Anyone else had One incision for lymph nodes and tumour removal

Hi pat2

When i had my mastectomy on 16th January I also had full node clearance.  And all through the mastectomy site.  I did not have an incision under the arm.  I too am still waiting radiotherapy 16 weeks on from op.  My boob wounds haven't healed.  I had a skin graft 2 weeks ago and am hoping this will have worked.  I suspect my radiotherapy will now start beginning of June - 20 weeks after op.  I have started on Letrozole.  See my profile for more details.

Whether this will affect risk of spread I try not to think too much about.  I can't change the fact that I haven't healed.  So burying my head in the sand on that one.  Having a lot of other issues too so only so much I can worry about.

Do hope you get sorted soon.  

Hi Pat2,

My wife had a bilateral mastectomy along with left sentinel node sweep (removing 10 nodes, of which one was affected) through the mastectomy incision.

My guess is that the tumour is removed first as a matter of priority, followed by the lymph node(s). However, because it *is* a guess and because I don't have any formal medical training, nor very deep physiological knowledge, I'm inclined to suggest that the only people who could answer your question would be of the medical/scientific persuasion. Basically anyone with an understanding of human pathology at the cellular level. To be honest, I'm not sure *how* different cancers spread - I know they spread through the lymphatic system and the bloodstream, but I'm not at all sure what the actual cellular mechanism is or even if it differs from cancer to cancer.

While I like to think cross contamination would be considered by the surgical team and assessed at a scientific level for risk management purposes, I think the best person to direct the question to would be the surgeon who performed the surgery (to establish the methodology used and whether barrier procedures exist to prevent cross infection), or similar qualified individual such as an oncologist.

I'd be very interested to know if you find anything out. Similarly, we have a post surgery appointment in a couple of weeks so I'll add it to our list of stuff to ask. I'll let the group know if I find anything then or in the meantime as I do a lot of reading on the subject.

Wishing you the very best.

Dom.

Hi pat2, and welcome to this community, though sorry you’ve had to join the club we’d all rather not be in! Your situation sounds similar to mine, I also had one long incision, although I think there were 2 separate deeper incisions at either end as the top and bottom took longer to heal. Like you my (2) nodes were negative. And I had an impressive haematoma, whole lower boob was black and blue, quite the rainbow effect with the bright blue dye and yellow bruising! It resolved slowly on its own. I haven’t heard anything about one incision being worse re spread,  but the whole recurrence fear is always there. Re radiotherapy, I too worried about delay (started 11 weeks after surgery) but was reassured by starting hormone therapy a few weeks before. In the end I was glad of the delay as it gave my boob longer to recover from the surgery.

 Have you a date for radiotherapy yet? I must say that I felt much better once I had definite dates and once it all started. The gap between surgery and rads was a horrible sort of limbo, I hope you get started soon. 

I’m sure others will pop in to share their experiences, one wonderful thing about this site is that you’re never alone. Wishing you well, keep posting and let us know how you are getting on, HFxx

Hi Anne,

I am so sorry to hear that you are also having healing problems and I hope that your skin graft is successful and radiotherapy can start very soon for you Anne. I took a look at your profile and sadly see that you have been through a lot since your diagnosis, I am sorry to hear that and wish you a speedy recovery.

I was also supposed to have been given Lectrozole but they decided to change to Tamoxifen which I am not so happy about. My concern is that not all nodes were taken and huge haematoma with subsequent draining and only one incision leaving nodes that could become infected but as you say worrying doesn't do us any good and we cant change the past. I think I will start to feel better once radiotherapy starts waiting isn't easy. Its been a long journey so far as radiologist missed tumour on routine mammo. I found 2.5cm tumour , then GP didn't want to refer me as mammo up to date. I ended up having to be assertive and demand referral. Her answer to that was "Well I cant just refer you as I would have to examine you first!" She tried all tactics to prevent referral was determined not to refer me. Post op I had infection chest and waterworks, a huge haematoma whole breast hard and black and blue been draining until 10 days ago. Graded as 2 needing chemo but did Onco test and from this result decided endocrine and radiotherapy. Now waiting for radiotherapy that they hope I will be healed for at some stage. A bit in limbo.

How do you find the Lectrozole?  I have become nauseous since taking the Tamoxifen so now have anti sickness tabs and also become much more anxious and tearful since starting taking them 3 weeks ago hoping to settle on them. I had hoped to have the Lectrozole as they have less side effects and better results from what I read.  

Take care

Pat

xxx

Hi pat2

I must admit, I would have thought that is didn't make any difference - hadn't ever thought about it until your question! but I wouldn't have thought so as when they remove the tumour they are looking to get up to 1cm clearance around it.  I had mine done via one incision but despite having 8cm+ removed, I recovered very well from this and sentinel node clearance, so unlike you, I didn't have a haematoma or post op problems - sorry to hear that, but great news that you had the negative nodes

This link may be useful for you if you haven't seen this.

