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Topic: Recurrence or Stitch at Alloderm-Muscle Seam? Rice grain

Forum: Not Diagnosed With a Recurrence or Metastases but Concerned —

Meet others concerned about developing a recurrence or metastases.

Posted on: May 8, 2016 11:41PM - edited May 9, 2016 12:00AM by Nopoli

Nopoli wrote:

Hi everyone, Has anyone had sutures show up at the junction between the muscle and Alloderm? I had my double mastectomy with immediate silicone implant reconstruction four months ago. A visible bump has suddenly appeared on the left side, which my MO seemed concerned about this past week when she examined me, which I waived off as the Alloderm seam. Three days later I took a second look and touched it, and it looks exactly like a grain of rice (long grain), and it's hard like raw rice. It seems to be getting bigger (fatter/longer? my imagination?). The bumb is in the middle (left to right) of the breast, about an inch above the scar (nipple removed), and it is in the Alloderm-muscle seam (I think the seam is high on this side, because they cut away two inch band of muscle to biopsy). The skin is so thin, when you press, you can see the rice grain is on that line. Looks white and raised. The thing is I don't recall it being there before, and she definitely did not see it when she examined me about two months ago. I have an appointment with the PS nextweek, so I will show it to her, but she is very much a PS, even though this is all she does with the breast care center, so I'm thinking I should contact my surgeon. My last appointment was a month ago, and the next one in 5 months (on 6 month schedule now).

I'm concerned because my surgeon recommended radiation on the left but the radiation oncologist said that the risks outweigh the benefits , especially because the implants are already in (another canceled the appointment on me; assistant told me doctor doesn't think you need radiation over the phone). I had extensive grade 3 DCIS (with comedo necrosis, LCIS, cancerization of lobules, ADH ...). There were at least two areas that have margins less than 1 mm, one of which is near chest wall (3 pathologists confirmed it). The pathologist also saw foci suspicious for microinvastion but could not prove it histologically, and they found isolated it tumor cells in one of 3 sentinel nodes (I had 1 needle biopsy and 1 core biopsy several weeks before the mastectomy). So deep inside I wonder if I'm being under-treated. Well I hope it's just a suture, but .... Can a recurrence of DCIS happen this quickly--even if there is microinvasion, ITC and close margins?

Also on the right side (prophylactic mastectomy that revealed a stage 1, grade 2 ILC), I have 4 hard bumps (round lentil size or smaller in an uneven wavy pattern) in the outer mid to upper quadrant. Two of the bumps are visible. I'm thinking these have to be stiches! (There were only 2 pathology slides for the right breast. Hmm) These started to appear sooner--probably after the swelling subsided.

P.S. I've been on Tamoxifen for a month. Sorry this is so long. I have an anxious mind and have been compulsively looking up recurrence rates and personal recurrence stories for different scenarios. I know I need to move forward and focus on positive habits, my job and other responsibilities, but can't seem to find the mental discipline to do so. This is not healthy. Urgh. Thanks for reading.

Dx 1/21/2016, ILC, Right, <1cm, Stage IA, Grade 2, 0/14 nodes, ER+/PR+, HER2- Dx 1/21/2016, LCIS/DCIS, Left, 6cm+, Stage 0, Grade 3, 1/3 nodes, ER+/PR+, HER2- Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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May 9, 2016 09:22AM KBeee wrote:

I do know a few gals who had sutures which did not dissolve and eventually came to the surface. Hoping that's what it is for you as well.

Karen. Dx 8/5/2013, IDC, Right, 1cm, Grade 2, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 8/26/2013 Mastectomy: Left, Right Chemotherapy 9/20/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 12/12/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 1/23/2014 Reconstruction (left); Reconstruction (right) Surgery 1/29/2015 Lumpectomy: Right Dx 2/2/2015, IDC, Right, 1cm, Grade 2, 0/0 nodes, ER+/PR-, HER2- (FISH) Dx 2/25/2015, IDC, Right, 1cm, Grade 3, 0/13 nodes, ER+/PR-, HER2- (IHC) Surgery 2/25/2015 Lumpectomy: Right; Lymph node removal: Right, Sentinel, Underarm/Axillary; Prophylactic ovary removal Chemotherapy 3/31/2015 AC + T (Taxol) Radiation Therapy 8/25/2015 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy Femara (letrozole)
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May 9, 2016 10:14AM Nopoli wrote:

Thanks, KBee. I appreciate your response. I hope so too. I guess I just have to get it checked out rather than either fretting (anxiety) or be complacent (avoidance). :-) I've been reading some of your posts recently. You are so very helpful. I'm glad you caught your recurrence early due to your self advocacy. You appear to be doing well. I hope it isso.

