Tumor Invading Pectoral Muscle - surgical concerns
Hi, everyone.
I was diagnosed in September 2017 with a 7cm tumor. The imaging was unclear just how much it had invaded my chest muscle. It could have been a lot, or the shadow could have been mostly the encased tumor pushing into the muscle. I'm just about to finish up neo-adjuvant chemo. Through physical exams my MO believes that tumor has shrunk considerably - I can only feel about a 1cm lump now - right at the crease of my breast - up against the chest.
I am between breast surgeons right now and am not scheduled to see my new surgeon until next month. I have so many questions filling my head already! According to the last surgeon, they would may need to cut into at least 1/4" of my chest muscle when they remove the tumor. (I am hoping for a lumpectomy if possible but realize it may need to be more extensive.)
I am becoming nervous about having muscle surgically removed. I've been searching on the boards but haven't found any discussions about pectoral muscle involvement. I'd really appreciate hearing from someone who may have had muscle removed during surgery.
- is it possible to have a lumpectomy with muscle removed, or does that automatically mean I'll need a mastectomy?
- is the recovery time much longer or more difficult?
- cosmetically how did it look? did you any special procedure to correct the loss of muscle volume?
Thank you for taking the time to read my post. If you have any suggested questions re: muscle invasion I should be asking my surgeon, I'd love for you to share them.
Comments
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Not the same but I had extensive lymph node involvement that included the infraclavicular lymph nodes which are between your pectoral and another chest muscle. The combination of the surgery and extensive radiation to the area has made for a long recovery. I had a mastectomy and no reconstruction. I am 18 months past surgery and have needed regular physio to manage tightness, pain and cramping of the pec muscle. It has recently improved a lot but still causes some pain and cramping.
Other things to consider are do you need radiation? In my case it was not really the surgery but the resulting scar tissue from the surgery and fibrotic tissue from radiation that has caused problems. If you need a mastectomy do you intend to do reconstruction? Will it be possible with the damage to the muscle and surrounding area? Will your reconstructions options be limited or require multiple surgeries?0 -
Hi AgathaNYC- I had lumpectomy with partial removal of chestwall muscle. My surgeon suggested lumpectomy. He said I can have mastectomy but I would still need radiation therapy in my case. I agreed with lumpectomy because
1. my lump was on the edge of the breast close to underarm,
2.my tumor has been attached to the chestwall wall. After chemo, the tumor was still not free moving from the chest. I don't know if mastectomy will help with the chestwall issue.
I don't know how much chestwall muscle being taken, but my surgeon said he took as much as he can safely do so. Taking more than that, he is afraid that my breast would drop down.
My post surgery pathology report is a mess. I don't have clear margins, especially on chestwall! The tumor was the same size , same stage and the same grade as before. But I am recovering well from the surgery. I had a drain for a week and 3/15 nodes positive. I have occasional sharp shooting pain on the surgery site. I have regained a good range of arm movement. My right breast has been a smaller breast, got even smaller after the surgery. I lost about a third of my right breast. With bra on, I can't tell much difference. However, with the loss of muscle and lymph nodes under arm, I do feel a lump towards the back of my armpit. When I walk and swing my arm, I feel skin rubbing against each other at the back of my armpit. If I wear bra with a bit of padding on the side, I feel normal there.
Even with the messy pathology result, my surgeon still says he doesn't think more surgery will help in my case.
I would ask my surgeon which surgery will give me a better chance of clear margins. Good luck.
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Dear Beauz - thanks for sharing your story.
It's good to hear that you were able to have a lumpectomy with the tumor still attached to the chest. I'm sorry that the margins weren't clear. I hope that radiation will be able to take care of that. Are you considering any sort of reconstruction to fill in the tissue you lost or for the skin under your arm?
My oncologist thinks I will likely go on Xeloda, too - but after surgery + radiation. I hope that Xeloda is treating you gently.
