Click on the pictures = enlargement

Click on the red words =

further pictures or text (in German)

SURGERY

Clarifications at the Breast Center have been made,

what next concerning the lump and microcalcifications?

In December 2003 I heard for the first time that with a mammacarcinoma the axilla lymphnodes should also be removed. I then read in the internet about the possible side effects, like movement restrictions, lymphedema etc. Also, that for the majority of women with removed axilla lymphnodes, such an intervention would not at all have been necessary. Thus, prior to the operation, I was intensely concerned with this matter, and could then conclude: unnecessarily removed lymphnodes  - that does not have to be!

What means Sentinel, what is a Sentinel Lymph Node Biopsy? a detailed explanation:     

Preparation for the sentinel node biopsy (SLNB) took place the day before in order to be able to find the sentinel lymphnodes during the surgery.

This method is only practicable if the axillary lymphnodes in the palpation findings and with the ultrasound analysis do not yet look attacked.

If the frozen section during the surgery should, however, give the result that the sentinel lymphnodes contain cancer, then the remaining lymphnodes must be removed.

January 29^th, 2004: The range of the former lump in the left breast, also the one with the microcalcifications in the right breast, were marked with injected radioactive substance, in order to indicate the situation of the sentinel lymphnodes. These could be found the next day by the gamma detector and be removed by a small cut in the axilla.

My questions and considerations before the surgery:

- Together with the cancer, will there really only be removed the most necessary part from the healthy tissue? The breast was anyway not too voluminous and shouldn’t therefore become much smaller. In thoughts I dispelled the cancer.

- Will it be for sure a breast-conserving surgery with aesthetic appearance and nice, not thick, surgical seams? A good-looking breast is enormously important for a woman (also for older ones!).

The introductory talk with the surgeon, on what should be cut out and on how a good result could be obtained, was very encouraging.

The detailed description of the sentinel node biopsy and further details worked reassuringly. I found it very important to know as much as possible about the coming things, so the inevitable was no more a terrible phantom.

The required cuts were already marked on the skin, which gave me the impression that I would go the next day to a cosmetic surgery.

A quiet fear remained that after the surgery there would be too much of the breast missing... also the fear of the full narcosis.

THE SURGERY  -  THE REPORT

(all reports are in German)

Data on surgery - January 30^th, 2004 

DETAILED REPORT  (in German)

DETAILED REPORT  (in German)

Segmentectomy Mamma at the left:

Removal of the glands in the 1 o'clock and 4 o'clock axis,

Marking of the resection margins with metal clip.

Adaptation of the glands.  

This means the two margins are joined together to give the breast again a nice form.

DETAILED REPORT  (in German)

with small picture to enlarge

Sentinel Node Biopsy,  Mamma at the right:

Removal of 3 lymphnodes,   

Frozen section.

DETAILED REPORT  (in German)

Segmentectomy, Mamma at the right:

Removal of the glands between 10 o'clock and 1 o'clock

with re-excision in the 1 o'clock axis,

Marking of the resection margins with thread.

Adaptation of the glands.

This means the two margins are joined together to give the breast again a nice form.

DETAILED REPORT  (in German)

with small picture to enlarge

Mastopexy on both sides:

Both nipples with areola are shifted in order to improve the optical appearance.

(By joining the remaining gland tissue =  adaptation, the nipples are not anymore in the right position)

DETAILED REPORT  (in German)

with picture: not suitable for sensitive persons

DIAGNOSIS SEGMENTECTOMY PREPARATION LEFT

(in German)

DIAGNOSIS  SEGMENTECTOMY RIGHT  

I felt well during the hospitalstay (6½ days):

It would have been a great relief if the surgeon could have visited me still the same day, or at least the next one, although there was a weekend coming up. I would have liked to know this and that about the surgery, also I wouldn’t then have felt so lost. On the last evening in the hospital, he finally visited me. (I know: too little time!)

I was missing strict instructions for the correct movement of my arms.  I had on both sides a sentinel node biopsy (SLNB) and knew the advantages of this method. But how did I have to store the arms in bed, how much was it allowed to move them? I was disconcerted.  - Later I became aware that only little movement would have been recommendable for a good healing process in the armpit.

For me it would have been helpful to receive already soon after the surgery the dates of the intended longer-lasting examinations and discussions. I was in good physical and also mental condition and I would have liked to fill up the time in between usefully because waiting for the uncertain made me somewhat jerky.

The picture of the skeleton scintigraphy showed no metastases in the bones.

Further data: degenerative changes of the vertebral column (spinal column). Rhizarthrosis left. Degenerative changes of sternoclavicular and AC-joints on both sides.

Hip joint prosthesis on both sides.

The ultrasonography of liver and kidneys showed also no metastases.

The operation went very well. The drainage tube for the wound liquid on the right could be removed three days later, that on the left, however, only on the day leaving the hospital, thus five days after the operation. The breast was still held in form with transparent adhesive foil. It appeared to have been well shaped, operated on exactly as the doctor beforehand had planned with me.

- How do I have to behave myself when I am back home again? And how long do these behavior rules apply?

I had received many very well-meant advices. I did not know quite exactly what actually was now correct.  - I felt, however, so well that I started immediately with the housework, especially with the watering of the numerous flower-pots using a bigger watering-can. That was probably wrong, because the seromes arisen after one week (a swelling caused by the localized accumulation of serum within a tissue in the range of a wound) could have been released by too much movement.

- What is the normal healing process? About how long can it last until the "normal condition" is there again?

- Which complications can occur, and what is to be undertaken in such a case? Such references would have helped me very much after leaving the hospital.

COMPLICATIONS:  SEROMA

The lymph had itself on the eighth day after the surgery suddenly accumulated, probably I had been too active.

Those seromes (on the pictures still covered with plaster, and like small tennis balls sitting in the armpit) were quite unpleasant. I could not set the arms close to the body anymore, the back musculature cramped very painfully. Consequently, the liquid had to be punctured several times, until it had found another flow path.

CICATRICES

After taking off the bandage, I was disappointed about the appearance of the seams, I thought that the margins of the skin would lie beautifully next to each other. They were stitched together invisibly, but at both sides of the seams there were a few unpleasant skin rolls. I remembered, that after the hip surgery at a time I had rubbed in "Keli-med", those cicatrices became very fine, hardly perceptible.

Perseverance in putting on the cream, however, is necessary!!

I have thus rubbed onto this scar during a few months this specific ointment: No more bulges, only well visible cicatrices as lines. I wonder if these will further diminish. 

Which adjuvant (complementary) therapies will be provided/required?