Lumpectomy Lounge....let's talk!
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kabozzle, while reexcision was not my experience (actually it was but it happened during the surgery as the tissue was checked in the lab) but you will find that many people who post on these threads have had that experience. It really is not unusual, as stressful as it is.
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Kaboozle, I had a re-excision. They used the super-lightweight anesthesia and I was in and out of the OR in about 20 minutes, and home shortly after. I'm trying to figure out what you mean by letrozole slowing the cancer growth. If you had a lumpectomy with nothing in the sentinal nodes, what cancer is the letrozole slowing? I'm confused.
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Not sure what you mean by "letrozole has slowed the cancer growth by (percent)." How on earth can they tell the "rate" of the cancer "growth" (I assume that's what you meant by "slowed it down")? They don't measure growth rate by percentages; and that's not what letrozole does, and certainly not how it works. (Why were you put on letrozole before lumpectomy anyway)? You had the tumor removed, the cavity was immediately radiated, the nodes came back cleam. Margins for re-excision are exceedingly small--no more than a mm or two (usually no more than one or two speckles on the entire perimeter), and the new standard of a clear margin is "no tumor on ink." So what makes them think that those few tiny cells left behind are growing (especially since they'd been radiated), much less by a certain percentage? Could it be that you misinterpreted what your doctor told you?
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I needed a reexcision with my first round of BC. The surgeon cut in the previous area and I had no issues with it. I was a little lopsided but nothinig a good bra couldn't hide. That was 13 years ago. Unfortunately I had another BC in the opposite breast this year but didn't need a reexcion this time. Now I am no longer lopsided!!
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Thank you all for the replies. I am now scheduled for a re-excision Nov 12th, ugh, (soonest I could be fit into the surgery schedule). Because the unclear margin was near the chest wall, they've chosen to go back in.
I'm in Oregon, intraoperative radiation for breast cancer is not considered the standard of care and it's availability is extremely limited. It's only done 4x/month, and has to be fit into both the surgeons and radiologists busy schedule. Since I fit the qualifying criteria, I wanted a shot at this even though it delayed my surgery by approximately a month. My surgeon chose to start me on the letrozole preoperatively.
The percentages I referred to in my original post were based on Ki-67 staining (tissue proliferation rates) checked preoperatively on the original tumor biopsy and again on the excised tumor a month later. (I've included a brief explanation of what Ki67 staining is) Not all physicians utilize this test.
Ki67 is a special stain that gives a sense of how aggressive a tumor is. The pathologist takes the biopsy or surgical specimen, prepares it, puts it on to a glass slide, stains it for this protein, and look at it under the microscope. It's a protein in cells that is involved in cell replication, so if many cells are expressing it, the tumor is growing quickly; if very few cells express it, then it is growing slowly. The pathologist needs to count about a thousand cells and determine the percentage of cells that are Ki67 positive. Therefore, the number that comes back should be a percentage from 0 - 100%.
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Kaboozle, perhaps your onc. took part in a (still experimental) study out of the UK (just read the article in the Doctors' Digest listserv) that gave 2 weeks of letrozole to postmenopausal ER+ patients pre-surgery, testing for Ki67 before & after. (Not all MOs even measure Ki67, especially for tumors with a mitotic rate of only 1. My MO didn't, for that reason, and my low OncotypeDX score bore that out). The "after" test (about $80 US) supposedly predicts recurrence risk at about 5% of the cost of genomic assays like Oncotype or Mammaprint.
Before the advent of genomic testing--or for tumors with higher mitotic rate--Ki67 staining had been nearly universal. The genomic assays essentially mimic Ki67 staining, but add other factors to further refine prognistic scores. But the "percentage" given in Ki67 stain results is the percentage of the sample testing positive for Ki67, not necessarily a measure of the speed of growth (which is still rather general). So if your doc says the "percentage" went from 7% before to 1% after, that's a drop in the Ki67 percentage from the original biopsy to the post-op path report.
Still, you will have to (or be urged to) take letrozole for at least 5 years. (I'm coming up on 5 yrs next month, and it hasn't been bad at all).
Just for spits & giggles, you can plug in your numbers (age, grade, tumor size, node status) at cancermath.uk to see what the statistical guesstimates for recurrence-free and overall survival are with & without various endocrine therapies.
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Hi, Had a lumpectomy with sentinel node biopsy on Thursday October 29th. Today is Nov. 4 and I finally had the nerve to pull off bandage covering the strips placed over the incisions. I had an interesting finding. Although the radiologist marked my breast where the lump was located, I see that the surgeon made the incision outlining the nipple.
The lump was located 5cm from the nipple at 1:00 o'clock. I had given no requests to keep breast looking scar free before going into Surgery. I just wanted the lump out and surrounding normal tissue removed.
So my question is: Why did the surgeon make an incision to remove the lump so far away from where the lump was located? I'm recovering ok. The pain is not too intense. The incision under the armpit is still quite tender and sore. Been trying to keep my arm moving but not too much. It is my right arm and I'm right handed. So I use my right arm a lot as you can imagine.
