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Topic: fluid accumulation after drain removal

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

Posted on: Oct 2, 2007 07:52PM, edited Oct 2, 2007 07:52PM by 3boys4me

3boys4me wrote:

I had my single mastectomy on 9/6 and my drains removed on 9/20.  I've been in twice to see my surgeon since then to have fluid aspirated.  I see him again this Friday and he said if I am still filling up with so much fluid, I'll need to have another drain inserted.  Anyone else experienced or heard of this kind of thing?

** Live Well * Laugh Often * Love Much ** Dx 2/2007, IDC, 5cm, Stage IIB, Grade 2, 6/14 nodes, ER+/PR+, HER2-
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Oct 3, 2007 03:27AM , edited Oct 3, 2007 03:27AM by Towhee

Oh, yes. I had a double mastectomy on 9/29, drains removed after two weeks. I've gone in twice, once each week, for followup and needed to be aspirated. Not excessive, but enough to need removing. Last week the nurse did it and couldn't get anything from one side, despite knowing it was there. Thursday is my next "date". My doc hasn't mentioned another drain. That would be a bummer. 

Fingers crossed for both of us! 

2007, IDC, 2.9cm, Stage IIb, Grade 2, 1/4 nodes, ER+/PR+, HER2- Bil Mast, Aromasin, no chemo "If you want to make God laugh, tell him your plans"
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Oct 3, 2007 06:33PM ryleigh05 wrote:

I have recently had a double mastectomy on 9/7, my drains removed on 9/13.  On 9/21 my took 75cc off my left and nothing off my right.  I moved so my mother could help me and saw a new surgeon yesterday and he said that I had fluid build up but felt that aspirating them would be more room for infection than letting the fluid go back into my body.  Not sure but know what you are going through

Good Luck

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Oct 3, 2007 11:23PM , edited Oct 3, 2007 11:23PM by Determined1

Well, I didn't get any drains, but I'm squeezing fluid from my incision several times a day.  Seems I've developed seroma.  From what I understand, this fluid used to be handled by my lymph nodes, but since I had the ones that serve my breast removed during my SNB, the fluid doesn't know what to do with itself.  So it's building up in my breast area.  There are a couple of holes in my incision, so I just squeeze the fluid out, clean the area, and put a dressing on it.  My doc is okay with this (although it totally grosses me out).  I'm having a 3rd lumpectomy (a re-re-excision?) on the 15th and he's planning to use the same incision, so he'll clean it up then and give me some antibiotics.  I'm just supposed to let him know if the fluid changes color or I show signs of infection.  Other than that, I guess this happens regularly, (mostly to mastectomy patients, not lumps, but that would be me--bucking the trends wherever I go!).

From what I've read you do need to get the fluid out--either aspirate it or have new drains installed (or you could try my way--jk).  I don't think it's a panic-worthy condition (if it is, would someone please tell me so I can be reacting properly here???).

Let us know how it goes for you.

D1

The things that we're afraid of are gonna show us what we're made of in the end. Dx 8/17/2007, IDC, 1cm, Stage I, Grade 2, 1/7 nodes, ER+/PR+, HER2-
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Oct 4, 2007 04:04AM geebung wrote:

After my lumpectomy, a seroma formed and I could hear the liquid sloshing  whenever I walked around. As it wasn't really worrying me, my surgeon said it was fine and that the fluid would just re-absorb.

Ater I had my mastectomy in April this year, I had my wound aspirated twice and the fluid was very blood-stained. I was warned that having it drained would increase my chances of infection and that it would eventually re-absorb so I didn't have it done again.

Since then I have relied on lymphatic massage to keep the lymph build-up under control.

gb 

Dx 2/26/2007, DCIS, 6cm+, Stage 0, Grade 3, 0/2 nodes, ER+/PR+
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Oct 4, 2007 10:45AM , edited Oct 4, 2007 10:45AM by Determined1

GB,

Where can I get more info on lymphatic massage and how to do it?

