Recurrence or Stitch at Alloderm-Muscle Seam? Rice grain

Hi everyone, Has anyone had sutures show up at the junction between the muscle and Alloderm? I had my double mastectomy with immediate silicone implant reconstruction four months ago. A visible bump has suddenly appeared on the left side, which my MO seemed concerned about this past week when she examined me, which I waived off as the Alloderm seam. Three days later I took a second look and touched it, and it looks exactly like a grain of rice (long grain), and it's hard like raw rice. It seems to be getting bigger (fatter/longer? my imagination?). The bumb is in the middle (left to right) of the breast, about an inch above the scar (nipple removed), and it is in the Alloderm-muscle seam (I think the seam is high on this side, because they cut away two inch band of muscle to biopsy). The skin is so thin, when you press, you can see the rice grain is on that line. Looks white and raised. The thing is I don't recall it being there before, and she definitely did not see it when she examined me about two months ago. I have an appointment with the PS nextweek, so I will show it to her, but she is very much a PS, even though this is all she does with the breast care center, so I'm thinking I should contact my surgeon. My last appointment was a month ago, and the next one in 5 months (on 6 month schedule now).

I'm concerned because my surgeon recommended radiation on the left but the radiation oncologist said that the risks outweigh the benefits , especially because the implants are already in (another canceled the appointment on me; assistant told me doctor doesn't think you need radiation over the phone). I had extensive grade 3 DCIS (with comedo necrosis, LCIS, cancerization of lobules, ADH ...). There were at least two areas that have margins less than 1 mm, one of which is near chest wall (3 pathologists confirmed it). The pathologist also saw foci suspicious for microinvastion but could not prove it histologically, and they found isolated it tumor cells in one of 3 sentinel nodes (I had 1 needle biopsy and 1 core biopsy several weeks before the mastectomy). So deep inside I wonder if I'm being under-treated. Well I hope it's just a suture, but .... Can a recurrence of DCIS happen this quickly--even if there is microinvasion, ITC and close margins?

Also on the right side (prophylactic mastectomy that revealed a stage 1, grade 2 ILC), I have 4 hard bumps (round lentil size or smaller in an uneven wavy pattern) in the outer mid to upper quadrant. Two of the bumps are visible. I'm thinking these have to be stiches! (There were only 2 pathology slides for the right breast. Hmm) These started to appear sooner--probably after the swelling subsided.

P.S. I've been on Tamoxifen for a month. Sorry this is so long. I have an anxious mind and have been compulsively looking up recurrence rates and personal recurrence stories for different scenarios. I know I need to move forward and focus on positive habits, my job and other responsibilities, but can't seem to find the mental discipline to do so. This is not healthy. Urgh. Thanks for reading.

Thanks, KBee. I appreciate your response. I hope so too. I guess I just have to get it checked out rather than either fretting (anxiety) or be complacent (avoidance). :-) I've been reading some of your posts recently. You are so very helpful. I'm glad you caught your recurrence early due to your self advocacy. You appear to be doing well. I hope it isso.

Thanks, Kessa. I'm glad your bumps went away, so you have one less thing to wonder/worry about. It's reassuring to hear about your experience--physical and emotional. Can you ask for another ultrasound for the lymph node if it hasn't shrunk, or even a needle biopsy?

Thanks for your view on the RO. I am considering it in the back of my mind, although the prospect of a disfigured foob is daunting. Went to a lecture and the photos were terrible. The other thing I've noticed, with this new regional data sharing of medical records among hospitals and providers, is that it's difficult to get an independent opinion. Doctors tend to want to know whom else you've seen and what they said, it they just see it in your records. There appears to be a group think mentality.

I know I sound negative, and I am very grateful for the great care, but that was my observation when I was going for all the additional opinions for breast surgery, pathology, reconstructive surgery, medical oncology and radiation oncology. (My diagnostic phase lasted more than 2 months, because all the imaging contradicted the two biopsy pathologies; imaging showing at least stage 3 cancer in left but pathology showed 6 cm long DCIS and LCIS in a sclerotic lesion, which became micro invasive by the time of surgery. Then they discover a new cancer in the other breast after surgery that never appeared on imaging, so I had to go in for an axillary dissection. Dealing with cording right now.) So a bit of battle fatigue right now.

I feel guilty for being anxious and a little down right now, because I realize other ladies went through so much more with their chemo, radiation and or Herceptin and with more advanced diagnoses. I need to get a grip. But on the other hand this is not a rational experience. You're worried too and I'm just learning that this is a common experience, so I'm hoping to learn new ways to adapt to this new reality of uncertainty. I read that CBT is very effective, combied with mindfulness, physical exercises, and a dash of faith. :-)

Sorry, I'm long winded. Hope your day goes well Kessa. Wishing you more peace of mind

Hi Farmerlucy, Thanks for your empathy and reassurance. Hope so too. Sorry for your own mind bender! Your case sounds similar to mine with the prophylactic turning out to be not so.

Yes, the ILC dx after surgery was a bit of a bad surprise, but it confirmed for me that I made the right decision. The RO said I would have been in big trouble, because often its detected only when it's grown to stage 3 or so, so I was lucky. Once I got negative results from the axilliary dissection I could breathe easier. Also the good finding was what two BS told was most likely an invasive 3 cm IDC (based on 3D mammo, MRI and US, although to biopsies showed otherwise) turned out to be a larger benign sclerotic lesion all overlapping the DCIS, LCIS and all the other junk. LOL. (The path report was an alphabet soup of various types of breast disease and cancer cells.) Someone was watching over me. My Mom passed away from recurring and bilateral (not synchronous) metastatic breast cancer.So it was a scary/stressful journey that got better, for which I am grateful.

I will post again once I know more. Thanks.

This is reassuring Juliecc. An update: I visited both my PS and BS and both said it was a stitch.The BS said it usually takes six months for stitches to dissolve: unfortunately, I don't know whether she means six months from the time they appear or six months after surgery. I'm guessing the latter. The good news is the "rice grain" stitch on the left side has disappeared. But the round hard nodules on the right have not.

I asked the BS if they would take a baseline US or MRI and she said no. They only do these tests if they see something clinically significant. Honestly, with US being so inexpensive, I don't see why breast surgeons don't have them in the exam room. I actually do know of one BS who does so, but she is not my current BS.

Curious thing: I had last seen the BS in late March, and at that point, she said congratulations, now I will see you in six months (i.e. September). Prior to that she had been seeing me weekly (BMX mid-January; right axillary dissection 3rd week in February). However, after I visited her in mid-May, they updated my patient portal with an upcoming appointment in late June. Hmm. I guess she wants to monitor me more closely now?

Good wishes to you ladies.

hey ladies, just left my PS office had to take out some saline from the TEs, I too have bumps about 4-5 one side and one on the other. He assured me they are stitches which can take up to 6 months to fully dissolve. He took out saline so theres not so much pressure on my skin which should help the process along. I don’t want any complications, just when I’m feeling like there’s joy and peace after a cancer diagnosis, sending positive vibes