Lumpectomy Lounge....let's talk!
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My understanding is that a Lumpectomy IS a partial mastectomy. Just make sure it's coded that way.
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Niten- Yes, mine was covered. I'm getting cranky just thinking about your insurance questioning this. This is a Federal Law and it is very clear! The law is the "Women's Health & Cancer Rights Act of 1998". It is not cosmetic surgery! Breast reconstructive surgery, including matching procedures on the good breast are covered. So is a BMX if you only have cancer in one breast. OOOO, now I'm indignant and angry!
Mine are an excellent match. My PS left the bad girl a little larger to allow for some shrinkage with radiation.
Please PM me if you want. My DH is very up to date on all this insurance stuff and we are willing to help you figure this out!
Poppy
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And yes, a lumpectomy is a partial mastectomy.
Looks like we have your back, Niten! Or maybe we are looking out for your front....
Poppy
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from what I can figure out: excisional biopsy, lumpectomy, breast conservation surgery, and partial mastectomy are all used interchangeably. To me they have different degrees of severity but maybe its just coded for insurance purposes.
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I had my Lx yesterday, so I thought that I'd share my experience for anyone facing the same, remember your mileage may very.
We arrived at the hospital at 7am for 1:30 pm surgery. I had pre-op testing the week before, else I'd have had to be there at 6. I changed into hospital pants and two johnnies, first one open in back, second one open in front. My husband was allowed to stay with me during the prep. First thing they didi was to put in an IV line into my left hand. First try didn't go so well, so they brought someone else in for the second try. Apparently I have thick skin, lol. The first try was so painful, I began to get really nervous about the rest. I started getting sweaty, so they put a cool cloth on my head and an ice pack on my neck.
Next step was to place the wire, so down to women's imaging. They used an ultrasound to locate the tumor, numbed things up, then used a long hollow needle to place the wire. I'd say the same amount of discomfort as with the biopsy. The wire is left sticking out of my skin, then off to a mammogram to check placement of the wire. My tumor was near the armpit next to the chest wall, so it is a little tricky to get via mammogram. I'm so lucky that they caught it at all. One the wire was set it was off to Nuclear Medicine.
In Nuclear Medicine, they were to inject radioactive dye to find the sentinel lymph nodes. I laid on a table that went into a machine that looked like a small version of an MRI. The doctor came in and made four injections directly into my nipple. I was unprepared for that. Since my tumor was near my armpit, I assumed the injection would be near there. The tech let me hold his hand during this part, but it wasn't nearly as painful as it sounds. I guess the lidocaine that they injected me with for wire placement travels, and numbed up the nipple some as well. Once the dye was in, they moved me into the machine so that they could track the movement of the radiation. The doctor came back after 30 minutes, and made some marks on my skin to show where the lymph nodes were. The surgeon also has a Geiger counter probe in the OR as well. They let my husband come in to Nuclear Medicine as well, so he got a bit of an education watching the radioactive material drain through my lymph nodes. From there, it was back to the waiting area for surgery.
It was only 9:30 am when I got back from Nuclear Medicine, so it looked like we would have a long wait, but the woman scheduled for surgery before me arrived late, so they decided to switch us because she wasn't ready to go before me. My BS came in to say hi, then the anesthesiologist and anesthesia nurses. The anesthesiologist asked me a lot of questions, and explained everything that would happen. They were giving me propophol, which I guess can burn going in. From there, they wheeled me to to OR which was smaller than I expected. I got onto the table myself, and they put warming blankets on me. The nurse injected a relaxer into the IV, then lidocaine which was to help with the burning of the propophol. She said that I might start to feel funny, and that is all I remember until I woke up in recovery.
