Lumpectomy Lounge....let's talk!
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Tamoxifen is a different class of anti-estrogen drugs from aromatasee inhibitors. It's a "selective estrogen receptor modulator," or SERM, the same class as raloxifene (Evista). Because it doesn't reduce the amount of circulating estrogen (instead, it keeps it from being accessed by estrogen receptors), it doesn't weaken bones. (In fact, Evista is sometimes prescribed as a bone-strengthening drug; but it's not as effective as Tamoxifen at keeping estrogen away from ER+ tumor cells' estrogen receptors). But people do report hot flashes and weight gain on Tamoxifen. All things being equal, preventing aromatase from being the catalyst in conversion of androgens to estrogen is more effective (at least statistically) at preventing recurrence than is blocking estrogen receptors. (But 20 years ago, Tamoxifen was the only tool in the endocrine-therapy arsenal).
Per BCO's own site:
"An aromatase inhibitor is the best type of hormonal therapy to start with for postmenopausal women. When treating early-stage, hormone-receptor-positive breast cancer, aromatase inhibitors have more benefits and fewer serious side effects than tamoxifen."
Low-dose aspirin alone may not be sufficient to prevent Tamoxifen from causing blood clots. Not having a heart condition won't either. If you must go on Tamoxifen, ask your doctor about either switching to chewable uncoated baby aspirin or a regular aspirin, or a different blood thinner. Statins don't affect blood clotting, but do lower serum LDLs & tirglycerides (which may or may not form "friable," aka unstable. arterial plaques which can combine with blood clots to cause heart attack or stroke). Not sure if Tamoxifen raises LDLs to the same extent as do AIs.
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Alice, looking at your profile, I am humbled by the road you have traveled.
I try to keep in mind that I am one of the lucky ones. And beating cancer may bring some unwelcome changes. But I have learned that I am strong enough to speak up and ask a zillion questions. if that’s what it takes.
My quick thinking and mind sharp are not something I am willing to give up. There has to be an answer better than choosing between cancer and my mental capabilities. If not, I’m pretty sure I will pick my mind. But I’ll look for alternatives first.
By the way, I love your statements about cancer being a bitch, but you’re a bigger one.
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Thank you for the encouragement. It's nice to have this place where I can vent.
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Hello!
I had my lumpectomy on Dec 20th. I'm still in pain. Wondering if this is normal after 16 days out. My nipple is sore and a bit enlarged but my incision was midway between my nipple and lower breast so no where near the nipple. Also, have a super small random temp of 99 but not all of the time. I'm also in early menopause. Just wondering if anyone else experience longer term pain? Not sure how long this lasts or if something is wrong.
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Hello Ladies,
I have been trolling this community since my DX 10.23.18. Finally decided to add my voice - if only to say thank you for sharing your thoughts and concerns. It’s been of great comfort.
My story: Lumpectomy 6 weeks ago. Developed a huge hematoma the day after surgery. The colour and bruising have subsided but my left boob is still huge. At least 2x normal size. (My surgeon made ref to a certain baywatch actress - not very appropriate I would think). The hematoma/ seroma is probably about the size of a goose egg.
My question: Should I have this thing drained? There is some pain but not unmanageable. Mostly discomfort. I am concerned about internal scarring if I wait too long. I understand also hematoma/seroma can take many months to reabsorb on their own. I plan to delay Rads until this complication is resolved.
Has anyone experienced anything similar post-op?
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QueenB, this does sound a bit out of the ordinary. I'm guessing your surgeon would like to take a look--could be a little infection or a fluid buildup, or perfectly normal. This kind of issue is pretty common and your BS does want to see you now, rather than waiting for your regular followup.
Freebee, I think one criteria for determining whether to drain a seroma is whether the surgeon thinks he might be causing more of an issue. I had a seroma just under my skin that formed a racquetball sized lump. It was drained and the bleeder repaired. The surgery was brief, but, argue as I might, they did insist on general anesthesia. I needed to heal from that surgery before I could start rads, which made me extra jittery.