D1

The things that we're afraid of are gonna show us what we're made of in the end. Dx 8/17/2007, IDC, 1cm, Stage I, Grade 2, 1/7 nodes, ER+/PR+, HER2-
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Oct 4, 2007 10:58AM rsimon wrote:

I was aspirated once a week for two months after my double mastectomy.  The surgeon said it was not unusual.   Just a pain having to drive back and forth

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Oct 4, 2007 03:29PM , edited Oct 4, 2007 03:29PM by Towhee

Just got back from an appointment with my breast surgeon who drained 40cc from one side and 20cc from the other. This is my third time, and she said that doing it is mainly for my comfort. If it doesn't bother me, it doesn't need to be done.

I didn't think it bothered me, but it did feel good afterwards, so I made another appointment and will cancel if I don't feel a need. She said with good technique the risk of infection is almost non-exsistent and has no qualms at all about doing it.

My surgeon is such a kick! Whenever I ask her for a prediction, like how long the drains would be in or how long the fluid would keep building up, she grins and says, "Within a year." It's so individual and the range of normal is wide. Don't you love it?Smile

2007, IDC, 2.9cm, Stage IIb, Grade 2, 1/4 nodes, ER+/PR+, HER2- Bil Mast, Aromasin, no chemo "If you want to make God laugh, tell him your plans"
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Oct 4, 2007 05:52PM Kathy_K wrote:

I had my mast. and reconstruction on 9/17 and still have a drain that is putting out 45cc a day.  We had hoped that it could get pulled today but have to delay it.  My PS doesn't like to pull too soon but also doesn't like it to stay in there too long, either due to the risk of infection.  He said that this drain was near the lymphatic sack and since I had the SNB it will keep pumping out fluid until it heals and seals.  So, in the meantime, I stay on antibiotics.

When a woman tells the truth she is creating the possibility for more truth around her. Adrienne Rich
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Oct 4, 2007 09:28PM , edited Oct 4, 2007 09:28PM by Towhee

Awwww...what a bummer, Kathy! Getting that drain out makes it feel like it's all over. Until, of course, they find fluid and have to drain it a few times.Surprised No one ever told me about that possibility!

Here I thought having them in for two weeks was long! But I didn't have reconstruction, so a bit less surgery there to heal. I also had SNB, and more fluid collects on that side. I never thought of putting that together. Embarassed

Actually, once I got the hang of managing the drains, I didn't mind them too much. As is usual for me, I expected the worst, so was pleasantly surprised. 

Hoping for healing and sealing!

Towhee 

2007, IDC, 2.9cm, Stage IIb, Grade 2, 1/4 nodes, ER+/PR+, HER2- Bil Mast, Aromasin, no chemo "If you want to make God laugh, tell him your plans"
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Oct 5, 2007 05:24AM geebung wrote:

Hi D1,

Sorry for taking so long to get back to you - it's been a busy day. 

I am wondering if you could ask at your breast centre. (At the b centre where I was dx, there is a part-time physiotherapist who has done a Vodder therapy course) Or google lymphatic drainage therapists and Vodder. (Vodder therapy is a particular type of lymphatic drainage). Some therapists specialise in vodder, others do a combination of vodder and other types of massage. Sorry I can't be more specific but I am probably on the other side of the world to you!

g b

Dx 2/26/2007, DCIS, 6cm+, Stage 0, Grade 3, 0/2 nodes, ER+/PR+
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Oct 5, 2007 05:42AM geebung wrote:

Hi again D1,

I just re-read your main post and I am so sorry you are having these lymph problems. I think you are very brave to squeeze it out like that. Doesn't it hurt??! I am in awe of such stoicism! The things all you poor dear women go through. I have such a rush of admiration for you all.

hugs,

gb 

Dx 2/26/2007, DCIS, 6cm+, Stage 0, Grade 3, 0/2 nodes, ER+/PR+
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Oct 5, 2007 07:58AM Sandra1957 wrote:

I had my right drain in for three weeks and then was still aspirated weekly through the first week of April.  My bilat was on February 15. My plastic surgeon whom also saw that first week of April told me to quit everything: laundry, dishes, cooking, housecleaning, lifting, and especially vacuuming for a week and it will stop.  I did, and it did.  By the way, I'm right-handed and my left drain was out after two weeks w/o aspirations.  Oh, and I'm still wondering why my breast surgeon didn't tell me this. 

