Tumor Invading Pectoral Muscle - surgical concerns

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.

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.

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.

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

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.

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.

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!

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?