Someone else on this thread had a large and, I think, deep, seroma that was not drained. It sounds as though your BS has left the decision up to you. Draining the seroma will certainly delay rads, but for a fairly predictable time. How long your seroma will take to heal on its own is less easily determined. I do not think your BS or RO will feel it necessary, or appropriate, for your seroma to fully resolve before rads begins, as there is a preferred window of time in which to begin treatment.. You do want to grill both your BS and your RO about all your options and their pros and cons.
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Freebee, my entire breast was at least 3 times its normal size and a blackish purple. My incision opened and the majority of it drained out on its own at home. I had rads when my incision stopped dripping blood, but I still had a pocket of hematoma which had clotted and turned hard. my surgeon wanted to open it up and clean it out, but I got a second opinion and they said don't do anything because it could cause further bleeding. That said, I have a rare bleeding disorder which aggravated the hematoma. Your situation may be different. I do know that I will have this for a very long time as it takes forever for the body to absorb this much blood.
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I'm the one who had a deep internal mammary seroma, which was exacerbated by radiation and caused my breast to bulge on the side. Per my lymphedema OT, I wore a "Swell Spot" pad inside my "leisure" bra at night and at home. Took about 6 months for the swelling to subside, and another year or so for it to shrink to the tumor-cavity size (visible on mammogram, not externally). The axillary seroma was near the surface and burst when the incision was pulled open by the weight of the breast. It basically "drained" itself, and was sutured closed, rather than re-Steri-Stripped.
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Thank you Wised, Brookside and ChiSandy for sharing your thoughts and experiences. VERY helpful and appreciated. I see my surgeon tomorrow. I am also seeking a second opinion - not easy to find though. My rads have not yet been scheduled and probably won’t be for at least another two weeks, which allows a bit more time for recovery.
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How long did pain last for most people here? My surgery was 12/5. The pain is not terrible, but it still definitely hurts with any pressure. My incision is on the top of my breast toward my sternum, so it's an awkward and easily bumped spot. I work with infants and toddlers, so have kids climbing on me, sitting on my lap with their heads against my chest, etc. I'm still having to change how I hold babies and how I interact with toddlers because it hurts. It looks fine. Maybe a little swollen but nothing dramatic. Still definitely hard in the surrounding area. I'm thinking it's still painful because of the very unprotected location and that I might not notice it as much if I did a different type of work, but I'm interested in what seems to be "normal" for this type of surgery. As a contrast, my underarm incision is pretty much fine and I've recovered most of my range of motion (with some tightness). There's some tenderness, but it has improved much more than the lumpectomy area in recent weeks. (And yes, I will call my surgeon's office to get their opinion. I meant to today but things got crazy.)
Thanks for any wisdom/experiences you can share!
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Hi OT,
I had my LMX 23/11. First two weeks were Hell, but things improved.I just went back to the gym this week. My arm and chest area are still tight compared to the non-surgical side. Not painful as such, but uncomfortable. Half of my boob is still numb.
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I have a question maybe someone can help with. I have had a limp where the lumpectomy was (5/17) and now it feels bigger. In exactly the same spot, but it sees to me that earlier it was smaller. I had been having so many breast exams over the 1st 1 and 1/2 that all told me this was normal. I am now out 16 months and next appt is in May, but I am finding myself worrying t what if this is a local reoccurence? Last time I was checked was in Sept by a radiologist.
Has anyone had this experience with a lumpectomy?
Thanks
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MickeyB, your lump is most likely a seroma. Mine is still there nearly one year after lumpectomy. I was feeling some other changes which had me worried. However, at last week's diagnostic mammogram and ultrasound, the radiologist assured me that there are only normal post surgery changes. Will see BS this Wed. and discuss with her. If you continue to believe the lump is larger you might want to seek an earlier appointment, for peace of mind if nothing else!
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Seromas can be enlarged by radiation, and continue to grow for months after finishing treatments before they start shrinking. You might also have a knot of scar tissue--my surgeon's NP warned me that sometimes happens, so not to freak out.