I look forward to any insight on the decision to remove lump so far away from where the lump was located. And how do I know that all the cancer got removed? I know, Doctors and Surgeons are extremely intelligent and knowledgeable. But I still feel like a swollen lump area in the breast. I worry that maybe some cancer was left in there. Probably not, I'm just a neurotic at heart.
I wish they had more time to explain and answer questions as they come up on this journey.
The surgery started at 3:30pm and lasted until 5:30? however, I woke up at 7:30pm. So I am wondering why it took so long to wake up? I was under anesthesia for approx. 2 hours. Did the surgery last longer than expected. If so, why?
Based on what I've read, people usually wake up 10 mins after anesthesia is stopped. I was told I would be ready to leave the hospital at 5:30pm. I felt bad about having my driver wait so long. I could have said pick me up at 7:30pm. No one told me anything. The nurse gave me a sheet of paper to inform me when my next appointment would be and what meds to take. That was it.
In the meantime, before my next dr. appointment which will be in approx. 10 days. this is a great resource. Thank you.
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That's appearance sparing surgery, and yes it looks really weird at first. I know b/c that's what my breast surgeon did. I was pretty shocked when I first saw it but the results have been great. You cannot see the incision today, in fact it was practically invisible within 8-9 months.
And yes, the sentinel node incision was the worst, that one hurt far more and for longer than the lumpectomy. But it too faded really well.
Best of luck with your recovery.
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Cherisse, echoing what edj3 said, it's for appearances. I can't see my scar two years later, although I have a faint one where the node was removed. No big deal except certain bras still aggravate it occasionally. I just don't wear those bras anymore.
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SO I did not care about how my breast would look after surgery. The Surgeon never asked if esthetics was a priority to me....cause it was not....I wanted all the cancer lump out with extra to be sure. I even felt relaxed the day of surgery because I was feeling relieved that the lump was going to be taken out. Also, I did not think I had cancer going through my sentinel lymph nodes and fortunately pathology report reflected that. I am relieved however, I am even more worried now that my gate keepers are gone and the pathology report says that I have positive cancer at the margin. ugh....why not take out as much as you can to make sure all the cancer is out. Now I've read in my chart that another surgery will be underway. I understand the medical field has to follow protocol but I really didn't want to have my sentinel nodes out. They were negative anyway. All I wanted was to have all the cancer lump taken out all of it and more. I don't freaking care how the breast look. So worried its going to have an opportunity now to metastasize. No one listens!!!!!!!!!!!!!!!!!!!!!!!!!!!
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Cherisse, did you have all your nodes taken out?
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Cherisse, sentinal nodes are only part of the lymph system in and around your breast. It does not sound like your axillary nodes were touched and you still have lots of lymph drainage available.
As to waking up after anesthesia, 10 minutes maybe with very light anesthesia. However for your breast surgery a deeper level of anesthesia and muscle relaxation was needed. The length of time to wake up will vary from one person to the next but is likely to be longer than 10 minutes. The experience you describe does not sound atypical.
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Cherisse, please go to your "dashboard" for instructions as to how to fill in your diagnosis, surgeries, & treatments--then post it as a "sig file" aka "sig line" which will appear at the bottom of your posts. We can't give you informed advice without getting the full picture.
The whole reason for a sentinel node biopsy is that those are the first lymph nodes to which cancer would spread should it (hypothetically) spread. Hence the term "sentinel." Back in the day decades ago, they'd take the entire first level of axillary nodes, sometimes all the axillary nodes, without knowing their status (they used to cut first and ask questions later). Taking the sentinels for biopsy is the only way to know for sure if they're negative for cancer. It's much less invasive--and if 0-3 are positive, no need to dig beyond them. As Beaverntx says, you have dozens more nodes remaining to do their jobs.
Not at all unusual to need a re-excision to get clear margins. (The latest definition of "clear" is "no tumor on ink*," so much less tissue needs to get removed on that second pass). I went "under" at about 1:30 pm, and "came to" in the recovery room about 4. Even though lumpectomy is less invasive than mastectomy and is outpatient surgery, it still has to be done under general anesthesia (not just the "conscious sedation" such as propofol you get for, say, a colonoscopy) because you have to be perfectly still for the duration. That includes a powerful muscle relaxant injection and intubation.
Needing a re-excision is NOT a slam against the skill of your surgeon. It's not always possible (in fact, usually impossible) to determine margins with the naked eye while you're on the table during surgery, and the only way to know for sure they got it all is by post-op biopsy by a pathologist. Those "leftover" cells are not visible except via a microscope.
And it also doesn't mean those straggler cells are going to metastasize. Breast cancer doesn't spread that fast.
*"Ink?" They use a surgical marker to draw the boundaries of the tumor and surrounding tissue to remove. Used to be a margin wasn't "clear" unless there was at least 2-4mm between the marker line and any tumor cells. Now (beginning in 2017) so long as there are no tumor cells touching that marker line, the margins are considered clear. But some surgeons are still kickin' it old-school.
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kaboozle- my MO put me on tamoxifen before surgery... same reason you’re probably put you on letrozole. Apparently it’s common in some countries to do this while testing and waiting is happening to slow the rate of growth. My MO suggested I do it and I said yes.