I lost track of time along the way, but I think that I went into the OR around 11 am, and I woke up around 1:30 pm or so. I woke up quicker than I expected. They gave me cranberry juice and saltine.crackers. My husband came in as soon as I woke up, and he helped me get dressed. They put a front zippered bra on me in the OR. They also gave me two refillable ice packs to put under my arm. We were home by 3-ish. I convinced him to take me for ice cream while we waited for my prescription for Vicodin. Once I got home, I slept until dinner. I had a normal dinner (my mom made chicken parm and stuffed shells). I took the Vicodin just before going to bed, but I didn't really need it.
I'm just about to take a shower and see what I look like. The range of motion in my arm is getting better already. I can take the bandage off within 1-3 days, I can get it wet and soapy. I hope some of this info helps anyone going into this. Remember, my tumor was almost under my armpit, which is a lot less sensitive than some other places might be. First step is over, follow up appointments on Oct. 6 with BS, RO, and MO.
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Thanks Birdgirl11. Supposedly a lump is a partial but they may be different diagnostic codes for insurance purposes.
Poppy and Pontiac- I am in the process of clearing the language up with the PS. They are planning on the lift and reshape of the bad boob and lift and shrink the good one.
I think he is used to more MX and BMX's so he wasn't as familar with insurance on LX reconstruct. He put in for preapporoval and authorization so we will know shortly. He is the one that told me they might not cover it. Thank you for the confirmation. I will look up the law to be familar as well.
AS for the LX with nipple removal, It went very smooth and no pain issues to speak of. I took the pain killers for the first 24 hours then moved to taking them b4 bed for the next 2 nights. I was afraid I might roll over on my stomach or flop onto the bad side in the night. Buts thats all I needed.
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I also had the nuclear meds injected in the nipple. The only difference was I felt 2 of the 4 needles going in and it hurt. She ( radiologist) said that the local doesn't always cover the whole area and that to grit thru it. It hurt but was over quickly.
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nitegirl - I am having the same problem with my insurance company. However, I believe it is just because it was coded wrong. It was coded as a biopsy instead of a LX/partial MX. The hospital will just have to recode it and resubmit it.
Just as an update for me, I met with the MO and RO this week. We are on hold since it appears that the Oncotype DX was never ordered after my surgery. So 3 weeks of waiting before I know for sure if off to Radiation I go or whether I get to do Chemo. My MO says she does chemo on any patient that gets a score in the intermediate or high range so a good chance I will get it but who knows. On the bright side it gives me a few more weeks to heal before anything else happens.
I hope everyone is doing well!
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I'm having lx and ALND in October - a few days before a big birthday - how's that for a rotten start to a decade? Could have put it off a week and maybe still will but there are timing issues, and part of me just wants to move on. Still, I won't be having the birthday I pictured...
Anyway, my tumor is deep, and around the 3-3:30 position. The BS says she'll probably go in from near the nipple - not what I was expecting and incision will be maybe 3-4 cm long - again, bigger than I was thinking since it's a small mass. She says she stitches very carefully and tries to maintain symmetry between the breasts (mine are small) and to make it look as nice as possible, including reducing dimpling, etc. I've got one more appt. before surgery and I'm going to ask her if she has some photos of HER work.
Still, I'm freaking out about what it will look like. I made the mistake of looking at some photos on line and found myself wanting to cry. I don't care about it impacting my sexual attractiveness, but I'm freaking out about a big, ugly scar on a not-so-big breast and really having a hard time with that. Of course, the ALND scar won't be visible unless I hold up a mirror underneath. That's the one I really don't care about, so of course it will be all but invisible.
Any input from anyone? Was anyone semi-pleasantly surprised by the results? If this were on my leg or arm I wouldn't blink an eye but this really hits hard.
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Hi ladies
For those of you who had a lumpectomy after neoadjuvant chemo with complete pathalogical response or reduction of the tumor to something tiny, how big was the mass that was removed from your breast during lumpectomy?