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Beaverntx - thank you for your response. I am probably going to call. I never had a lump with cancer and it's odd now that I have a lump post surgery! It is sore when I press on it but that may be because I keep feeling it. The only way to get reassurance is to have it checked out - just hate the worry!
Anyhow thanks - wasn't sure what a seroma was - or that it could continue out this long.
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If it hurts, it's almost certainly a seroma (which is Nature's way of filling in the void left by internal tissue removal--it's fluid). Annoying but harmless.
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Hi Ladies,
I have a question about "clear margins" for a lumpectomy. Is there a minimum amount of millimeters that would be considered clear margins? Mine were 5mm on 3 sides, but only 1mm on the 4th side. My surgeon said this is OK and is still considered clear margins, but Im nervous. Thoughts?
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It might be a seroma or scar tissue, or a little of both. I remember my two years out visit with my BS. I was concerned because my scar tissue had changed. In other words, there was a bigger, differently shaped, lump. It was normal. I'd known scar tissue continues to form for a year, but mine grew for two.. I've since had bunches of breast exams and mammos and a couple of ultrasounds, and all has been well.
Certainly do visit your BS. I was so surprised at how detailed my BS's notes are. I had a benign lump in my other breast that I was certain had grown. He checked his notes and was able to tell me that it was five milimeters a year earlier, and was five milimeters now. Your BS knows exactly how your lump should feel. If there is any question at all, he'll send you right downstairs for a scan.
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kec1972- I'm not in medical field, but I think clear margin differs from surgeon, to region of the country or world. I think my surgeon said 3mm. You can look at your pathology report, its quite detailed. It could ease your mind.
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Kec1972 - I asked my MO about it because one cell was 1mm. She sent me the BC guidelines. The notation meant 1mm from the from the ink. They inked the margin around the lumpectomy site and anything in the ink is too close. Anything outside is within standards.
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Hello comrads, I am eight weeks out with a large lump where the lumpectomy was performed. I had a PS look at it today and he said that the lump was solid - there is nothing to drain. Has anyone experienced this before? Will this thing go away on its own? It’s also immobile. When I shake my chest, only the non-surgical boob moves. Now that’s a sight.
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There used to be a minimum distance expressed in mm from the ink for margins to be "clear." But a couple of years ago, the breast surgical oncology dept. head at City of Hope did a lecture mentioning their standard: "no tumor on ink." No need to measure. More and more surgeons are adopting that standard.
As to that hard lump, Freebee, it could be scar tissue--some people tend to be keloid-formers (those scars form faster and are thicker).
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Thanks ChiSandy. That makes sense. I’ll look it up. I suppose the upside is that there is no dent, for what it’s worth.
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To those asking about how much pain is normal, that's a tricky question. When I had my excisional biopsy, in which the surgeon burrowed in from the armpit side of my boob all the way to above the nipple to cut out a hunk, I was like, piece of cake. No worries. A little aching, a 2 inch incision, went shopping the next day. Took an acetaminophen for pain meds. No biggy.
When it came back cancer and the surgeon told me she was going to follow the exact same path in again I wasn't too worried (well I was about the CANCER part, but not the actual surgery part so much) although I didn't know how much boob I'd have left when she was done. What I had NOT counted on was the post operative hemorrhage I had and instead of going home they put me out again, cut me open, cleaned out all the blood and fluid, re-stitched all the torn internal stitches, placed more clips and stitched me up again. Two boob operations in one day.
Pain? Oh my god. I still get mad when I think about how UNtreated I was for pain. I got nothing, not even a T3. I got plain old Tylenol every 4 hours (they kept me overnight in hospital to pump fluids into me and make sure I didn't burst forth in more spontaneous bleeding). I was black and blue to my pubic bone! I literally looked like I'd been hit by a truck. My side, stomach, ribs and pelvic area were BLACK AND BLUE. IT was so gross. And the pain. I told my husband that if this kept up I was going out to the tack shed and getting that stiff we give horses that need pain control and I'm mad I didn't just do it. The pain incapacitated me for a very long time. The doc told me that blood is an irritant in tissue and when you bleed into an area, it is painful. No kidding.