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Thinking back, I wish I could finish the full course of taxol. I stopped after taxol #7 because of low counts of neutrophils and a bit of neuropathy. My oncologist called it quits. My surgeon said chemo should have worked by then. But I could still feel that the tumor was shrinking with each taxol… I am done with surgery for now. No reconstruction, can't see the need. I am happy with the shape. My surgical incision is a level line of 13cm long starting from near areola to the back of armpit. My surgeon said the lost muscle will not grow back. I did have some skin cut off because part of tumor was glued to skin as well. I wonder how he managed to find enough skin to stitch up. Must be a saggy baggy. LoL. He said the scar is healing nicely. In a way I am glad to have Xeloda first because it will give the wound more time to heal before radiation. So far I am alright with Xeloda, just a drop of energy.
Best wishes to you.
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Hi there—I had surgery on December 28th to remove what was left of my tumor. Should note my BC was a reoccurrence after 10 years and bilateral mast in 2007. Am HER2+. I also had invasion in pec muscle and chest wall. Surgeon was able to to get clean margins and other than a few cells around nerve endings—all is well. Surgery was the easiest part of my treatment protocol.
Started chemo in August 2017 and expected to continue until August 2018 with just perjeta and Herceptin. Will begin 40 rounds of radiation the week after next and then Femara March 1st for 5 years. Fingers crossed that my reconstruction will survive. Hoping for no further surgeries.
Took awhile to get my head wrapped around my new normal. But so far managing through it all. Take care
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I also had to have muscle taken in 2009, when I had a local recurrence. My BF found a lump under my mastectomy scar -- I hadn't had recon. On biopsy, it turned out to be some of my original tumor cells, now turned invasive and growing into my chest wall. My surgeon removed my lump and some surrounding pectoral muscle tissue, going down to the bone in one spot. He also took out 10 of my axillary nodes, of which three were positive. After surgery, I had two kinds of chemo, then radiation.
I call it my upgrade surgery, upgrading me to a full radical mastectomy. The muscle doesn't grow back. It's sometimes hard for me to find a prosthesis that fits well, as not many ladies today need or get surgery this extensive. But we do what we must to get cancer-free.
My treatment took about a year. It pushed me into menopause at age 42. The node removal and radiation made my lymphedema worse. But I'm still here, NED, eight years after my second dx. I wish you clean scans, a skilled surgeon, and not too bad side effects.
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Dear Beauz - Sorry it took so long for me to respond. I lost track of the thread. Chemo brain has been really doing a number on me. I hope you've continued to heal nicely. I hope that notion that you should have had a few more Taxol doses doesn't still nag you. All the "what if" doubts that nip at us can be unrelenting. I have a pack of my own, but I try to push them aside as soon as the show up. Good luck with the Xeloda. How are your hands and feet doing?
Hi, ehall - Thanks for sharing that surgery was the easiest part of your treatment so far. May I ask did you breast surgeon remove the tumor from muscle and chest wall or did a thoracic surgeon assist?
Hi, amygil81 - I am so happy to meet you eight years out, NED. You are so right, we do what we need to do to get cancer free.
I had my post-chemo mammogram and MRI yesterday. I am hoping the imaging will show that the tumor has retreated away from the muscle. Hoping, but prepared for what surgery might bring.
If muscle tissue is removed is recovery any more complicated or lengthy than standard breast surgery? I live alone and am trying to figure out my post-op plans for friends to come stay with me.
THANK YOU, LADIES!
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Originally I was scheduled for a lumpectomy with a 1.2 cm in pectoralis muscle.. unfortunately a MRI turned up a second tumor in the breast so I had a mastectomy . The tumor in the pectoralis major was 2.5 cm.it was larger than expected. My surgeon did tell me based on size and location if the tumor is deep into the pectoralis muscle it can cause breast unevenness. My tumor was not deep. I was fortunate.No thoracic surgeon. No additional down time. Good luck
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Agatha, have you gotten your reports yet? Can I ask what you'll be having for surgery?
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Hi, amygil81 - Thanks so much for asking.
