I have just had a double mastectomy (grade 3 multi-focal on right and DCIS on left) following chemotherapy. Micromet was found in 1 of the 3 sentinel nodes on the right, suggesting that at least one was involved before chemo started. I will probably have radiotherapy (I am only 39 so belt and braces!) but I am not sure whether to have a full lymph node clearance. Has anyone else been in this position? Had I had surgery before chemo then I would have had the clearance as they would have seen the positive node. My surgeon has agreed to do it but thinks the risk of the side effects (lymphodema) are not worth the effort but would do it for my peace of mind. Would appreciate any thoughts!
Hi Peachy,
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Hi Peachy
Are you likely to have radiotherapy as part of your treatment in addition to the chemotherapy?
I had a left mx with immediate reconstruction and the pathology from that operation indicated that of two sentinel nodes removed that one was clear and the other full and encapsulated with cancer.
My breast surgeon was of the opinion that I should have an axillary clearance but sent me to see the oncologist “for some statistics!!” He said that if I was having chemotherapy that would most likely get whatever - if anything - that was in the axillary nodes and the radiotherapy which I would be having anyway would finish the job.
The outcomes whichever route I went down would be similar so I went for whole breast/axillary radiotherapy and avoided another operation. That said, lymphodema may still be a side effect of radiotherapy which was explained to me when I had my planning appointment.
It might be worth asking your oncologist what he thinks.
Good luck
The situation has changed slightly in that both the surgeon and radiotherapy consultant are recommending that I don’t need either a clearance or radiotherapy as I don’t meet the criteria. However my double mastectomy was after chemo so everything had shrunk anyway. Originally I had a 24mm grade 3 tumour with other multi-focal lesions on the right side (they only measured the biggest one) and DCIS on the left. One node was suspicious but inconclusive from biopsy on the right so they put a clip in so they could make sure they removed it during the sentinel node biopsy. After chemo I was left with 3 grade tumours, downgraded to grade 2, all about 10mm and a micromet in one of the 3 lymph nodes taken from that side although I am not sure if the clipped one is one of them yet. The left side was clear. My concern is that if I still have a micromet after chemo then if there is cancer in any of my further nodes then surely I should have more treatment to them as the chemo hasn’t necessarily got rid of it all? Both consultants are happy to do the clearance or radiotherapy if I want it (I believe it would be an either/or) but both are saying I don’t really need it. I know I should take their advice but not sure how I can live with the fear of some still being there. Any advice/experience welcome!
Hi Peachy. Hopefully both consultants gave you some evidence for their decision?
what you need to do…is keep asking yourself that same question…‘will I be worrying that I should have had node clearance if I dont?’
we cant make your decision…you must make it as you will have to live with your choice…however, a couple of thoughts…I did have full clearance and it still came back…so that isnt foolproof…and can you manage to ‘move past it’ if you dont have node clearance?
the other thing you can do…is leave the door open…say you want to think things over.
hope that helps
Moijanxx