Dx 1/21/2016, ILC, Right, <1cm, Stage IA, Grade 2, 0/14 nodes, ER+/PR+, HER2- Dx 1/21/2016, LCIS/DCIS, Left, 6cm+, Stage 0, Grade 3, 1/3 nodes, ER+/PR+, HER2- Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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May 9, 2016 12:57PM Kessa619 wrote:

Hi there. I had two spots like that. I noticed them about a month post-mastectomy. I showed them to all my doctors and they all thought they were sutures based on location. I sort of wanted an ultrasound to confirm, but none of them thought it was necessary. They finally went away just recently.

I am like you - in constant worry mode about recurrence. I have a palpable lymph node that the surgeon said is just reactive. She looked at it on ultrasound and said it looked normal, but I still worry because I know that is not conclusive and it is still there nearly 4 months after my mastectomy. I am not aure the fear will ever go away.

I would get another RO to weigh in...I would not count the phone consult as a well-reasoned second opinion. Goood luck!

Oncotype 18, age at diagnosis 43 Dx 10/20/2015, IDC, Right, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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May 9, 2016 01:37PM Nopoli wrote:

Thanks, Kessa. I'm glad your bumps went away, so you have one less thing to wonder/worry about. It's reassuring to hear about your experience--physical and emotional. Can you ask for another ultrasound for the lymph node if it hasn't shrunk, or even a needle biopsy?

Thanks for your view on the RO. I am considering it in the back of my mind, although the prospect of a disfigured foob is daunting. Went to a lecture and the photos were terrible. The other thing I've noticed, with this new regional data sharing of medical records among hospitals and providers, is that it's difficult to get an independent opinion. Doctors tend to want to know whom else you've seen and what they said, it they just see it in your records. There appears to be a group think mentality.

I know I sound negative, and I am very grateful for the great care, but that was my observation when I was going for all the additional opinions for breast surgery, pathology, reconstructive surgery, medical oncology and radiation oncology. (My diagnostic phase lasted more than 2 months, because all the imaging contradicted the two biopsy pathologies; imaging showing at least stage 3 cancer in left but pathology showed 6 cm long DCIS and LCIS in a sclerotic lesion, which became micro invasive by the time of surgery. Then they discover a new cancer in the other breast after surgery that never appeared on imaging, so I had to go in for an axillary dissection. Dealing with cording right now.) So a bit of battle fatigue right now.

I feel guilty for being anxious and a little down right now, because I realize other ladies went through so much more with their chemo, radiation and or Herceptin and with more advanced diagnoses. I need to get a grip. But on the other hand this is not a rational experience. You're worried too and I'm just learning that this is a common experience, so I'm hoping to learn new ways to adapt to this new reality of uncertainty. I read that CBT is very effective, combied with mindfulness, physical exercises, and a dash of faith. :-)

Sorry, I'm long winded. Hope your day goes well Kessa. Wishing you more peace of mind

Dx 1/21/2016, ILC, Right, <1cm, Stage IA, Grade 2, 0/14 nodes, ER+/PR+, HER2- Dx 1/21/2016, LCIS/DCIS, Left, 6cm+, Stage 0, Grade 3, 1/3 nodes, ER+/PR+, HER2- Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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May 9, 2016 02:53PM farmerlucy wrote:

I had some bumps but they were symmetrical so that was an easy call. I hope your's are just stiches too.

So sorry for the surprise ilc on the prophy side. This stuff is so insidious. Sucks. Totally sucks. A post mx dx is a real mind bender.
Dx at 51 after a preventive mx that wasn't. Oncotype dx 3. 3D tattoos from Vinnie! PTSD?? You are not alone! Surgery 2/20/2012 Prophylactic mastectomy; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Dx 2/24/2012, IDC, Right, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- (FISH) Surgery 3/10/2012 Lymph node removal: Sentinel Surgery 7/21/2012 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 4/9/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 4/13/2015 Prophylactic ovary removal
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May 9, 2016 10:17PM Nopoli wrote:

Hi Farmerlucy, Thanks for your empathy and reassurance. Hope so too. Sorry for your own mind bender! Your case sounds similar to mine with the prophylactic turning out to be not so.

Yes, the ILC dx after surgery was a bit of a bad surprise, but it confirmed for me that I made the right decision. The RO said I would have been in big trouble, because often its detected only when it's grown to stage 3 or so, so I was lucky. Once I got negative results from the axilliary dissection I could breathe easier. Also the good finding was what two BS told was most likely an invasive 3 cm IDC (based on 3D mammo, MRI and US, although to biopsies showed otherwise) turned out to be a larger benign sclerotic lesion all overlapping the DCIS, LCIS and all the other junk. LOL. (The path report was an alphabet soup of various types of breast disease and cancer cells.) Someone was watching over me. My Mom passed away from recurring and bilateral (not synchronous) metastatic breast cancer.So it was a scary/stressful journey that got better, for which I am grateful.

