By my understanding, I agree with moth. Another consideration for placement of the incision is aesthetic, for where the scar will show. This might or might not be a priority, depending on the surgeon and the patient's diagnosis and circumstances.

So you had a wire placement (using mammography, most likely) prior to surgery? The wire may have been placed into the lump from the top of your breast, but that doesn't mean that the surgeon is going to go in the same way. The surgeon simply has to find the wire and remove the lump, which probably is easier from a different angle, because the wire stays in place and in the lump until the surgeon removes it. If the surgeon cut at the same spot as the wire, he would have to remove the wire before finding the lump. So logically it makes sense that the incision was in a different location.

I'm glad you decided to have the SNB. Read these pages from BCO for things you can do to reduce the risk of lymphedema:

Reducing Risk of Lymphedema and Lymphedema Flare-Ups https://www.breastcancer.org/treatment/lymphedema/...

Cherisse, NO, the sentinel arm cannot have IVs, needle sticks or.blood pressure cuffs:

To protect your skin:

• Don't get manicures that cut or overstress the skin around the nails. Work with a manicurist who knows your health history and takes special care of your hands. If you're considering a certain nail salon, do your research. Ask around to find out if there have ever been reports of unsanitary practices or if clients have experienced bacterial, fungal, or viral infections. Artificial nails can also become infection sites if not fitted and maintained properly.
• Don't allow the skin of your at-risk arm or hand to be pierced or pressured for any reason: for example, injections, blood draws, intravenous lines, vaccines, and blood pressure. It's up to you to remind physicians and nurses about this at every appointment. You may wish to invest in a lymphedema medical alert bracelet you can wear on the affected arm. These are available for purchase through the National Lymphedema Network. Another option is a G-sleeve, a flexible garment worn on the forearm and clearly labeled "no blood draws, no blood pressure, no IVs." You can put it on before doctor visits or wear it continuously during a hospital stay. If you've had breast cancer in both breasts along with underarm lymph node dissections, ask if you can have any blood draws or blood pressure measurements taken on another area of the body.

To protect your arm and hand from overuse, trauma, or too much pressure:

• Avoid taking unusually hot baths or showers and immersing the arm and upper body in high-heat hot tubs or steam baths. If you wish to use a hot tub, keep your affected arm out of the water and limit your exposure to 15 minutes or less.
• Don't apply heating pads or hot compresses to the arm, neck, shoulder, or back on the affected side. Also, be cautious of other heat-producing treatments provided by physical, occupational, or massage therapists, such as ultrasound, whirlpool, fluidotherapy (which combines high heat and massage), or deep tissue massage. Heat and vigorous massage bring extra fluid into that area of the body.
• Avoid carrying heavy objects or shoulder bags on your at-risk arm, especially with the arm hanging downward, at least initially. As you strengthen the arm over time, you should able to carry heavier objects again.
• Avoid wearing tight watches, bracelets, or rings on your affected hand or arm.
• Avoid wearing clothing that has tight sleeves or that restrains movement.
• Avoid exercises that put great pressure on the arm — such as push-ups, the downward dog position in yoga, heavy weightlifting, or bowling — until you and your therapist determine what your arm can handle and how to build up its strength.

The risk after snb is low, but low risk is not no risk. Unfortunately lymphedema can happen even years after, so many of us believe in taking care of that arm for always. With exercise, the important thing is to work your way up to your goal. You can be very active, just be smart and condition gradually. Some doctors do not know much about lymphedema, so getting advice from a lymphedema specialist is a good idea.

A source of information:

http://www.stepup-speakout.org/

I imagine if lymphedema were to happen it would show up this week? Absolutely not. While it often shows up within weeks or months of surgery, it can show up many years later if you do something that affects the lymphatic system in your arm.

If it does not show up I was told i would not have it moving forward. Is this true? Absolutely not.

Is it a crap shoot? Yes.

