Axillary Dissection or radiation

Do your research on ANDs and ask your surgeon if he will do an ARM (Axillary Reverse Mapping) procedure before he removes them. It's kind of like a sentinel node biopsy procedure where they shoot some dye in to see the sequence of drainage. This will tell him which are the primary nodes that drain your arm, and hopefully, he can avoid removing them. It's thought that this procedure will reduce the occurrence of lymphedema if the surgeon leaves those nodes.

Radiation, while reducing the success rate of implant reconstruction, also kills off the lymph nodes and leaves you vulnerable to lymphedema. 

So if I had the choice, I'd go with the AND with the ARM and hope for the best.

Boy, nasty decision is right! Actually, either route leaves you with lymphedema risk and it would be hard to say which was more of a risk than the other. So (since you're asking for opinions) I'd opt for the AND, which eliminates all the rotten rads risks.

I'd also suggest that if you decide on the AND (I suspect you'll have a hard time finding a surgeon who can do the ARM procedure, as it's so new), that you insist on a pre-op visit with a fully-qualified lymphedema therapist. (Here's a Therapist Locator to find a well-trained one near you: www.mylymphedema.com.) S/he'll be able to do baseline arm measurements  for later reference, teach you a gentle massage technique you can use prophylactically to help prevent lymphedema, and give you tips on simple lifestyle changes that can also reduce your risk. But you have to have a referral from any of the doctors on your team, and you may have to insist on that.

You can learn about how to handle your lymphedema risk at the National Lymphedema Network: www.lymphnet.org. Their Position Papers on Risk Reduction, Exercise, and Air Travel are especially helpful, and it makes great sense to follow those guidelines, as the risk is for life. 

Hi, Nancy,

I'm really curious -- did you have the ARM procedure, and if so how did it go for you? I know the research, but I've never talked to anyone who's done it. wish it were SOP, y'know? Maybe soon!

Be well,

Binney 

Did you have an SNB? I don't quite understand how you got into this spot. Aren't they either supposed to do a dissection or do the SNB and then removed more if it's positive (on-the-spot?).

Did the surgeon tell you no implants w/radiation or did the PS tell you that?

Sometimes if they put the expander in, expand and then radiate it works -- the chances of a complication are greater, but not everybody has problems.

Hi Tarasim,

I feel for your situation.  But I don't understand why you can't have an implant if you have radiation.  My ps was able to do both; I was very concerned as some studies (by no means all) found a high failure rate if radiation was done after an implant was put in.  They did tend to be the older studies; newer ones mostly found no effect on an implant.  Anyway, I did have immediate reconstruction with a silicone implant and then radiation, and there was no problem.  The radiated breast is a little firmer than the other one, which also has an implant, but they match well enough so that I am happy with the outcome.

I would consult another ps about this.  The poster just above had a successful experience with expanders, an implant, and radiation and I don't see why it wouldn't be possible in your case.  (My ps was able to put in an implant during surgery thereby skipping the expander process, but I think that as far as radiation goes, it's the same idea).

Best of luck with your decision.  I also chose radiation over a disection - I really don't want to develop lymphedema!  But please investigate this further - I don't think the decision should have to be radiation vs. reconstruction.

Thinking of you,

Kerry