fairly logical.

How close are you to your surgeon - this is off the map but sometimes those with a lot of experience can comment on experience alone so its not fail safe - of how easy or hard an operation may technically and what things "looked" like when they got in there. Its hard because its an impression and it can be wrong which is why they dont usually answer those questions. The easiest way would be to ask both surgeon and ROs - what would they do if it was them ? and why would they make that decision for themselves? that allows a bit more free discussion.

I wish I could tell you an answer.

Probably the thing to do is make sure that to the best of your ability the people involved in your care are high quality and people who you feel comfortable with - and it sounds like you are doing that already.

Its a very hard time - but three years down - I can tell you its easier and it gets better. Most women even with good size lesions with good treatment and who are compliant with long term medication do not reoccur. Hang in there!!

If ( and I say this because the mods are around) I had to change one thing about going through this would be to meaningfully support women (and its more then yoga) with their stress levels ( multiple sources - health, family, financial, work).

Again Wishing you well whatever decision your team and you make 🙂🐣🌷

I was in your shoes 8 years ago. I had a mastectomy & 2 sentinal nodes were found to be positive.

If I had a lumpectomy, an ALND, would not have been offered me.

There was a study on women with lumpectomies that showed RADs was just as effective & caused less lymphedema than ALND.

But since I had a mastectomy, did that study really apply to me?????

My MO wanted me to have the ALND.

My BS & the RO I was referred to thought the risk for LE would be greater with the ALND than with RADs.

I opted not to have the ALND & had RADs instead.

PM me if you want further info. I don't check in here at bc.org very often