Good news. The MRI and mammogram showed that the tumor did in fact recede from the pectoral muscle. Overall it shrunk in size and became MUCH less dense. The surgeon won't know for sure until she sees it during surgery, but doesn't think she'll need to take any of the muscle, or if anything just a shave. I'm so fortunate the neoadjuvant worked well for me.
I'm going to have a lumpectomy on Monday morning, with a reduction on both sides following in a couple of weeks. My surgeon wants to get the pathology back to make sure she got everything before she hands me off to the plastic surgeon.
After that I'll have radiation.
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Agatha, how did everything go for you?
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Hi, amygil81 - Thanks for asking :-)
I had the lumpectomy and got a pCR. No evidence of cancer left in my breast. Also, she surgeon didn't even have to scrape the muscle to get clean margins.
Chemo really did the trick for me!
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AgathaNYC- I had a tumor in the pectoral muscle. I did not have the Neoadjuvant treatment prior to my surgery because they thought my tumor was extremely small. It turned out to be 2.5 cm the true size of the tumor. It still went fine. They removed it with clean margins. So I'm very happy for you that everything went great. Best if luck.
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I have a similar surgery coming up, the MRI is suggesting the muscle has been infiltrated. I expect they will be removing some pectoral muscle with the surgery. For those with similar surgeries, how did the recovery time differ from the original surgery? Are there any ongoing issues with the loss of some muscle? They are doing surgery first with chemo and radiation to follow. (Mine is estrogen and progesterone positive and seemingly grew while I was on tamoxifen.) I see the oncologist on Monday to follow up with the CT scan results, although, from what the nurse told me, it sounds like it has not metastisized.
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jo6359, did they have to remove pectoral muscle in your case? Are you having any issues from the loss of the muscle. I am trying to figure out my recovery time, etc. At this h=time I am trying to minimize the amount I time I miss work for surgery since I will be missing time later with chemo and radiation.
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Notinoz, how are things going for you now? I had a similar diagnosis some years ago, my original tumor growing back into my chest wall. See my post higher up in this column. I hope all goes well with you this time around, which none of us wanted.
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notinoz- my surgeon did remove some of the pectoral muscle. Fortunately the margins were very clean. I haven't had any issues so far. Tere's definitely an indentation in my r ight chest. The left side of my chest is very flat and the right side is noticeably different because of removing some of the pectoral muscle. I return to work part-time within 3 weeks. Fortunately I was able to adjust my schedule. I was not permitted to do any transfers or lifting for four to six weeks post-op. A lot depends on what type of work do you perform. The drainage tubes came out within eight days and I was thrilled. By the 6th day the insertion site of the tube was very itchy and uncomfortable. You will do great.
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Wondering how you are doing? I have similar diagnosis accept my hormone receptor status is different. Similar surgery scheduled. Had you had recon after your Mastectomy? Were they able to close the incision easily? Hope you are doing well with follow on treatment!
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celebris-I had the option of having implants put in as soon as my breasts were removed. I did not want reconstruction. I have no regrets. When I wear fitted shirts the indentation from the right side is evident. I try to wear slightly looser tops unless I'm wearing a padded bra.
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My oncologist is calling for a radical mastectomy because of a tumor under the pectoral muscle. I'm concerned about losing the entire pectoral muscle, primarily because of the potential loss of mobility. Why can't they take just the muscle above the tumor? If they did take the entire pectoral muscle, how limited would my capabilities be? Would a tool like the Proton Beam at MD Anderson be a another viable option?
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Hi ehagen, and welcome to Breastcancer.org,
We're sorry to hear of your diagnosis, but we're really glad you've found us. You're sure to get some good answers here to your question, as this is the perfect thread to share your diagnosis; however, it's been quiet since February, so we're not sure others will be back to weigh in. You may want to start your own thread here in the Surgery forum.
Please let us know if you need any help at all. We look forward to hearing more from you soon, and supporting you all the way!
--The Mods
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