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January 2019 Surgery Support Group

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  • specialk
    specialk Member Posts: 9,227
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    mactaz - you have a number of things to consider, and are in the same rock vs hard place as me with the skin cancer consideration. Even more so as your skin cancer was melanoma - mine have been basal cell - but I have had a lot, with one an infiltrating on my shoulder only a couple of inches from my nodes - certainly in the field if I had done rads.. I know they are good at reducing the scatter, but... Mine grow fast and quite a number have had to be done by MOHS, and I have had two recurrences. How accurate was your previous imaging? If it was accurate, this may better inform you as to cost/benefit analysis of allowing node(s) removal. Keep in mind that what usually "light up" with tracer/dye are not individual nodes, but rather the little fat pad. How many nodes are contained within can't be known before removal - usually it is one or two, but sometimes more, particularly if you have a larger number of nodes naturally. Sometimes dye/tracer is taken up by a more diffuse area and some BS will keep removing anything that turns blue. Maybe have a conversation about removing the first if several have tracer/dye and if they are clear, stop there. I will certainly keep a positive thought that you have a one node clear SNB, and even though it would require another surgery if you ultimately decided on ALND due to unexpected cancer, allowing the SNB only during BMX/TE placement would give you more information with which to make a decision. If no cancer, off you go. If positive, then you have more info to help you decide what to do without having the ALND done simultaneously. The ALND surgery for me was outpatient, an easy surgery, but the expected limitation post-surgically with some discomfort of tingling and numbness that was expected, and did resolve over time. I will say that the SNB exam done in the OR during BMX is cursory - not a very thorough look, so there are sometimes surprises, as there was for me. I had 20 IST (isolated tumor cells) in the one node removed, would never have been seen while I was in surgery - very, very unusual to have such a large node up the chain, but I have seen it happen to a number of those here on BCO. Sorry to hear that your BS is not as progressive - I was fortunate that mine had been head of surgery at an NCI center for many years before I became his patient, and has made a point of keeping up with latest techniques as well as innovating on his own. My chemo port was placed by him during mastectomy so I had no external incision, and my SNB was done through the cancer side mastectomy flap so no underarm incision there either.

  • mactaz
    mactaz Member Posts: 592
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    SpecialK, I like your suggestion regarding conversation with BS and waiting on sentinel node results before any decision on ALND. Thank you for your help

  • santabarbarian
    santabarbarian Member Posts: 2,310
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    Also Mactaz you my want to ask her to specify the # of sentinel nodes she plans to take. My surgeon said she would take my formerly cancerous enlarged node + 4 sentinel nodes, and when I woke up it tuned out to be +3. If you had multifocal tumor you might be talking a few in each area.

    The lymph flows from nipple "up" the breast, towards the armpit ... so above the tumor/s towards the armpit would be the node/s cancer would likely travel to.

    But it sounds like your self advocacy has already gotten you into a better option than her initial push...

  • mactaz
    mactaz Member Posts: 592
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    Santabarbarian, thanks for your thoughts. I haven’t discussed yet with BS, still gathering data and my thoughts. Next Friday I need to have all my ducks in a row so I can have that conversation.

    How are you feel8ng, sounds like all is going well, I hope that cont8nues.

  • mactaz
    mactaz Member Posts: 592
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    Suzzana, Good luck tomorrow!

  • yogamom2
    yogamom2 Member Posts: 64
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    Suzanna, Best of luck for your surgery tomorrow. I'm on the 8th. Ready to get this over with. Wishing you a quick recovery and good pathology results to follow.

  • specialk
    specialk Member Posts: 9,227
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    Just want to clarify - sentinel lymph nodes are located in the axilla, they are not mammary lymph nodes located in the breast tissue. See graphic and links below. The SNB is typically done on the first nodes dye or tracer has traveled to in the axilla, and the "sentinel" nodes are usually just the first nodes in the axillary chain. Mammary lymph nodes are examined with the removed breast tissue if one is having a MX/BMX, but these are not sentinel nodes.

    Sentinel lymph node biopsy of the breast

    https://www.breastcancer.org/illustrations/i0051

    https://www.mayoclinic.org/tests-procedures/sentinel-node-biopsy/about/pac-20385264

    https://www.sciencedirect.com/science/article/pii/S1015958414000232


  • Suzanna
    Suzanna Member Posts: 10
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    Thank you for the well wishes. I know everything will go great, i just know it. I went to the PS today and he drew everything on my chest and breasts. He also said I will probably go home tomorrow night. Sounds like a piece of cake. Now to get a few hours of rest before the big day. 😘😘

  • Notgivingup
    Notgivingup Member Posts: 143
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    Good Evening All.

    I am scheduled for surgery on January 23rd. I will be having a lumpectomy with sentinel node removal. I will admit that I am scared about having surgery, but I do want to get it over with.

  • mactaz
    mactaz Member Posts: 592
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    Hello Notgivinup, welcome to the January surgery topic. We all understand how you are feeling and are here to support each other. If you read some of the threads, for instance one by Santabarbarian, she had her lumpectomy and writes about her experience. There has also been a lot of discussion around nodeextractions and clothing for after surgery.