Cherries- I remember reading 30% of all lumpectomies need a reexecision after surgery. Mine happened during the initial surgery... margins kept coming back positive.
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Perhaps, because of age I had conscious sedation, not general, and,perhaps also because of age ,they did not take my sentinel node. There was no tumor on ink, but narrow < 1 mm on one of the margins, < 2 on another. It was decided during tumor board that a re-excision might be a good idea to help me, again because of age, to avoid radiation. I remember looking forward to it so I could sleep for a little while. Margins were widened but 3 mm of residual IDC and LVI were present. MO thought I could either not have radiation and if it came back locally, I could then have another lumpectomy and radiation then, or radiation right away which he thought might be better. So 16 rounds of partial hypofractionated radiation.Dana Farber, where I got second opinion, said their standard is still 3mm from margin. Tomorrow I see so cute and skilled BS for routine checkup. Will be, as always, nervous.
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Hi, everyone! Had my surgery 10 days ago and awaiting results of oncotype testing.
I’ve been doing well but yesterday out of the blue I had several sharp pains in a row. They stopped. But since then the affected breast has been more tender, even to a light touch. Is this part of the healing process? Nerves reattaching or something?
Everthing looks fine and incisions are healing nicely. Thanks for any input you might have.
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In a month after radiation I will be prescribed arimidex. I am deciding if I want to take it or not. Will it really prolong my life and by how much andis there a way to determine that? I am 67 with stage 1A, grade 2, lobular, no node involvement.
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SpringDaisy, All the studies say that Arimidex and the other AI's do definitely help. I did 5 years on Arimidex, starting at age 69 and finished when I was 74. I had few problems with it. Why wouldn't you want to take something that helps you live for many more years likely cancer free? For me it was a no-brainer. I want to live as long as possible and keep BC from coming back. I've had many upheavals in my life the past 6 years from my BC DX: BC treatment, husband having surgery and then having to go to a nursing home, his death in 2015, my selling my home of nearly 50 years and moving across the country to live near one of my sons. I didn't need to worry about BC returning. You have to make the decision based on what YOU think is best for YOU. This was what was BEST FOR ME! Good luck!
HUGS!
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thank you for your input. I am sure I will take arimidex. Did you have bad side effects or not?
I've usually had good health so0 -
I had no problems with Arimidex. I was already creaky in the morning and found that taking REGULAR (not decongestant) Claritin helped a lot with that. I was losing hair before it and I still after it.
HUGS!
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oh thank you that makes me feel better. And hugs back to you also!
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Glad to help you. It is all so scary. BTW, please fill out your profile and make each item PUBLIC so we know your diagnosis, treatments, etc. It appears in the signature line at the bottom of every post. Thx
HUGS!
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Mskiles it is probably all the nerves starting to wake up. Be warned you might even get some intense itching, that is another sign of healing. Good luck!
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Springdaisy,
I have exactly the same stats as you. I was diagnosed a year ago & I agree with Peggy. Why not give it a try? As far as side effects, I had some but they were hard to differentiate between Arimidex & ending up so lethargic due to COVID. I have felt more fatigue after a year but I've decided to take it at bedtime rather than in the morning. My mornings are devoted to getting up & getting going.
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I always take my letrozole at bedtime.
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Pontiac Pegit is good to read this 6 years later! I have not been on the site since those last days of treatment in 2014-2015.....until now! I’m still taking Arimidex and will be doing so a total of 10 years. Recently I’ve been feeling an achy kind of pain in the breast that went through treatment. I signed back in after these years of keeping it out of my mind!
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FionaScottie, I get that too occasionally. I had physical therapy in January for not exactly lymphedema but for aches and pains from my surgery and how things were "re-arranged." That did wonders. I know what to do so that my side, back, breast, etc don't hurt. It was really worth doing. My NP who is my PCP recommended it when I was complaining about all these annoyances. I was sure they were from the surgery (yup even after 6 years). And they were. I had a breast cancer specialist. I also find that I have to wear a different bra (or actually wear a bra rather than a padded cami) some days for the support. It's all just a PIA. You might see if one of your doctors will prescribe therapy for you with a breast cancer specialist.
I'd have taken Arimidex for 10 years if my MO had recommended it. But he thought 5 was appropriate given my age (74 when I quit it after 5 years).
Hope that this info helps. Glad you have been doing so well!! Love hearing from you!
HUGS!
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Hello All,
I had lumpectomies on both breasts a month ago.
Does anyone know if the scar tissue below the incisions ever goes away? I can still feel it and they are hard. It doesn’t really hurt, but feels tender still. Thanks0 -
Hello datagirl,
I had a lumpectomy 10/23/20, and am experiencing the same thing. Thankfully, it is lessening each day. I was concerned enough to call my drs office. It was causing me a lot if discomfort especially in the late afternoons and evenings after I had been up all day. He explained about scar tissue and such, and told me it would resolve. He was right, it is almost gone and almost all of the tenderness is gone. Hang in there
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Thanks, Sherry. That makes me feel better
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