I'm always steppin' in and out of crap!
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Oct 5, 2007 02:23PM , edited Oct 5, 2007 02:23PM by Determined1

Thanks for the suggestions, gb.  It appears that my own technique (The D1 Technique) is very similar to the one that Dr. Vedder teaches.  Turns out necessity is the mother of invention!  Now that I know I'm on the right track, I'm going to be a little more aggressive about it--I didn't realize that I was getting more benefit from the massages than just the drainage of the seroma.

And, yes, physically, you are on the other side of the world from me, but on this site I don't think that matters one little bit.  Thanks for helping me out.

D1

The things that we're afraid of are gonna show us what we're made of in the end. Dx 8/17/2007, IDC, 1cm, Stage I, Grade 2, 1/7 nodes, ER+/PR+, HER2-
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Oct 5, 2007 02:25PM 3boys4me wrote:

Lini57 - I like the way your ps thinks.  I may just have to follow his advise Laughing 

I got aspirated again (3rd time) today and he took 120cc's.  I go back Tuesday and again the following Monday.  I don't want to get drains put in again so will continue to be aspirated until my surgeon tells me otherwise.  The problem is I can't start chemo until the fluid subsides so my whole treatment keeps getting pushed back and that's a bummer.  I just want to carry forward and get this done.

** Live Well * Laugh Often * Love Much ** Dx 2/2007, IDC, 5cm, Stage IIB, Grade 2, 6/14 nodes, ER+/PR+, HER2-
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Oct 5, 2007 02:55PM Binney4 wrote:

Hi, D1,

I just wanted to add my agreement with geebung that it'd help if you had a chance to consult with a well-trained lymphedema (LE) therapist. Here's a website for finding one near you:

www.mylymphedema.com

Just follow all the links from the Therapist Locator.

I'm not sure what you mean by getting more aggressive about it, but the thing to remember is that the lymph vessels are directly under the skin, and they're tiny and easy to squash. If you squash 'em it'll delay getting the lymph through them instead of helping. LE massage is a VERY light touch, about like petting a kitten. Also slow and rhythmic. The fingers don't move across the skin with each stroke, they very gently move the skin instead.

If whatever you're doing is helping, and your doctor is okay with it, then continue but don't get more aggressive. And if he'll give you a referral to a therapist to learn the proper order, direction, and hand positions of actual LE massage, that's even better. LE massage has been shown to help prevent the development of LE, but it needs to be done properly, especially "clearing" the existing nodes in the neck before proceeding to move lymph fluid toward them. (One word of warning: at the  earliest sign of infection -- redness, warmth, itchiness, fever -- do NOT massage the area, and get help right away.)

Okay, I'll quit! Clearly I'm obsessed Wink

Hope the healing's quick and thorough!

Binney 

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Oct 5, 2007 06:31PM geebung wrote:

Binney makes some really good points. Somewhere on the internet there is a great video with animated footage of how the lymphatic system works. (Wish I could remember the link). It shows how the nodes fill and pump out, draining into larger lymph vessels. When the nodes are interrupted by surgery or radiation, they don't work so efficiently due to a decrease in their number and/or scarring which prevents efficient drainage. That's why the manual drainage is so beneficial as it reopens the flow, preventing the uncomfortable build-up. And it is SO gentle and soothing and it does make me feel like a cat being stroked! I almost purr!

gb 

Dx 2/26/2007, DCIS, 6cm+, Stage 0, Grade 3, 0/2 nodes, ER+/PR+
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Oct 5, 2007 10:15PM , edited Oct 5, 2007 10:15PM by Determined1

Binney, thanks for the link.  I think I should clarify--when I say I'm going to be more aggressive, I should say I'm going to be more diligent about my massages.  They do seem to help.  I think I inadvertently found the way to massage the fluid out--and it's much like the procedures the websites describe.  Luckily, the fluid has been less today--I'm hoping that's a sign that my body is figuring this out.  I'm not looking forward to having more lymph nodes removed in 10 days' time, but at least I have some way of helping my body recover.  I didn't check with my cancer center today about a therapist for more tips (it was more important to me to get my roots colored--you never know how long I'll have them!), but hopefully I'll have a chance next week.

