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All TopicsForum: Surgery - Before, During, and After → Topic: SNB with Bi-lateral Mastectomy?

Topic: SNB with Bi-lateral Mastectomy?

Forum: Surgery - Before, During, and After — Surgical options and helpful tips for recovery and side effects.

Posted on: Feb 17, 2009 06:41AM

BonnieKJG wrote:

After the pathology from my right-breast lumpectomy showed multi-focal ILC, and LCIS (in addition to the original IDC) - my doc is recommending bi-lateral mastectomy. I understand the increased risk now with the multi-focal lesions and LCIS makes that a prudent choice - but my question is around the SNB process. Previous mammos and MRI showed nothing in the left side (the "good" side); so how can the SNB process "find" a sentinel node?  Seeking feedback - for those of you who have done PBM - what has been your experience? Did you have the SNB done on both sides?  Thank you!

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Feb 17, 2009 11:43AM, edited Feb 17, 2009 11:45AM by samiam40

I had cancer on the right side, and a bilateral mx.  I elected to have sentinal node biopsy on both sides, the cancerous one and the "healthy" one.  This decision is controversial.  However, everyone has a sentinal node on each side (or more than one in my case) whether they have cancer or not.  It's just the "gatekeeper" node, the first one cancer would reach if it were metastasizing. 

Hindsight is 20/20 so I'm not sure whether I made the right decision in getting the SNB on the healthy side.  No cancer was found in the left side, and now I have pain and a giant scar there from having 4 sentinal nodes removed.  I had 6 sentinal nodes removed from the right side--I guess I'm just an extra sentinal kinda gal.  

However, if you are getting a mastectomy, you only get one chance to do a SNB.  If you elect not to, and they do find cancer in the "healthy" breast, you have to go back and get an axillary dissection of the whole node system, which is a much more complicated process and comes with a higher risk of lymphadema.

Good luck whatever you decide.

Dx 1/12/09 @ age 40, IDC 2.6 cm, Stage 2a, Grade 1, 0/10 nodes, ER+/PR+/HER2-, Onco 14, BRCA neg. Bilat mx w/TEs 2/3/09. CMFx6 3/2-6/15/09. Zometa 5/09-9/10. Tamox 7/09-present Exchange w/gummy bears 9/9/09. N/A recon 12/16/09.

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Feb 17, 2009 12:22PM Beesie wrote:

Bonnie,

Finding the sentinel node on the left side won't be a problem - the sentinel node is the sentinel node whether or not you have breast cancer.  We all have many lymph nodes in our underarm area.  The sentinel node is simply the first node in the string of nodes.  The theory is that anything that enters the lymphatic systems enters through this first node - the guard node (that's why it's called the "sentinel").  The way the sentinel node is found is by having 4 - 6 injections of radioactive blue dye around your nipple (each aimed in a different direction into the breast) and then by following the dye as it moves towards the lymph nodes.  If the dye from all the different injections converge at the same node, then you have a clear sentinel node.  Sometimes the dye moves to a couple of nodes - in which case both are considered to be sentinel nodes.  And sometimes the dye either doesn't move to the nodes or it moves to many different nodes;  in that case (which is unusual) an SNB can't be done and more nodes need to be removed.

So finding the sentinel node isn't a problem but I agree with Samian that you might want to consider whether having an SNB on your left side is necessary.  While having an SNB instead of a full axillary node dissection does reduce your risk of lymphedema, it still puts you at risk.  The risk of lymphedema stays with you for life, meaning that you will always have to be careful in the use of your arm.  An SNB is necessary on your right side, but having one arm available for blood draws and blood pressure etc. might be easier than being concerned about both arms.  Reading up on this recently, I believe the risk of lymphedema from an SNB is about 3%.  On the other hand, if you don't have an SNB and from the mastectomy it's discovered that you do have invasive cancer in your left breast, then it will be necessary to check your nodes and, as Samian mentioned, after a mastectomy, an SNB can no longer be done (because there is no breast there in which to put the injections to find the node) so a full axillary dissection will be necessary.  My suggestion is that you ask your surgeon what he/she believes your risk of lymph node involvement to be on your left side, given that there is no sign of breast cancer but that you do have LCIS.  Weighing that risk against the 3% risk from an SNB might help you decide what's the best course of action.

Dx 9/15/05, DCIS-MI, 6cm+ Gr3 DCIS w/IDC microinvasion, Stage I, 0/3 nodes, ER+/PR- “No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke

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Feb 17, 2009 03:39PM Jamie6 wrote:

I only had tumor on the right breast, but had SNB on both, and had bilateral mastectomy last week.  So far, neither of my arms have any problems at all.  BTW, my nodes came back cancer-free during their "quick test" so that was nice.  I'll have the final pahtology report in a day or two to confirm this good news or ruin my day if the report comes back with microscopic findings that the "quick test" didn't detect. 

Either way, I don't regret getting SNB on both sides since I got lucky from not having any negative effects so far.

Good luck :-)

DX 01/22/09 IDC 1.3cm, Stage 1, Grade 1, 0/2, ER+/PR+/HER2-, BRCA 1&2 negative, dbl mast 02/09/09 w/TE. OncoDX score 16

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Feb 18, 2009 05:22AM BonnieKJG wrote:

All - thank you for your responses and good wishes...this makes sense now and seems a prudent approach. I had only been thinking about the "sentinel" part in connection with cancer and not as the general "gatekeeper" of the lympathic system.   

Darn...Having had the SNB on the right side, I was kinda hoping it would not be required again - not my favorite activity!  But it would be better all around than having the full anxillary dissection.  

Bonnie

Bonnie

Dx 12/31/2008, IDC, 1cm, Grade 2, 3/10 nodes, ER+/PR+, HER2-