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Topic: Axillary Reverse Mapping (ARM) before SLNB

Forum: Surgery - Before, During, and After — Surgical options and helpful tips for recovery and side effects.

Posted on: Jun 7, 2020 05:50PM

Emily12 wrote:


I am scheduled for BMX for DCIS in which my BS wants to take some SLN. I was told that some big university centers are doing ARM where a blue dye is injected into the arm to determine the upper extremity lymphatic drainage and ensure that nodes that drain the arm are not taken when the SLN biopsy is performed.
I am terrified of developing LE. I am very active and would do anything to avoid changing my lifestyle due to LE. I met a surgeon who said that given the stage of my cancer at this time she will only tag and mark nodes that drain the arm if they are also serving as SLN and will not excise them until the pathology report is completed. If the pathology on the other “pure" SLN is clear she will leave the marked nodes in. If not she can always go back and biopsy them.
I hope my explanation makes sense. It was easier when she drew a picture.
My question is has anyone had that procedure to limit the chances of taking a node that drains both the breast and the arm?

Do you see any concerns with the procedure? I read in the lymphedema node that some women get LE even with one SLN or none taken. So I wonder if it is worth pushing my surgery, changing hospitals and doctors for a procedure that may not help much with LE.


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Jun 8, 2020 10:55AM - edited Jun 8, 2020 10:56AM by Each_day_2018

I havent' had that procedure, but wanted to comment... I had 4 nodes taken, one was near my sternum, but I have had no problems with Lymphedema. I think it all depends on how many and which ones they take and of course, the individual. After your surgery, ask about physical therapy. No one mentioned that to me until over a year later and I never would have thought about PT. I didn't go because of Lymphedema, but I was having soreness in my arm from the surgery (yes even a year later!). Anyways, they have therapists that specialize in Lymphedema care so if that is a concern of yours, definitely bring it up!

Diagnosed at age 31. Dx 6/28/2018, IDC, Left, 4cm, Stage IIIC, Grade 2, 3/4 nodes, ER+/PR+, HER2- Dx 9/6/2018, LCIS, Left, <1cm, Grade 2, 3/4 nodes, ER+, HER2- Surgery 9/6/2018 Mastectomy: Left Chemotherapy 10/11/2018 AC + T (Taxol) Radiation Therapy 4/28/2019 Whole-breast: Breast, Lymph nodes, Chest wall Surgery 8/29/2019 Prophylactic ovary removal Hormonal Therapy Arimidex (anastrozole)
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Jun 8, 2020 06:26PM - edited Jun 8, 2020 06:30PM by buttonsmachine

I also haven't done this procedure, but I think it's definitely worthwhile to try and avoid lymphedema, or at least minimize the risk as much as possible.

If you do it, please let us know how it goes for you.

Diagnosed at 32. Local recurrences in skin one year later due to needle seeding at initial biopsy. Dx 8/2016, IDC, Right, Stage IA, Grade 3, 0/2 nodes, ER+/PR+, HER2- Dx 10/2017, IDC, Right, Grade 3, 2/12 nodes, ER+/PR+, HER2-
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Jun 9, 2020 01:27AM buttonsmachine wrote:

PS I did get mild lymphedema of my breast after my first two nodes were removed, and subclinical lymphedema of my arm after the next eleven were removed.

It's been manageable for me, but it's a constant battle to avoid bothering the "affected" arm. It doesn't seem like that'd be too hard, but year in and year out it gets tiresome. Lymphedema is definitely worth avoiding if you can.

Diagnosed at 32. Local recurrences in skin one year later due to needle seeding at initial biopsy. Dx 8/2016, IDC, Right, Stage IA, Grade 3, 0/2 nodes, ER+/PR+, HER2- Dx 10/2017, IDC, Right, Grade 3, 2/12 nodes, ER+/PR+, HER2-
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Jun 13, 2020 10:38PM Emily12 wrote:

I didn’t go with the ARM procedure. I had to wait another month to get the surgery had I opted for it and I just wanted to be done. I had my surgery 2 days ago. 2 SLN were removed. Now I have to wait for the payhresults and I guess the constant scare of developing lymphedema. I am terrified of it. I have read a lot of the posts on the LE board and I know I am not naturally a careful person. I will be looking for PT who specializes in LE to understand the Do’s and Don’t’s

Thank you all for your feedback and support.

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Jun 13, 2020 11:19PM ajminn3 wrote:

I haven’t heard of this, but it sounds interesting! I had a BMX with 3 SLN removed and haven’t had any SEs yet beyond the immediate healing. I’ve got good range of motion, no pain or swelling, and can exercise just fine

Dx 12/2019, DCIS, Left, 6cm+, Stage 0, Grade 2 Dx 1/2020, IDC, Left, <1cm, Stage IIA, 1/3 nodes, ER+/PR+, HER2+ Hormonal Therapy Aromasin (exemestane), Zoladex (goserelin) Surgery Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Targeted Therapy Perjeta (pertuzumab) Targeted Therapy Herceptin (trastuzumab) Chemotherapy Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy Whole-breast: Breast, Lymph nodes, Chest wall
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Jun 13, 2020 11:51PM Cowgirl13 wrote:

Emily, I had 3 nodes taken out and I haven't ever had a problem and its been 11 hears. Just wanted you to hear some good news. If you have to have your blood pressure taken, have them use a manual pump. The automatic ones are killers.

Be the kind of woman that when your feet hit the floor each morning the Devil says: 'Oh crap! She's up! Dx 5/28/2009, IDC, Left, 2cm, Stage IIA, Grade 3, 0/4 nodes, ER+/PR+, HER2+ Surgery 6/17/2009 Chemotherapy 8/3/2009 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 12/21/2009 Hormonal Therapy 2/22/2010 Arimidex (anastrozole)
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Jun 14, 2020 12:23AM Emily12 wrote:


thank you for the encouragement. I have seen women with 4-5 and more nodes who never developed LE and others who hardly had a node removed and that did it for them. The thing about LE is that it is very difficult to predict what causes it. You may do everything right and still get it. I hope I am lucky as you and never have it.
thank you again for reaching out.

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