Thanks to both of you, gb and Binney (obsession is good--don't lose it), the support is so wonderful.

D1

The things that we're afraid of are gonna show us what we're made of in the end. Dx 8/17/2007, IDC, 1cm, Stage I, Grade 2, 1/7 nodes, ER+/PR+, HER2-
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Oct 6, 2007 10:04PM janlyn wrote:

Hi all,

I had my bil/mast from 08/28 IDC with one node +. I have had accummulation which concerned me, and when I ask my surgeon

who did the mast, he suggested to have the other surgeon who did the tissue expanders drain this fluid. He however did not seem concerned and said he would just leave it alone. I am now confused

since so many women have the extra fluid drained. What is in there is starting to solidify. I am getting nervous. Any thoughts. I wonder if this will ever resolve by itself.

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Oct 6, 2007 11:28PM geebung wrote:

Hi Janlyn,

After a while the fluid does start to solidify. I think that is why lymphatic massage is useful as it keeps everything moving. When your scars have healed, the therapist shows you how to massage the scars to stop adhesions. According to my surgeon, everything reabsorbs eventually but I really think that massage has to be a good thing because it feels so good! In the last few weeks, I have had very little buildup and am now concentrating on keeping the scars supple. 

gb 

Dx 2/26/2007, DCIS, 6cm+, Stage 0, Grade 3, 0/2 nodes, ER+/PR+
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Oct 7, 2007 08:10AM Kara wrote:

I had a bilateral mastectomy w/TRAM flap reconstruction on June 27th.  The drains removed about a week later and the plastic surgeon put me into a surgical girdle with zippers up the sides.  It helped keep the abdomanal area compressed.  The girdle was to be worn 24/7.

I was too active (walking around the block) and had some fluid build up ... he had to drain a few spots on my abdomen on two separate visits.  They put me into a smaller surgical girdle (two sizes smaller) with no zippers. 

The girdle actually felt good and I think helped fluids from accumulating.  Once I no longer needed one ... after about 6 weeks, I would still put one on when I felt some fluid build up or if I was going to exercise.

Kara Dx 4/25/2007, IDC, 1cm, Stage I, Grade 2, 0/7 nodes, ER+/PR+, HER2-
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Oct 7, 2007 12:14PM , edited Oct 7, 2007 12:17PM by janlyn

Thanks gb, I will start to do the massage, but have you heard if the lumps do go away. Mine is about the size of a lemon, I wonder if surgery is ever done for have you heard ?

janet

Baltimore

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Oct 7, 2007 04:06PM , edited Oct 7, 2007 04:08PM by geebung

Janet, my scar used to have very firm, lumpy sections on the side nearest my sternum. With massage these have loosened up and are now soft. I am still manipulating the scar to stop the adhesions. I was told that it takes 2 years for adhesions to become permanent - shows how long it takes to completely heal! It would be a good idea to see a therapist so she can show you the technique - you put your fingers on either side of the scar and move the skin in opposite directions. It should not hurt. My therapist also rolls the scar over on itself - that's a bit harder to explain how to do that so let an expert show you. 

Before I had my mastectomy, I asked my surgeon to do a skin saving one in case I decided to have a reconstruction at a later date. He told me that with skin saving mastectomy, there is more room for lymph build-up. Still, it's worth it if you want recon. (I still haven't decided).

gb 

Dx 2/26/2007, DCIS, 6cm+, Stage 0, Grade 3, 0/2 nodes, ER+/PR+
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Oct 8, 2007 09:08PM , edited Oct 8, 2007 09:16PM by lionessdoe

I was just diagnosed today with breast lymhedema. Hopefully it will resolve by itself. Apparently it is rare.