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Hi SJacobs from Massachusetts -
I really did appreciate your post today, as I am scheduled for a lumpectomy on this coming up Tuesday. In your post you wrote - Next step was to place the wire - is that in addition to the microchip marker that was placed in your breast. I have to report to the admission department by 10am for a 12 noon procedure. The 4 shots into the nipple sound a bit scary - hope the novocaine works. The way it was explained to me all the sentinel node stuff would be done as part of the surgery. By that I thought they literally meant while I was asleep. Did you have any pain upon waking up the next day (today). Was the analysis of the lymph nodes available on the same day? Or do you have to wait for the final pathology report?
I'm just about to take a shower and see what I look like - that is from your post. You can take a shower on the very next day? I was told that there couldn't be any showers for the first week! I also live in Massachusetts - in Burlington. Where do you live? Where is your cancer treatment center located? This is my experience with cancer, which was found during a routine mammogram, then magnification, followed by multiple ultrasounds, and finally the biopsy. I was diagnosed on the Friday of Labor Day weekend.
MarieBernice6234
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Hi, MarieBernice -
Can't speak to the rest of your questions but yes, the wires are in addition to the marker that was placed during the biopsy. They are used to guide the surgeon down to the tumor.
You can ask for all the lidocaine you want for the injections into the nipple.
And yes, the sentinel nodes are removed during the surgery but it takes the marker dye a while to travel to them, so it's injected a while prior to the surgery.
My diagnosis path was very similar to yours and at just about the same time. However, my lymph node was seen on spot mammo.and US and then core biopsied. I'll have surgery middle of October. Good luck with yours on Tuesday!
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HI Hopeful8201 -
Thanks for clearing up that matter for me. If I need more lidocaine, I will definitely ask for it!
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hopeful I just wanted to let you know that I have about a two inch scar where my lx incision is. It will fade in time. My breast looks exactly like it did before surgery. It is a tad bit higher than the other, but only I would notice. I am very pleased with the results. No dimpling, no indentations nothing at all like that. I bet yours will be the same and your incision will be a bit smaller than mine. Good luck
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Thanks a bunch, Nancy - that's good to know. I actually wouldn't mind if BOTH of mine ended up a big higher
I'm small breasted but they're just a bit lower on the chest than I'd like. No dimpling or indentations is very reassuring to hear. At first I was just relieved that I wasn't looking at losing the entire breast but the closer I get to surgery, the more the reality of change, any change at all, is hitting me. It doesn't help that I'm probably obsessing about the "small" stuff in order to avoid thinking about the reality of the big stuff - cancer. It's good to have the reminder that the scar will fade, although any I've ever had seem to last forever. Has anyone used any of the commercial scar treatment creams/oils?
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Hello,
I am a newbie to this site and also to what I have been experiencing as of lately with something called a phyllode tumour. I am a 21 year old female and just last week went through a lumpectomy. I'm here because I have a few questions and concerns about the procedure I just went through and no one in my family has ever gone through this so I was really excited when I found this chat room. First off my breasts use to be perfectly aligned but now I noticed that my left breast (the one I got my lumpectomy done on) looks like it is a bit higher then my right one. I've never had that problem before. Will it go away or will they stay like that? Secondly I finally felt comfortable enough to touch the area where my lump was removed and I noticed that the area feels hard and that I can feel a tiny bit of what feels like a lump. Is this normal? Is it because I had the surgery exactly a week ago from today that my tissue is still swollen and trying to mend itself? Like I stated before no one in my family has ever gone through this, I am the first so I have no one else to ask these questions to. If anyone wishes to answer my questions I would truly appreciate it.
Thank you,
Tanya
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Tanya: very normal to feel lumps and bumps along your incision line, and they will continue for several weeks. Do you have a second incision too from a sentinel lymph node removal? I found that incision stayed tender the longest. As for the change in alignment, that is probably going to continue to change over the upcoming weeks as your breast goes through the various stages of healing, with no guarantees where it's going to settle in.