So to answer the question, how long did it hurt, a) hardly at all b) so long I cried and got stuck in the bathtub and couldn't get out. Now isn't that helpful?
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How long are you under anesthesia with a lumpectomy? Also, did everyone receive general anesthesia or is there an alternative -- like what they give you for colonoscopies? I am terrified of anesthesia. ---- of course I seem to be terrified of everything since this diagnosis (-:
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Jesse, it is general anesthesia. It can take an hour to two hours to complete the lumpectomy. A colonoscopy can be performed in 20 minutes or so. Just because a lumpectomy is outpatient surgery it is still major surgery. Just look forward to a very peaceful sleep for a couple of hours.
If you have experienced problems with anesthesia be sure to discuss your concerns with your anesthesiologist. Also if you have any problems with pain meds be sure to discuss them with your breast surgeon.
Sending ((hugs))...you are going to do well.
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jessie123- you can ask your surgeon for details on what methods of anesthesia will be used on you, and how long its anticipated you'd be under.
For my LX I was intubated, and under for the duration of the surgery, its been a while, but I believe 1-2 hours. For my reexcision, I believe it was MAC which I think is general, and no intubation.
Ask questions, take notes, if your not comfortable with the answers, seek a 2nd opinion. Best wishes to you.
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Jesse123 I agree with CindyNY, ask questions. Are you just doing a straight lumpectomy because that will impact the time. I actually went the route of Oncoplasty Surgery which is a Lumpectomy with Plastic Surgery at the same time. Due to the location I was going to most likely have a divot in the top of my chest and I'm too young for that. In addition I also had my boost of radiation during surgery instead of at the end. All that being said I was out for 6 hours and stayed overnight. The good news I had one surgery instead of multiples and the remaining radiation will only take 3 weeks instead of the normal 5-6 weeks.
Good luck and ask questions, you are your best advocate.
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has anyone had lumpectomy with local or regional anesthesia?? I am looking for a surgeon that will do this. I live in the Midwest region of US but would travel to have this option.
So scared of general ane
Leawoodgal
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The reason not to do regional or local for a lumpectomy is that it's not just a superficial surgery or a biopsy--it goes deeper, and too much tissue is usually taken, along with removal of sentinel nodes for biopsy, for the patient to be awake. The surgery takes at least 1-2 hrs., and the patient needs to be perfectly still. This requires, if not full general (gas) anesthesia, at least propfol. I had a general with intubation for my lumpectomy with SNB, and propofol without intubation for my arm/wrist/hand triple orthopedic surgery. Both times felt exactly the same going under & waking up.
The only major surgery I ever had that didn't knock me out a was an emergency C-section, for which I was given an epidural--of necessity, the operation has to be quick (10-15 min., less if there's fetal distress) so that as little anesthesia as possible can affect the baby. And the epidural wore off as they were beginning to suture me. (But I was so "over the moon" at finally meeting my son that I didn't mind the pain. A C-section is still a delivery, and still for a joyful payoff. Nothing joyous about getting a large chunk of flesh--and nodes from a separate incision--removed for what is definitely not an occasion to celebrate. Unlike general anesthesia (gas or propofol), loco-regional is administered once and it lasts however long it lasts and wears off when it wears off. A general is administered constantly by the anesthesiologist--who monitors vital signs and makes sure the right amount is given, just enough for unconsciousness and lying still (too dangerous for the surgeon to hit a moving target) but not too much to have difficulty awakening the patient. And a regional block over a large enough area to safely cover lumpectomy and sentinel node removal might even involve the lungs--which requires breathing assistance anyway. Do you really want to be awake on a ventilator? I wouldn't want to be awake & aware while they were slicing & digging & scooping & stitching.
It's okay to be afraid even if the fear is objectively groundless. You own your emotions and nobody can tell you what to feel. But you will be fine after a general.
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