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Topic: Anyone had add’l surgery after mastectomy to clean up margins?

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

Posted on: Nov 24, 2021 07:25PM - edited Nov 25, 2021 05:08AM by Jen2957

Jen2957 wrote:

Hi, all!

I had my unilateral mastectomy on October 21. I will be five weeks out tomorrow, but just found out this week that the multidisciplinary team has decided it would be worth going back in to clean up one of the margins. I am perfectly fine with the cautious approach, but was just beginning to celebrate a bit that everything is healing so nicely and my incision (a single one along the mammary fold) is fading and smoothing out. I am in the middle of tissue expansion right now, and though they will deflate a bit during surgery to provide more room and so there will be less stress on the new incision as it heals, that will be a difference from the first surgery- they were unable to fill at all during the mastectomy.

My question is, for anyone who has done this before, what was recovery like after this second, less invasive surgery? My understanding is that they will go through the same incision, so I'm not sure if that makes it more or less painful or slow to heal.

Thanks so much! Have a wonderful Thanksgiving if you are in the states and celebrate that holiday. If not, have great weekend!

Jen

“Enjoy the little things in life because one day you`ll look back and realize they were the big things.” ― Kurt Vonnegut Surgery 10/21/2021 Lymph node removal: Sentinel; Mastectomy: Right; Reconstruction (right): Tissue expander placement Dx 10/28/2021, DCIS/IDC, Right, 5cm, Stage IB, Grade 1, 1/3 nodes, ER+/PR+, HER2- (IHC) Surgery Radiation Therapy Hormonal Therapy Aromasin (exemestane)
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Nov 25, 2021 07:41AM SuQu31 wrote:

Jen,

I had a close margin near the skin of my cancer breast and chose surgery (instead of rads) to take an additional “wedge" of skin. (This is what my surgeon called it). You can see my dates in the signature line- it was soon after the first surgery. They removed some saline from my TE before the surgery. Compared to my first surgery (and a second surgery at midnight after the first one to check some excess bleeding), it was no big deal at all. It was an outpatient procedure and we were back home within a few hours. I do have a rather large scar from the re-excision, but that's because it was near the skin, and I don't care- I just wanted it out!

I was still recovering from my more involved lat flap procedure, but I do not recall much pain at all. It did cause some delayed healing on that side, so I increased my protein, Vitamin C and Zinc and watched it like the obsessive person I am for any signs of infection. But you should be dealing with something very different since you are far out from your initial surgery. Also, I had three different surgeries within 10 days, so it took a while to clear my “anesthesia brain"

I will add that it was after the re-excision that I first thought I might be experiencing some lymphedema, so that is something to keep in mind. Just take it easy and don't push yourself too hard during the additional healing time.




Re-excision for close anterior margin 10 days after BMX. Dx 10/31/2018, DCIS, Left, Stage 0, Grade 3, ER-/PR- Surgery 12/9/2018 Lymph node removal: Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Latissimus dorsi flap; Reconstruction (right): Latissimus dorsi flap Dx 12/10/2018, DCIS, Left, 2cm, Stage 0, Grade 3, 0/3 nodes, ER-/PR- Surgery 12/19/2018 Surgery 9/13/2019 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Nov 26, 2021 05:38AM Jen2957 wrote:

SuQu- Thanks so much for your reply! Wow! You went through it for those first couple of weeks, didn’t you? It sounds like an exhausting, foggy-brained whirlwind! I am so happy it all ended well.

It sounds like, other than the timeline, our situations are similar. I don’t think I get the option of no rads; I had a positive lymph node and several margins that were closer than they like. My tumor ended up being much larger than anticipated, but was equally mixed with IDC and DCIS. Like you, I have the “I don’t care- just get it out mentality” and that applies to rads as well or me.