Welcome to the group, lots of good info here, if you can't find an answer to your questions or you just need some support be sure and keep checking back.
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Tanyak,
I am sorry you have to be here, but glad they caught it early. My lumpecotmy was 1 1/2 weeks ago. Because of the horizontal incision, my breast is quite higher. I am 46 so they were sagging a little bit.
They had to remove all of my nipple too. by pulling the skin up to close and stitch it raised mine. That may be the case for you only on a smaller note. Ask your surgeon if it will settle? If they are alot different, you might want to consult a Plasitic surgeon since you are so young. I pray they got all of your tumor and that you have a long and cancer free life. LIFE IS GOODNitengirl
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MarieBernice I am at Mount Auburn Hospital. I live in Holliston and work in Waltham. Are you at Lahey? The wire is in addition to the titanium marker that they put in during the biopsy. If you are going in at 10 for a noon procedure, they may be doing some things (e.g. Nuclear med) while you are asleep. I was in at 7 am for 1:30 surgery (although they ended up being able to take me in at 11). You should definitely ask your BS or even the BC social worker how things are going to work. I took a shower the next day, I have a waterproof dressing that they said can come off in 1-3 days. I'll probably take it off tomorrow. Also, my tumor is almost under my armpit, right next to where they removed the sentinel nodes. I am a DD cup, so all I am expecting is a slight dimple. Things may be different for others depending on the location of the tumor. I should also say that there was quite a bit of ink on me from the doc marking where the injections were and where the nodes were. I used alcohol to get it off, but it was a bit of a shock the first time I saw it because I didn't realize that it was ink at first!
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Wow, so many Mass locals, sjacobs - I grew up in Holliston and live nearby! I just had my lx a week ago Wednesday. I knew going in that I would have axillary dissection, so no nipple shots for me, but I can tell you that the lidocane works very well. I had to have the guidewire placed first and it did not hurt at all. It's a flexible wire that they place on your clip inside and then they coil up the wire that is outside and tape it down to your breast while you wait for your procedure. The lumpectomy site doesn't hurt at all. It is healing nicely and I never needed more than Tylenol to manage the very minor discomfort for the first 24 hours. Similarly, I have an incision for the axillary dissection (much more involved than sentinel as they remvoe the entire fat pad of nodes) and that site is only mildly uncomfortable when I move certain ways. If I'm still, I cannot even tell that I had surgery. I received my pathology yesterday and I am CANCER FREE! I still have AC chemo coming up in a couple weeks and radiation, but I am so thrilled to have made such great progress so far!
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Thank you for replying! I don't think I had any other incision done. My doctor told me I'm having the tumour removed and never mentioned anything else being added or another incision. I also forgot to mention that I never had a biopsy done. Since I decided to go through with the surgery my doctor said that a biopsy doesn't have to be performed but since I got it removed they are going to look at the tumour anyway so within a week and a half I should have my biopsy results. My doctor says its probably benign but we obviously do not know for sure. A week after my surgery and I feel a lot more sore in the area where the tumour was removed then I did when I first got the surgery done. I guess I'm just really anxious and nervous.
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Linzer, glad to hear you got such a nice, clean path report, especially with the lymph nodes. I'm so happy for you!
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Hi everyone! I had my Lx and SLND yesterday and all went well. I was so worried about dye injection into nipple but it was just one injection into nipple and only stung for awhile. The wire location was fine and the first numbing shot was the worst of it. I've been taking Xstrength Tylenol and Motrin combo except for a Tylenol 3 today when I had bit more pain. I have one drain and from what I can see of my breast it looks alright except there is a bigger chunk missing than I'd expected. Hope this helps some of you who are as worried as I was about what the outcome would be. Take Care!
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alright linzer! So happy it went well for you!! Rosie
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Sue, so glad it went well for you. Sometimes a bigger chunk is needed to get clear margins. Sorry that you're uncomfortable but it will calm down shortly. I found my girl didn't bother me as much as the underarm incision (which can still be annoying). But all certainly not horrid. HUGS HUGS HUGS!!