    We are here for and don't hesitate to ask any questions. Take care

  • Cascadians
    Cascadians Member Posts: 72
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    Been busy attending to details of upcoming surgery. Called surgeon's office, found out assistant wrote prescription for 2 post-surgery camisoles. They are the Amoena Women's Hannah Post-Surgery Front Close Camisole. Also sold on Amazon. These have the pockets for drains.

    The way it works is this: Before surgery one goes to little store / service in hospital and gets fitted and 2 camisoles are put on hold for you. Then after surgery insurance is billed and somebody you designate goes to the little store and picks up the camisoles so you can wear one home.

  • Suzanna
    Suzanna Member Posts: 10
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    Well, I made it though. I ended up staying a night because they had to use a lot of anesthesia on me. I guess I kept burning through it and thrying to wake up. My BS took quite a bit more tissue than was planned, so my PS had to adjust his plans a bit. My BS removed only 2 nodes and they appear clean. Other than the nausea, which is under control now, my pain is pretty minimal from the reduction. Good luck to you all! Thank you for the many prayers. I truly feel they are working.

  • Hongh
    Hongh Member Posts: 51
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    Cascadians, I got the exact same prescription for 2 camisoles, and the place asked me to call them after surgery so they can bill insurance, but I can take the 2 camisoles home now, are we seeing the same Dr ? :)

    My Oncologist is on vacation and the dr I saw today cancelled my Herceptin + perjeta treatment for tomorrow, he said it’s too close to the surgery. My surgery is already late( 8 weeks after last chemo), and now he canceled the treatment, make me feel unprotected, and really nervous

  • alto
    alto Member Posts: 82
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    Thinking of you all. Sending my best wishes to those recovering, and good thoughts to those heading into surgery. Notgivingup... you'll do great!

    This week is "decision week" on my surgery: UMX without reconstruction, or UMX without reconstruction. I have to make the call and get the ball rolling.

    I met with a plastic surgeon yesterday, and he told me my best reconstruction option was a pre-pec implant. He's very experienced in this new technique.

    Honestly, I hadn't planned on reconstruction, and had not heard of this option before. The pre-pec option seems more appealing to me than an invasive technique, where they dig into muscles and tissue. But still, silicone and donor tissue feel a bit off to me. And as with any reconstruction, it could be more of a process than a one-time thing after all. But if I don't do pre-pec now, he said it won't be an option later.

    I thought mastectomy without reconstruction was pretty much the only way to go. I was so focused on just getting this cancer out and getting back to life. Now, I'm stalled. Thrown for a loop because the BS, PS, and my husband think I should consider reconstruction. And now I'm wondering if maybe it would be okay, and I will regret not doing it (and being half flat).

    Thanks to those who have provided encouragement already. I'm just giving myself a deadline of this weekend to decide. I've taken too long already.

    --

    Paget's (HER2+) / DCIS, grade 3 (ER faint+/PR-)
    Nov: quadrantectomy
    Dec: re-excision w/ sentinel node biopsy (0/2)
    Jan: UMX (upcoming)

  • Hongh
    Hongh Member Posts: 51
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    Suzanna, this is great news, you made it through, yeh! Wishing you a speedy recovery.

  • Hongh
    Hongh Member Posts: 51
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    Alto, I was thinking about bmx with no reconstruction initially, I just want to get rid of the cancer and don’t care about anything else.

    My BS talked me into reconstruction, she said I will regret later if I don’t do it, I can always remove it later if I don’t want it, and people did it are all happy later ...... so I decided to do it.

    My PS will put the TE on top of muscle, so it’s not that invasive. They will use “decelled” human skin to wrap the TE, since it’s “decelled”, it will have no compatibility issue.

    I can totally understand your feeling, even now I still sometimes think maybe I should not do it :

  • alto
    alto Member Posts: 82
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    So you are still waiting for your surgery?

    I will say I know one person who had it done, and she is happy with it. She is someone who absolutely wanted reconstruction from the start, but is happy with the results, even if it didn't get her full symmetry (which it won't for me, either).

    I think if I do it, it will take me longer to get into surgery, which is obviously not great.

  • Hongh
    Hongh Member Posts: 51
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    My surgery is scheduled on 1/15

  • mactaz
    mactaz Member Posts: 592
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    Suzzana, CONGRATS on getting through your surgery and now continuing to move forward. How exciting.

    Alto, I am scheduled for a UMX with reconstruction. I was unsure at first but then I thought about always having to wear a prosthetic So I didn’t look lopsided and didn’t want to deal with that the rest of my life. I will have a TE placed at time of UMX and then get a lift and reduction on remaining breast when he places the implant. I would have said you wouldnt have to make your decision right away since implant surgery can be done later. But I guess the new procedure you are talking about requires you to decide sooner. Either way, do what you want, not what others want you to do.