I found this comment on it at the Avon Center for breast cancer at John Hopkins (ask the expert):

Q:  

My wife is under the care of a rehab medicine therapist for lymphedema of the breast. She is much better in the morning upon arising, but as the day progresses, the erythema becomes much worse. Antibiotics have not helped (indeed, she now has mucousy stools-probably from the antibiotics- and was cultured for c. difficile today), and the pain and discomfort persist. Are there statistics for what percent of breast lymphedema cases are chronic? What the resolution rate is for lymphedema of the breast? Is there a web site specifically about this problem?

 

A:  

There are not unfortunately because it is a fairly rare occurence. When lymphedema of the breast is causing quality of life issues, and after a year of treatment with a rehabe medicine therapist still persists, sometimes women opt for more aggressive surgery and do mastectomy with reconstruction. it is a drastic step but sometimes the relief obtained by doing it is so positive that it is worth the loss of the breast, replacing it with a reconstructed one that can't develop lymphedema. Lymphedema that you will primarily read about on the internet relates to arm swelling which happens to about 7-10% of women having breast cancer surgery, specifically axillary node dissections.

Doe Dx 9/5/2007, IDC, 1cm, Stage IIIA, Grade 2, 4/19 nodes, ER+/PR+, HER2-
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Oct 8, 2007 11:11PM Binney4 wrote:

Oh, my.

Lionessdoe, I hope this particular post on the Ask the Expert site is a VERY OLD one, because the information is definitely out of date. The idea that lymphedema can't happen in a reconstructed breast would be news to a lot of the women here who have breast lymphedema in their reconstructed breasts -- many, many women right here on this site. As for the rate of ARM lymphedema after breast cancer treatment, it's variously been found in peer reviewed studies currently to be between 25% and 33% of us BC veterans.

But catch this: a study last year by Riitta Ronka in Sweden found that 26% of women who undergo a SNB and rads can expect to develop BREAST lymphedema. That is nobody's definition of rare.

The idea of having a mastectomy to "fix" breast lymphedema is no longer standard practise for the simple reason that it does not work.  In fact, the more surgery you have to the breast/chest area, the more damage to the lymph system. And the more damage, the worse the lymphedema. There's no way around that.

I can tell you this, though: the Expert on that site is very knowledgeable about breast cancer, but until rather recently she did not know much about lymphedema, and as a result sometimes offered misleading information (as in the question you quoted). She's been learning more about it lately with help from some of the advocates in the lymphedema community who were concerned about this problem, and her recent posts have been more accurate. Unfortunately, this kind of misinformation about lymphedema is not uncommon in the medical community, so getting straight answers can be difficult.

As for there being no websites to consult about this, that too is out of date. You can find information at the National Lymphedema Network at www.lymphnet.org (breast and chest lymphedema is actually called "truncal lymphedema" if you want to do a search for it). The Bellisse compression bra site also has lots of information and articles (including the study I mentioned above) on their website at www.bellisse.com  And the Lymphedema discussion board here on bc.org has a wealth of women with breast lymphedema who can answer your questions and cheer you on to complete control of this crummy condition.

Unfortunately, lymphedema of either arm or breast rarely resolves, and certainly not by itself. It is a chronic condition and, like bc, it is staged. So the sooner you insist on treatment the less internal and irreparable damage will be done. Briefly, breast lymphedema is treated by specialists called lymphedema therapists (usually specially trained PTs or OTs) who combine a special, gentle massage with exercise, skin care, and compression to help you gain control of the swelling, reduce the pain, and avoid infection (which is the most serious medical aspect of lymphedema). Position Papers on Therapy and on Therapist Training are available at the National Lymphedema Network website above.

Very gentle hugs to you, lionessdoe, as you tackle this latest leg of your bc journey. Please let me know if there's any way I can help.

