Unexpected removal of lymph nodes during BMX?
After a lumpectomy where i failed to get clean margins, I opted for a BMX. Because of existing neuropathy in one of my hands and arms, it was discussed and agreed upon with my surgeon, that I would not have lymph nodes removed. I just received my pathology and see that I had 4 lymph nodes removed on the non-cancerous breast side, and 1 node from the cancerous side.
This is where I am confused. Can there be lymph nodes inadvertantly removed that are just in the breast tissue that is part of the mastectomy? I've been trying to figure this out with google, and I can't seem to sort it out. Thought I would see if someone here can help me understand.
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Hi grace248 Hope you are recovering quickly from surgery. I'm sure you discussed with your surgeon that sentinel node biopsy is needed with mastectomy to see if the cancer is in the nodes. Typically prior to surgery a radioactive tracer is injected so they can determine cancer in the nodes. Was that your agreement? Where they suppose to perform just a biopsy without removing the node regardless if there was cancer present? Was there a concern from your imaging prior to surgery that your cancer had metastasized? Did they possibly biopsy the opposite side and there was cancer present so removed additional nodes ? Lots of questions to be addressed at your follow up appointment. Sorry I have so many questions just trying to understand.
When they perform a mastectomy all the breast tissue is removed and the lymph nodes are in the axilla not in the actual breast tissue. I can't imagine they inadvertently removed the node. Normally they check the first node, if there is cancer present they go on to remove additional nodes. Many times it's up to the discretion of the surgeon during surgery to decide how many they need to remove to have the best outcome.
I hope you get a good explanation from your doctor at your follow up to help you understand the decisions that were made during surgery.
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cookie54 - Thank you, I so appreciate your response. I realize I did not provide enough information.
My original biopsy and subsequent lumpectomy showed only DCIS in my right breast. However, since I did not receive clear margins during the lumpectomy, I made the decision to have a bilateral mastectomy. That was due to a long history of biopsies, extremely dense breasts, and a family history. (Part of that decision was also based on being proactive to avoid a cancer that would require node removal and radiation, since neuropathy is already a problem on my right side.) The DCIS was only in my right breast and the left breast was removed prophylactically.
I had the BMX about 2 weeks ago and the agreement with my surgeon was that there would be no sentinel biopsy. I did not have the procedure for radiactive tracing. My post-op appointment was with the PA and we did not discuss that the nodes had been removed. I have since seen it mentioned in my pathology report. There was 1 node removed from the cancerous right breast. My left breast which was being removed prophylactically was the side where the pathology shows 4 lymph nodes were removed.
All of the lymph nodes were clear, so I know I am so lucky to have such a favorable diagnosis. However I admit I feel more distressed than I have felt during this entire process, with the thought that nodes may have been removed unnecessarily. I am rambling I suppose and there is no going back at this point.
I have no medical background, and I have been googling trying to find some sort of logical explanation. I found references to intramammary lymph nodes online and that is what made me wonder if the 4 nodes in my healthy breast could be those? I have high regard for my breast surgeon, and I can't imagine he would not have a reason to take the extra nodes? I am trying to reconcile this in my mind and just let it go. My follow up appointment is in 3 weeks and I will ask then, but in the meantime I guess I am still searching for some logical explanation.
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grace248, Did you check the permission form you signed before surgery? I had a similar conversation with my surgeon at the planning appointment, especially since there would be no intraoperative pathology. However, the description of the surgery that appeared in my portal read “lumpectomy with sentinel node biopsy and possible axillary dissection” When I contacted her she told me it was her standard consent form but she would provide me with a custom one. It turned out that I had just one node involved so didn’t need further surgery. You would have to ask your surgeon but maybe his standard form was not what you had agreed to and he didn’t remember.
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maggie15 - Thank you for the reply. I am not sure about the signed permisson form. I am probably a great example of what not to do. I vaguely recall signing something when I was in the surgery prep area. At that point the ativan had kicked in. I was a nervous mess trying to hold it together before surgery.
This is the language that appeared in notes from my pre-op appointment several days before surgery: "She prefers not to involve removal of any sentinel lymph nodes because of her existing right arm issue and would not need one on the left since it is prophylactic."
The post surgical notes refer to one node on the cancer side that was palpable and that he removed it. So at least I can understand the reasoning there. There is no mention of nodes in the description of removing my left breast. I only know 4 nodes were present because ot the pathology report. From some info I am reading on line, I am wondering does anyone think it could be intramammary lymph nodes that I am seeing show up in the pathology?
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Thanks for the background info, so glad to hear of a favorable diagnosis. I do think it's possible the pathologist may be referencing the intramammary nodes in the breast tissue. Sounds like just descriptive lingo in path report. Let know how you make out.
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cookie54 - Thank you for your replies. I will let you know how it turns out. As I said earlier, I have high regard for the surgeon and I have to think there was a logical explanation. The presence of intramammary nodes would make sense.
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