I had my operation in July and once the cancer had been cut out, I just thought of the radiotherapy as belt and braces (as with the ER+ tablets) and mine didn't happen for a good couple of months, but I wouldn't have worried if it had been a lot longer as it was just a 'mop up' exercise just to make sure there was nothing else lurking.  I had the odd days when the machine was broken and tagged on the end, but again, I wasn't worried.  I had my first year all clear June 2018 - next mammogram due.  (the oncoDX test wasn't available in 2017 when I was diagnosed).

I now have learned that I must trust the professionals to know that they are doing and then I can enjoy my year until each June comes around for my mammogram and hope that it's looking good each year.

Kindest wishes,

Hi HF, Yes sounds a very similar situation to mine with whole boob effected . I can't understand why the surgeon does such a large incision if it causes such problems. I am a FF sometimes G bra size, so they wobble a bit even in a tight bra. I feel the 2 incision option would have been better for healing and disease control. Did you have stitches HF? The consultant said there will be no stitches used and was quite excited by this. I guess some type of glue must have been used not sure if this is a usual procedure.  Are you left with hard areas after your haematoma?  I have a lot of hard areas left in upper boob area which is uncomfortable and what the consultant radiographer seemed worried out. They didn't realise I had haematoma for 3-4 weeks by which time as yours it was huge hard and black and blue and when draining it was old blood and clotting all the time.

Unfortunately still no date for radiotherapy. I think I will also feel better once I have some dates and the healing process becomes more normal.

Thanks for the email, keep in touch and best wishes for a very speedy recovery.

Pat

xxx

You are quite right Lesley, I agree with what you say and in fact did look upon radiotherapy as you do as the belt and braces and would have carried on doing so without these post op problems. I hadn't been concerned about it all until haematoma and delayed radiotherapy already over 2 months. Had infact remained upbeat and positive until past two weeks. It is this damn haematoma and healing issues and delay in radiotherapy that are my concerns.  I thought that maybe the one incision technique had caused the haematoma. The radiotherapy dept said haematoma can cause healing problems post radiotherapy as well as problems administering the treatment if done too soon. I think once I have some dates and radiotherapy starts I will feel better. Just wish I hadn't had these post op complications and timely radiotherapy so I could have carried on feeling optimistic and trusting and it would have all been over by now instead of waiting . 

Good news to hear you have had the first year all clear .

Kindest wishes,

Pat

x

Hi pat2,

So sorry you've had to find the Forum, but you will be very well supported by the members. 

I too had a Mastectomy and 4 Nodes removed, 2 had micromets, 1 Incision site only. My Radiotherapy started 12 weeks after Surgery but Letrozole started prior to my RT. Regarding spread my Oncologist said BC can spread in other ways not just the Lymph Nodes, it's a worry I suspect we all have, I would think Surgeons are very aware of escaping cancer cells during Surgery and take as many precautions as they possibly can. 

My 4.5 CM Tumour, Grade 2 was found 6 months after a normal Mammogram, I saw my GP x2 between the Mammogram and being referred and each time was assured their was no lump and as I had had a recent Mammogram I should feel reassured! My 1st GP visit was 6 weeks after the Mammogram, I have to try and stop myself from getting too upset about this aspect of the journey, cause I can't change things but now but wished I'd not listened to them and insisted on a referral. 

Best Wishes.

Hi pat2,

Replying again to you! Glue is used by some Surgeons including mine!

Hi pat2, thanks, and yes I had stitches but they were mostly internal and self dissolving so just some straggly ends that were trimmed at a dressing change. I'm sorry they didn't pick up that you had a haematoma straight away, mine was unmissable so we knew it was there from a couple of days after the op, from what I remember. Nothing actually drained out, apparently the body can clear/ drain it internally in some cases, so they just left mine to sort itself out, which it gradually did. I don't know the rationale behind one incision, I think the surgeon might have said when I first met him (on the day of the op) that, because the lump was in the 'upper quadrant' of my boob, he'd be able to do just one incision. So it sounds like this is regarded as the preferred option where possible....Re hard spots/ lumpiness - I don't have this where the haematoma was, but along sections of my scar it's quite hard, I think it's where the deeper incision was made to cut out the lump and scoop out the extra stuff to get a clear margin? (I always picture an ice cream scoop but I'm sure it's nothing like that really!) I assume this hard section is scar tissue - no one who has examined me recently has expressed concern so I don't think it's a worry. 

I really hope it all starts resolving soon so that you can get on with your radiotherapy. And like someone said earlier, I think you should ask your BC team about your concerns so that they can hopefully reassure you re spread and recurrence. Hugs, HFxx