My mastectomy was actually an outpatient procedure as well, though they said they would have allowed me to stay if I really wanted to or if I had any issues at all. I had a unilateral with TE, so no flap to have to recover from. I laughed at your comment that you watched it like the obsessive person you are! I literally take photos each day after I have a surgery or injury just so I can identify any changes or inflammation. One really cool thing my plastic surgery used on me is a new “plate” that is impregnated with vancomycin and another antibiotic. It is a full palm size, fairly thin disk that he places under the tissue expander where it delivers antibiotics to only the local area - he has a friend at Stanford who has been using it and the rate of local infection has dropped to zero. I was one of the first few people here that my surgeon used it on and have been pleased to have no healing or infection issues. No systemic antibiotics necessary. The plate will remain in place until the TE is removed. It is made of a cement type material, so not made for comfort, but then, neither are TEs. 😂

Did they use your initial incision or did they have to create a new one? I’m hoping it will be the same, but don’t necessarily care as long as I don’t have to have the dreaded drain again! I will definitely be vigilant about lymphedema- that had not even crossed my mind! I have had some cording after my SLNB that was possibly caused by the drain placement and where it hit on the nerve root and biopsy incision area. Good times! There is a wonderful Australian physiotherapist who has some videos on her YouTube Channel of exercises and techniques that worked very well for me. Her name is Jen McKenzie and she specializes in breast cancer recovery, therapy, etc



“Enjoy the little things in life because one day you`ll look back and realize they were the big things.” ― Kurt Vonnegut Surgery 10/21/2021 Lymph node removal: Sentinel; Mastectomy: Right; Reconstruction (right): Tissue expander placement Dx 10/28/2021, DCIS/IDC, Right, 5cm, Stage IB, Grade 1, 1/3 nodes, ER+/PR+, HER2- (IHC) Surgery Radiation Therapy Hormonal Therapy Aromasin (exemestane)
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Nov 26, 2021 09:30AM SuQu31 wrote:

Jen, I took pictures too! My “good" side did fine but the “bad" side seemed very iffy for a while. And it was Christmas time, so I knew that calling someone about it would ruin their Christmas/holiday too, so I spent Christmas day looking down my shirt every other hour. LOL.

It turns out that I am a slower healer than some, so the added stress of removing more tissue and an additional surgery just made things even a little slower. And I had drains the entire time- did not get them out until sometime after the re-excision. With the lat flap, you have a round excision around where your nipple would be, with scars in the back. The plastic surgeon did those, so they are fine. The re-excision was a diagonal from where my nipple would have been up to my armpit, and since the close margin was on the skin side, it all shows. It still shows but I probably did not work as hard as I should have on the scars. None of them show even in a swimsuit, so I just don't care, especially at my age!

The “plate" sounds fascinating. One of my friends had an infection after her mastectomy and was hospitalized for several days. She is one of the healthiest, cleanest people I know (LOL), so that made me realize in a personal way how easy it is for that to happen, through no fault of anyone. And I am one of those people who will get an infection and not be able to shake it, so I was super cautious. I had a separate bathroom set up just for me and was pretty ridiculous about the anti-bacterial soap and hand sanitizer. My poor husband just realized that I need to worry about something and was very patient about the whole thing. It was actually his idea to go ahead and have the re-excision right away while I was still recovering from the lat flap. I don't think it extended my recovery, really.

As for the drain, think of it as a minor inconvenience that is really irritating, but might keep you from having a seroma or other swelling issues. If they recommend it, I would do it. And as for the lymphedema, I think I am the “unlucky" lucky person in several ways. Just DCIS, but surgery complications, close margin, hormone negative and still being screened for recurrence, even after mastectomy (although that makes me happy). Just 3 lymph nodes out, but lymphedema. But mine is not awful, and has not progressed. I wear a sleeve almost all the time, but I'm not sure it is absolutely necessary- you get used to it, like everything else.

Please keep me posted on how it goes.


Re-excision for close anterior margin 10 days after BMX. Dx 10/31/2018, DCIS, Left, Stage 0, Grade 3, ER-/PR- Surgery 12/9/2018 Lymph node removal: Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Latissimus dorsi flap; Reconstruction (right): Latissimus dorsi flap Dx 12/10/2018, DCIS, Left, 2cm, Stage 0, Grade 3, 0/3 nodes, ER-/PR- Surgery 12/19/2018 Surgery 9/13/2019 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant

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