I will post again once I know more. Thanks.

Dx 1/21/2016, ILC, Right, <1cm, Stage IA, Grade 2, 0/14 nodes, ER+/PR+, HER2- Dx 1/21/2016, LCIS/DCIS, Left, 6cm+, Stage 0, Grade 3, 1/3 nodes, ER+/PR+, HER2- Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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May 22, 2016 10:35PM Juliecc wrote:

i had small hard lumps along the seam. They didn't show up on ultrasound and they eventually went away. They were on both sides and I actually had more of them on the non-cancer side which reassured me. You could actually see the pea sized lumps under the skin.

Julie, age 49. Oncotype DX 12. Dx 2/3/2014, IDC, 1cm, 0/3 nodes, ER+/PR+, HER2- Surgery 3/10/2014 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 4/4/2014 Surgery 8/8/2014 Reconstruction (left); Reconstruction (right) Surgery 1/22/2015 Reconstruction (left); Reconstruction (right)
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Jun 5, 2016 05:35PM Nopoli wrote:

This is reassuring Juliecc. An update: I visited both my PS and BS and both said it was a stitch.The BS said it usually takes six months for stitches to dissolve: unfortunately, I don't know whether she means six months from the time they appear or six months after surgery. I'm guessing the latter. The good news is the "rice grain" stitch on the left side has disappeared. But the round hard nodules on the right have not.

I asked the BS if they would take a baseline US or MRI and she said no. They only do these tests if they see something clinically significant. Honestly, with US being so inexpensive, I don't see why breast surgeons don't have them in the exam room. I actually do know of one BS who does so, but she is not my current BS.

Curious thing: I had last seen the BS in late March, and at that point, she said congratulations, now I will see you in six months (i.e. September). Prior to that she had been seeing me weekly (BMX mid-January; right axillary dissection 3rd week in February). However, after I visited her in mid-May, they updated my patient portal with an upcoming appointment in late June. Hmm. I guess she wants to monitor me more closely now?

Good wishes to you ladies.

Dx 1/21/2016, ILC, Right, <1cm, Stage IA, Grade 2, 0/14 nodes, ER+/PR+, HER2- Dx 1/21/2016, LCIS/DCIS, Left, 6cm+, Stage 0, Grade 3, 1/3 nodes, ER+/PR+, HER2- Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Sep 20, 2019 05:53PM FarAwayToo wrote:

I know this thread has been inactive for more than 3 years! I hope all the ladies who posted are doing great and not worried about lumps/bumps on their reconstructed foobs. I'm posting because I have the same problem, and I found this thread a while ago - it kept me reassured that what I was feeling wasn't totally out of the norm.

I just went through several months of investigating mine. I have 5 lumps that go in an arc on my left (DCIS breast), and while PS was saying all along they were stitches, by the time I was 10 months post exchange I started wondering why they weren't dissolving and if I should get them imaged.

I had 2 US and 1 MRI. The first US wasn't able to find the lumps, even though the tech could feel them. The second US was performed by a different tech, and she found 2 of the 5 lumps, and you could certainly see on the screen that they were sutures. No inflammation around them.

MRI identified them as "sutures or staples", and also found some on the right, even though I don't feel any there. I was told that I have a very thin flap on the left, and therefore feel more abnormalities there. I guess so.

I am in a much better shape now knowing the lumps I feel are sutures. I also have a feeling that while my PS did my right, her resident did my left (perks of being treated at a teaching hospital). My left pocket is loose, and my implant flips. It's uncomfortable and probably isn't good for me in the long run. I'm going to see my PS soon (she left the hospital and has her private practice now) to see if anything can be done about it.

Dx 8/31/2017, IDC, Right, 2cm, Stage IIA, Grade 2, 0/4 nodes, ER+/PR+, HER2- Dx 9/15/2017, DCIS, Left, 3cm, Stage 0, Grade 1, 0/3 nodes, ER+/PR+, HER2- Chemotherapy 9/29/2017 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxol (paclitaxel) Hormonal Therapy 2/23/2018 Zoladex (goserelin) Surgery 2/28/2018 Mastectomy: Left, Right Surgery 2/28/2018 Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 4/5/2018 Femara (letrozole) Surgery 8/21/2018 Prophylactic ovary removal; Reconstruction (left): Saline implant; Reconstruction (right): Saline implant
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Mar 17, 2020 02:30PM Calendergirl wrote:

hey ladies, just left my PS office had to take out some saline from the TEs, I too have bumps about 4-5 one side and one on the other. He assured me they are stitches which can take up to 6 months to fully dissolve. He took out saline so theres not so much pressure on my skin which should help the process along. I don’t want any complications, just when I’m feeling like there’s joy and peace after a cancer diagnosis, sending positive vibes

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