Be well!

Binney 

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Oct 9, 2007 11:27AM lionessdoe wrote:

Binney,

Huge thanks for the updated information. I was scared stiff thinking that a possible mastectomy down the road may be my only solution. The pain from breast lymphedema is horrendous. I will check out the links. Thank you, thank you, thank you! 

Doe Dx 9/5/2007, IDC, 1cm, Stage IIIA, Grade 2, 4/19 nodes, ER+/PR+, HER2-
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Oct 9, 2007 02:30PM 3boys4me wrote:

I just got back from the surgeons office.  He aspirated 200cc's today and that's just since last Friday.  Our family is heading to Florida tomorrow, so will have drains put back in next Monday.  The surgeon said I'd have the drains in for 5-7 days, then I'll be able to start chemo the week of the 22nd. 

I hate the drains Frown

** Live Well * Laugh Often * Love Much ** Dx 2/2007, IDC, 5cm, Stage IIB, Grade 2, 6/14 nodes, ER+/PR+, HER2-
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Oct 24, 2007 12:30AM snherrington wrote:

You need to keep yourself wrapped 24-7.  I had a double mascectomy/tissue expander placement in 2004 and my doctor pulled the drains in the breast with cancer in 2 days and sent me home with 1 drain in the right breast for about 2 weeks.  I developed horrible seromas all the while going in for saline injections. I was having to have aspirations several times a week because I was in such pain... The aspirations caused a very severe infection and I had to hospitalized, had to have my surgery again to remove expanders and clean out infection which had already started to eat in to the wall of my chest.  The doctor that did this was different and he left my drains in for 2 weeks and advised staying wrapped, that is would cause less swelling and cause the fluid to absorb in to my body instead of building into seromas.  I had to basically stay bound for a month, only removing it when I showered... which was done quickly then back into wrapping.  Try that... and when it feels like it is getting better... continue it.

Dx 11/18/2004, IDC, 5cm, Stage IV, Grade 3, 6/11 nodes, mets, ER+, HER2+
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Oct 24, 2007 12:34AM snherrington wrote:

I hope you have your seromas under control before starting chemo.  The aspirations during chemo can cause a horrible infection due to your immune system shock.  Stay wrapped... that is the most important information I can offer you.  24-7 this will help the fluid absorb into your body instead of building up in a pocket.  It also decreases swelling

Dx 11/18/2004, IDC, 5cm, Stage IV, Grade 3, 6/11 nodes, mets, ER+, HER2+
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Oct 24, 2007 12:46AM snherrington wrote:

It is not necessary to have the fluid drained unless you are having alot of discomfort, however if you are undergoing chemo or about to you do not want to have aspirations done cuz it strenghtens the risk of developing an infection.  I developed a horrible infection that landed me in the hospital for 2 weeks on the strongest antibiotics you could think of... they had to go in and remove my expanders and clean out all of the infection, and then was sent home with an antibiotic pump that I had to carry around for 2 more weeks.  My best advise to you is to stay wrapped.  Wear your bra and wrap yourself with Ace bandages and wear them 24-7.  This will help the fluid absorb into your body and decrease swelling and pain. - SH

Dx 11/18/2004, IDC, 5cm, Stage IV, Grade 3, 6/11 nodes, mets, ER+, HER2+
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Oct 30, 2007 10:33AM 3boys4me wrote:

I've been going through the aspirations because I'm getting ready to start chemo and the dr wanted to have the fluid under control before starting chemo.  Like you said, he doesn't want to stick a needle in me during chemo and increase the risk of infection.

The good news is the fluid has decreased.  I go in one more time on Wed for my last (keeping my fingers crossed) aspiration and start chemo on Thurs.

My most recent problem is lymphedema.  It's mild and I'm addressing it, but it's so depressing to have it along with everything else with the bc.

Lisa

** Live Well * Laugh Often * Love Much ** Dx 2/2007, IDC, 5cm, Stage IIB, Grade 2, 6/14 nodes, ER+/PR+, HER2-

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