    Hongh, my H&P infusion will be on 24th and my surgery is the 28th, when I asked they said it isn’t a problem. Also I had my first treatment yesterday and had no SE so far. I might go back and ask again.

    Cascadian and Hongh, My BS also gave me a prescription for 2 camisoles and 2 bras. I’m going to wait and fill after I talked with my PS to see what he suggests.

    Hugs to all, stay strong....

  • Hongh
    Hongh Member Posts: 51
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    MACTAZ, my last chemo was 11/24, my first HP was on 12/14, I don’t have any SE either. Reading the note from my oncologist, he said if the surgery is early Jan , I only need that one HP, if late January, I will need a second one on 1/5, now my surgery is on 1/15, the Dr today just cancelled my treatment, I really need to talk to my oncologist next week when he comes back.

  • santabarbarian
    santabarbarian Member Posts: 2,310
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    Notgivingup: My surgery was lumpectomy plus 4 nodes. I did not need a drain. My lumps were near to the surface. I am amazed how relatively easy it has been. I took one pain pill the first day, and I have used ice intermittently for some mild pain and swelling. That's it. I feel normal and good! My arms are mobile. I can lift stuff. I think lumpectomies can be harder than this-- when the lump is a weird place or deep-- but I was very pleased to discover they can be pretty ok! I hope yours will be too!

    I asked very specific Qs of my surgeon: how big an incision? How much tissue do you foresee removing? She took a ping pong ball's worth, based on her hand gesture...

  • Notgivingup
    Notgivingup Member Posts: 143
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    Santabarbarian, thank you for giving me information. My tumor was(no longer there) at 6 o'clock. I'm not sure how many nodes my surgeon will take. I think only a couple. I should have had surgery a month ago, but my liver enzymes shot through the roof. Was in the hospital 2 times because they were trying to figure out how to lower them quickly. I am hoping not to need anymore chemo after surgery. They won't know until after my surgery is done.

  • santabarbarian
    santabarbarian Member Posts: 2,310
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    It's hard to believe imaging until you get the path report back... but I am hoping very hard you get a pCR!

  • kec1972
    kec1972 Member Posts: 71
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    Hi All,

    Just wanted to add myself to the January 2019 surgeries! I'm having my lumpectomy with sentinel node biopsy on Monday January 7...wish me luck! I'm so nervous as this is my very first surgery ever.

  • mactaz
    mactaz Member Posts: 592
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    kec1972, welcome. Looks like you have just been diagnosed, will you have other treatments after you surgery? We've had a couple of people go through a lumpectomy so far that went well so I'm sending you all the best vibes.

    Keep us updated on how things go on Monday.

  • Hazelhappy
    Hazelhappy Member Posts: 4
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    I'm having BMX with sentinel node biopsy without reconstruction on Jan. 9. I'm really ready to move forward! Positive energy to all of you!

  • mactaz
    mactaz Member Posts: 592
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    Hazelhappy, welcome to the January Surgery group. We are all feeling the same way and want to keep moving forward, although some (me for instance) are a little nervous. Will be thinking of you and sending you positive energy so all goes well with your surgery.


  • Mamihen
    Mamihen Member Posts: 10
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    Hello, my fellow January sisters-

    I am heading for my bilateral prophylactic mastectomies on January 30th. I decided to have TUG reconstruction surgery at the same time.

    I feel a little guilty to be posting here since my surgery is a prophylactic one, but it's a big deal for me and scary nevertheless. But I feel very very lucky.

    I had bilateral breast reduction early September of last year. The pathology report came back with LCIS in both breasts and also atypical cells in the left breast. The diagnosis was between ADH and DCIS, it was sent out to another hospital and came back as FEA. My breast surgeon explained that there weren't enough cells in the sample for a definite diagnosis, and due to the breast reduction we couldn't know where to biopsy. Since the atypical cells showed ER positive, I discontinued my estrogen hormone patch (hysterectomy and oophorectomy last year due to prolapse) and started on Tamoxifen.

    We had to wait till this week for a breast MRI due to the healing process and my surgeon warned me that there could false alarms due to scar tissue, but that she wants to see the MRI all the same. This will give us enough time to biopsy before the end of the month.

    I have pre ops coming up with the breast surgeon, the PS and my primary care doctor, so this is definitely getting real. Before the new year it was easier to put out of my mind, but now I am trying to read what I can and am so grateful for all the posts of this site.

    Thank you,

    Liv


  • mactaz
    mactaz Member Posts: 592
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    Liv (Mamihen), why do you feel guilty, you shouldn’t! You are still dealing with a terrible situation and had to make a very difficult decision. Welcome to our group, we are here to support each other in there surgical journeys.

    I am curious why you would do a biopsy if you have already determined to do the mastectomy? Is she going to excise anysentinel nodes during mastectomy or is that what she wants to checkout in MRI?

    Stay strong and much luck in your upcoming tests

  • mactaz
    mactaz Member Posts: 592
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    Kc1972, hope all went well today, let us know how you are. 🤗

    Yogamom2, sending you nothing but good thoughts and vibes for tomorrow.

    Wishing you both the best