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Hi Sjacobs146 and Linzer -
Mt. Auburn is also a very good hospital. It is very cool how both of you have spent time in Holliston. know a few people who live in Holliston. Linzer where did you have your procedure done? For the record, yes I am going to be at Lahey Clinic. Prior to my recent ankle fractures, I could easily walk to Lahey for my appointments in 10 minutes or less. I think that the game plan for me will be to get all the wire placement and the nuclear medicine items taken care of before the surgery starts. Just today i heard from my BS that my upcoming case was discussed at the Friday afternoon tumor board. Instead of just having one guide wire, the board decided that it would make more sense to place two of them. On will be for the area of distortion and another one for a clustering of microcalcifications. In the case this area is a developing suspicious area, they are going to take the calcifications out. Even if these calcifications are "brewing" something, it will not largely change the projected course of treatment. As far I know now they are only planing to take out 1-3 lymph nodes. As long as they give me a lot of novocaine or lidocaine for the needle/wire insertion, I should be okay with it. I don't know if Lahey uses the water proof dressing or not. I am not a particularly large girl (not double cup size) but my girls are quite dense.
The only area of confusion or interpretation is over what is truly "chemotherapy". I was once understanding that the aromatase inhibitor medication was "chemotherapy". There are those on this site that do not consider this to be chemotherapy. So I changed my thoughts until I spoke with another cancer survivor who is on oral chemotherapy. Today II spoke with my BS who said that it is a chemo blocker to help prevent the possibility of needing more aggressive chemotherapy. It is a lower dose form of chemotherapy that goes on for a prolonged period of time. I did find something on the internet - Compared to chemotherapy, aromatase inhibitors have few side effects. For example, they do not cause nausea. - See more at: http://ww5.komen.org/BreastCancer/AromataseInhibi...
That combined explanation makes more sense to me.
MarieBernice6234
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Sue - nice to hear from another in the Pacific NW! I'm glad to hear everything went well and wasn't as bad as you'd thought. Have a relaxing weekend, get lots of down time and take good care of yourself. Thanks for sharing your experience.
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Su, glad it went well for you! I think just the thought of these procedures is worse than what they turn out to be. They took more out of me than I expected, too. .. but just as long as the margins were clear, I'm good with it!
MarieBernice, They used 2 wires to locate 2 different areas on my breast, too. I wanted them to get out any suspicious areas, including those areas of calcifications. I think you will be so happy you are having both areas addressed.
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I may have 2 wires as well to enhance the 'flight path' as I think of it. Just listened to the recording of our consult and was really encouraged by doing so - it confirmed my sense that she's the right one for me.
She's very interested in the aesthetics of the results, as well as dealing with the cancer, so takes real pains to ensure that patients come out of it with a nice looking result. It's nice to know someone besides me cares about little things like that.
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MarieBernice: I am a Registered Nurse. the aromatase inhibitors are NOT chemotherapy, they are not a lower dose form of chemotherapy. They are a totally different classification of drugs. They are not a "chemo blocker" and are not used to prevent the possibility of needing more aggressive chemo.
If a person has a breast cancer that is estrogen +, meaning that estrogen supports it's growth, then an aromatase inhibitor is an option for treatment, with certain meds like tamoxifen being used for premenopausal women and meds like arimidex are used for post menopausal women, to decrease the amount of estrogen in the woman's body.
I just finished my 4 rounds of true chemotherapy, will do radiation next because I had lumpectomy. And then, because my tumor was estrogen+, I will start arimidex for 5 years.
They have their own list of side effects, related to the loss of estrogen: hot flashes, bone loss and osteoporis, weight gain, etc.MO can give you a better explanation than your surgeon, he's probably never prescribed an aromatase inhibitor, and as we know, doctors often aren't the best at explaining things.
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