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Posts 1 - 12 (12 total)
Dec 15, 2008 07:15PM flash wrote:
Mine took 3 1/2 hours but I think some of the wait was waiting for the lab to do the tissue dissection. Only did mast and snb. no recon
Dec 15, 2008 10:22PM Beesie wrote:
I had a single mastectomy and SNB with the breast surgeon and then the PS came in to put in the expander. Total surgery time was 2 hours.
Dec 15, 2008 10:40PM Springtime wrote:
I think they generally assume 1 hour per boob, and maybe 45 min to 1 hour for SNB? They have to wait around to hear back from pathology..
Dec 15, 2008 10:52PM car wrote:
It wasn't long--about 2 hours for a unilateral mx, SNB, and expander. It took me a long time to come out of anesthesia, though. All told, about 4-5 hours before I could grab the phone in my room and call my sister to tell her I was OK.
Dec 15, 2008 11:16PM Beesie wrote:
They don't always do the pathology check of the SNB node while you are in surgery. My surgeon only does that when there is a reasonable risk of lymph node invasion. When the risk of lymph node invasion is small (DCIS patients, for example) he doesn't bother sending the sentinel node to be checked because such a quick cursory check can easily miss a small invasion and if the risk of lymph node invasion is low, then in all likelihood, if there is any invasion, it too will be small. There have been quite a few cases here where women got the "all clear" on their sentinel node after surgery but then a small amount of cancer was found in the node when the more thorough pathology review was done later. So whether the node is checked during surgery depends on the diagnosis and depends on the surgeon. In any case, my understanding is that many surgeons do the SNB first and then the mastectomy or lumpectomy so that the results of the quick node check are back by the time the breast surgery is finished.
Dec 15, 2008 11:34PM otter wrote:
kateful, one thing that affects the surgery time is whether you're having recon.
I didn't have recon, and my left mast/SNB took about 90 minutes. I was wheeled into the O.R. around 9:00 a.m. and was in post-op recovery by 10:30. They even did frozen sections on the 3 nodes they took with the SNB and checked 'em out during the surgery. We knew my tumor was IDC, not DCIS, so maybe Beesie is right about not doing the frozen sections if they're pretty sure there is no invasive component to the tumor.
It really is a quick surgery, considering the size of the scar they leave behind!
Dec 16, 2008 07:59PM anianiau wrote:
Very sensible to ask this question! But the answer is a little complicated, and one size doesn't fit all. Here's a summary of what I learned, piecing info from the radiologist, the general surgeon and the plastic surgeon to whom he referred me. I have also added my "personal times", so to speak, for each step of the procedure.
1. What size bra do you wear now? I was a 42DD and thus there was a large amount of breast tissue to be removed. The greater the volume of breast tissue, the longer it takes to remove.
2. How compactly located is your breast tissue? I am post-menopausal and plumpish, so mine was fairly spread out. If you are premenopausal and athletic, perhaps the dissection will be less time consuming.
3. If you are having an isotope injected (Techetium-99) to locate the sentinel nodes, this will be done several hours earlier, in the hospital's imaging department or in the nuclear medicine department, Partly this is because by regulation, radioactive material is properly handled in contained environments, but also because it takes time for the radioactive isotope to be taken up by the sentinel nodes and they don't want to tie up an operating room for that. During this period you may be asked to massage your breast tissue to facilitate the uptake of the isotope. You'll be conscious during this time. I didn't find this procedure especially painful, though the Tech-99 injection stung a bit. They may have given me a local anesthetic injection. I was in the imaging department about 90 minutes. My DH was with me (he is a medical physicist, so he was permitted to be in this restricted area). Otherwise, I would have been bored out of my mind.
4. Once you get to the OR, depending on how difficult it is to trace down the sentinel node(s), that part of the surgery may last from 30 minutes to an hour. The blue dye some surgeons use instead of, or in addition to, Tech-99, is injected into the breast in the OR. Using both methods is thought by many surgeons to be the more thorough way to ID sentinel nodes.
5. Some surgeons are more experienced and some are just faster, and some are meticulous in their work and take longer no matter how much experience they have had. My surgeon had done fewer than 100 SNBs so he opted to ask a colleague to do that part. I was told the SNB on the left, with removal of 5 additional nodes from the left side, and a single node from the right side, took about an hour. That may have been because of the extra exploring that was done. However, if the sentinel nodes are difficult to locate, or are found in an odd place, this can add to the time. My sister's sentinel nodes were the internal mammary nodes, and were located in the area of her sternum; her tumor was also located at the edge of her right breast, near the midline, but the MD told her that the sentinel nodes would not have been found without the isotope injection. A friend had sentinel nodes removed from the area above her collarbone; in her case, the tumor was high on the breast. Most, though, are in the armpit or on the way to it.
6. The bilateral portion of the mastectomy took almost four hours more.
7. Reconstruction time would be additional, and it's considerable--in the range of five to eight hours for an autologous flap, depending on the procedure. ASK the plastic surgeon about those times, before making a commitment, so that you can consider your options realistically.
8. Complicating factors also add to OR time. Two common ones, according to the plastic surgeon: If you now have breast implants; if your implants have become "encapsulated" or "contracted" etc. this will add to OR time--just for the mastectomy!. Again, you should ask the plastic surgeon how this will affect your OR time, and what the recommendation is. Maybe it would be helpful to have a second consult, too.
9. The plastic surgeon told me that if I were to opt for placement of tissue expanders, that would add two hours to the OR time. Since I had a heart attack a few years ago, the extra OR time that would require led me to decide against immediate reconstruction. My thought is to heal from this surgery, then assess where we are in six months or a year.
10. You didn't ask about pain, but I think every woman facing mastectomy probably wonders what the level of pain will be. What I found surprising was that the simple mastectomy, even though it was done bilaterally, was nowhere near as difficult to tolerate (in terms of pain during recovery) as I had thought it might be. I am only 8 days post-op, so it's not something I've forgotten! Yes, the drains were a pain to deal with--they were removed today--and my underarms still look a little bruised, as does the area above each incision, and they feel sore. But the worst pain I had was from having the first set of adhesive tape removed at the time of the first dressing change on the first office visit! I learned from that experience that it made sense to remove the tape myself, having someone else start the edge for me. (My DH came to the appointment, so he got that job.) Then, holding the skin taut, I peeled the tape away from the skin very s-l-o-o-o-w-l-y. Maybe it took all of two minutes, but it made a real difference.
And the second worst part? Constipation! (Don't laugh!--and be prepared to deal with it!)
I hope that at least some of this information has been helpful to you. I especially hope that #10 in particular is reassuring news. Heartfelt good wishes go your way. Peace to you, kateful.
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