The extent to which you take precautions is up to you. Some people take extensive precautions; other people don't. Last I read up on this (which was a while ago, I admit), the risk of lymphedema developing after an SNB falls in the range of 5% to 10%. After a number of years, while some risk remains, the risk is likely lower. I took every precaution for 15 years but last year when I had the option to get my flu shot at the same time as my Shingles shot, I decided to do it, even though it meant that one of the injections had to be in my SNB arm. I just didn't feel like having to return to the doctor for the shot. I ended up having the Shingles injection in my SNB arm, and my arm was very sore for weeks - but no lymphedema. I've also inadvertently had blood pressure taken on my SNB arm a couple of times, with no effect. So I'm a little less fussed about it now, but I still take precautions when I can.

Please do read the 'step up/speak out' thread that Shetland Pony posted, You are at risk for the rest of your life and can develop LE even 25 years down the road. Even from just SNB. It's up to you to decide how much risk you're willing to take, but most docs severely underrate the issue.

Cherisse, as moth said, requiring a re-excision is not unusual. Cancer cells cannot be seen by the naked eye so the surgeon is operating blind. Prior to surgery, the surgeon decides on how large an area to remove based on the pre-surgery imaging, but imaging isn't precise and sometimes can even be very wrong. So it happens that the cancer extends beyond where the imaging shows it to be. Every surgeon goes into surgery planning to get clean margins but it often doesn't happen. It is not a mistake by the surgeon. It's just crappy luck.

As for the sentinel nodes having been removed, that's not a problem. Those were simply the first nodes in the chain. Now with those gone, there are new "first nodes" in the chain. You still have lots of lymph nodes to provide protection.

My mother was diagnosed with BC when she was 80. She had a lumpectomy and an SNB. Her nodes were clear but like you, the surgical margins were not clean. She went back in for re-excision surgery - it was a quick, easy surgery - and this time the surgeon got nice wide margins. Because of her age and because she now had such wide margins, she made the decision to skip rads. She also decided to skip anti-hormone therapy, again because of her age. She's 96 now and has never had a breast tissue again. I mention this just to explain that your situation is not unusual and it does not put you at any greater risk.

By the way, if you do a search on this board on "re-excision", you get over 11,000 posts.

Cherisse,

Could the lump be a hematoma?

"you explained its difficult to tell where the margins are but I thought the ink would have brought that to light." How? The ink is put there by the surgeon to indicate where he is cutting. This is based on the location of the tumor and the estimates of the size of the tumor based on the previous imaging. If there are microscopic cancer cells beyond the ink, the surgeon won't see them.

"My sentinel Nodes were negative for cancer. Hence, I am relieved and yet at the same time upset because they are no longer in my body to protect from the invasive cancer which is still in my breast." I think you missed the point that I made in my previous post. You still have many equally effective lymph nodes. You have not lost any protection. None. There is nothing magic or better about the sentinel nodes; it's simply the name given to the first nodes that the cancer cells arrive at should any cancer move from the breast through the lymphatic system. The nodes that follow in line behind the sentinel nodes are exactly the same except for their position in line. Now that the nodes that were further up the chain have moved to the front of the line, they have effectively become sentinel nodes. In any case, node removal is always done at the time of the initial lumpectomy. Yet the survival rate for those who have re-excision surgery (and therefore had some cancer left in the breast for a period of time after the sentinel nodes were removed) is at least a high as the survival rate of those who just have a lumpectomy. So there doesn't appear to be any reason for your concern.

Yes, there are devices that can be used to check the margins during surgery. This adds time to the surgery but more significantly, to my understanding, none of these devices are particularly effective. A study I read about the MarginProbe found that it only cut re-excision rates by 1/3rd. With that level of effectiveness, it's not surprising that very few surgeons use it.

Ditto to MinusTwo's caution about Aspirin. I was told to stay off Aspirin for quite some time before surgery and following surgery.