Sentinel node biopsies and lymphoedema risk

scientistamafier · 5 November 2023 11:41

I have had two lots of surgery for breast cancer. First was a left side mastectomy for extensive DCIS, that was in 2020. Then in July this year I had a lumpectomy on my right breast.

This time round I am having chemotherapy. For both surgeries I had a sentinel node removed for biopsy. When I go for chemo the nurses always ask which side to put the cannula. So far I have gone for the left side as that operation was longer ago. However I am considering alternating between each arm to spread the risk of a problem.

What would you advise? Also, in reality, how much of a risk is there of getting lymphoedema?

naughty_boob · 5 November 2023 14:30

I had bilateral lumpectomy and sentinel lymph node biopsy in July this year, with no lymph node affected by cancer I was informed the lymphoedema risk was very low 5%. Saying that they don’t want you to get lots of cuts or grazes or have lots of cannulas. I had a PICC line fitted for my chemotherapy. I don’t have great veins anyway, had a problem with blockage in PICC and they took blood with butterfly needle and I was black and blue for over a week! The PICC blockage was sorted with multiple flushes and waiting and hour and half to be flushed again and it cleared. They are not perfect but you can get your bloods done from it and your treatment.

Have a chat to your team.

scientistamafier · 5 November 2023 14:36

I had problems on Thursday with getting a cannula fitted. It took several attempts and I now have a 2 inch bruise. That’s what made me think about swapping sides occasionally. When I was a blood donor I always used my right arm as the veins were much better.

I think I am confused as to which “team” I should be talking to - chemo nurses seem to think my surgeon should have told me what to do, but it was never mentioned. I only hopefully have two or three more sessions to go so doesn’t really seem worth getting a line in now.

naughty_boob · 5 November 2023 17:37

When I say team I mean the oncology team who decide on your chemo regime. They were the ones who advised a PICC for me. I am having 12 weekly sessions.

Nurse_BCN · 6 November 2023 12:51

Hi scientistamafier,

Thank you for posting. It is understandable that you have questions about which arm to use for cannulation when you have had sentinel node biopsies on both sides.

Lymphoedema is swelling caused by a build-up of lymph fluid in the surface tissues of the body. This can happen as a result of damage to the lymphatic system following surgery and/or radiotherapy to the breast or axilla (armpit). It’s not clear why some people develop lymphoedema and others do not but the risk is greatest for those who have both surgery and radiotherapy to the axilla. People who have had a sentinel lymph node biopsy only, have a reduced risk of developing lymphoedema compared to people who have had a number of lymph nodes removed.

There’s no strong evidence that having injections, taking blood, taking a blood pressure reading or having intravenous medicines in your ‘at risk’ arm will cause lymphoedema. NICE guidance recommends that performing medical procedures on the treated side should depend on clinical need and the possibility of alternatives. As you have had the same surgery on each side you do not have an alternative option for cannulation, and it is reasonable to have your chemotherapy in either arm. However, as @naughty_boob says it is important to speak to your breast care nurse or treatment team about this if you’re worried.

There are ways in which to help reduce the risk of lymphoedema developing. Infection in your ‘at risk’ arm can cause swelling and may damage the lymphatic system leading to lymphoedema. Tips on how to help reduce the risk of infection can be found in the link above.

It’s important to keep the skin clean and well moisturised, to reduce the risk of skin damage and infection.

We offer a range of free supportive services for anyone who has had a diagnosis of breast cancer which you may be interested in. They include face to face and online courses and events.

For more details about all of these services, please see the information on the link, or call our free helpline if you would like to talk this through or have any further questions. The helpline team have time to listen to your concerns, talk things through and signpost you to more support and information. Your call will be confidential, and the number is free from UK landlines and all mobile networks. The number is 0808 800 6000, (Relay UK -prefix 18001).

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