Surgery

NONE. Life has so much more meaning than a disfiguring scar, or a hidden one. LIVE, LAUGH, and LOVE the one your with! None. Seriously, it is not as bad as people think.

Bilateral mastectomies were a must for me. The impact was minimal. I am a strong woman. I am not defined by my breasts. Life and love win. Cancer lost. I have a rather large laceration from melanoma surgery on the upper part of my leg. It is about 8 inches in length and 3 inches or so, wide. Its depth is about 1/2 inch to 3/4 inch, and the rather large muscle shows clearly. It was much too large to be closed with stitches. I chose to devise my own measures to conceal it rather than have more surgery involved in disguising it. I merely wear knee length shorts when exercising, longer-length styled trunks when swimming. The viewing of the wound does not bother or cause concern to me or my immediate family in the least.

Hi, I had two tumors one each in upper and lower right lobes. First, they did the tattoos and then the cast. The tattoo shows where the radiation is to be targeted. The cast is for your use only while receiving SRS so you don't move. You lay on the material and they wet it down, then shape it to your body. It dries quickly. Then you lay in it every time. I had 4 treatments for each tumor lasting 20 mins. each. They gave me a break in between. I did end up with esophagitis, very bad sore throat and hard to swallow. I used the magic mouthwash and it was gone within 10 days. I also used Prilosec for heartburn. I wasn't tired and never felt sick. My problem now is radiation scarring to the pectoral muscle and under the armpit. Though targeted, you have to remember that it has to go in and come back out somewhere. This was due to the location of the one tumor, so basically unavoidable. I have pain when I overdo it, but I'm doing very well overall. I started chemo within two weeks and I'm presently NED. Hi, I had two tumors one each in upper and lower right lobes. First, they did the tattoos and then the cast. The tattoo shows where the radiation is to be targeted. The cast is for your use only while receiving SRS so you don't move. You lay on the material and they wet it down, then shape it to your body. It dries quickly. Then you lay in it every time. I had 4 treatments for each tumor lasting 20 mins. each. They gave me a break in between. I did end up with esophagitis, very bad sore throat and hard to swallow. I used the magic mouthwash and it was gone within 10 days. I also used Prilosec for heartburn. I wasn't tired and never felt sick. My problem now is radiation scarring to the pectoral muscle and under the armpit. Though targeted, you have to remember that it has to go in and come back out somewhere. This was due to the location of the one tumor, so basically unavoidable. I have pain when I overdo it, but I'm doing very well overall. I started chemo within two weeks and I'm presently NED.

I opted for a bilateral. I only had cancer on the right side, but after finding that and getting my MRI, something popped on the left. We weren't sure what it was. I could have had it tested, but at that point I just knew I wanted to have both sides removed. So I chose to not get that side tested and proceed with a bilateral mastectomy.

After surgery, pathology showed it was not cancer, but I don't regret
making that decision. It was 100% correct for me.

That said, what is right for me, may not be right for you. And it's a hard decision to make. And I wish you best of luck making it. You have to do what you think is right for you, and only you. ((hugs)) I have only had the one breast removed. I discussed it a lot with my oncologist and did a lot of reading about recurrence. Plus I had 5 months to think about it during chemo. My oncologist said as long as being checked, going for mammograms and tests was not going to drive me crazy with worry, then I did not have to remove the other breast. What I read at the time is that most recurrence occurs in the same breast or in another organ. I knew that I would have radiation after the surgery so even the plastic surgeon I consulted beforehand said to come see him again 3-6 months after radiation was over. I think I decided to go with the simplest surgery possible hoping that recovery would be easier. I hear women say they choose the bilateral so that they will not have to go thru this again. My research did not find that reasoning to be valid. Breast cancer can recur and metastasize no matter what stage you have and what treatments you undergo.

The range of reported lymphedema in patient who undergo pelvic lymph node dissection is between 5-30%. However, it is important to note that the range varies widely based on several factors such as the tools to measure lymphedema or the medical comorbidities of the patient such as obesity, diabetes, hypertension, and cardiovascular disease. The range of reported lymphedema in patient who undergo pelvic lymph node dissection is between 5-30%. However, it is important to note that the range varies widely based on several factors such as the tools to measure lymphedema or the medical comorbidities of the patient such as obesity, diabetes, hypertension, and cardiovascular disease.

The robotic system is generally recommended in the setting of early-stage cervical cancer to perform a radical hysterectomy or radical trachelectomy. It is also very commonly used to perform simple hysterectomy and lymph node removal in the setting of uterine cancer. It may also be used when performing prophylactic removal of the tubes and ovaries in patients with hereditary breast and ovarian cancer syndromes.

The robotics approach may also be used in very select cases of patients with isolated recurrent disease.
The robotic system is generally recommended in the setting of early-stage cervical cancer to perform a radical hysterectomy or radical trachelectomy. It is also very commonly used to perform simple hysterectomy and lymph node removal in the setting of uterine cancer. It may also be used when performing prophylactic removal of the tubes and ovaries in patients with hereditary breast and ovarian cancer syndromes.

The robotics approach may also be used in very select cases of patients with isolated recurrent disease.

Laparoscopic surgery is generally not indicated in the setting of advanced disease. In other words, when patients have wide spread of disease the indicated approach is a laparotomy. This means an open abdominal incision. Typically, only patients with early cervical or endometrial cancer are candidates for laparoscopic surgery. It is important to emphasize that patients with advanced-stage ovarian cancer are not candidates for laparoscopic surgery.

There are other potential contraindications to laparoscopic surgery. These include multiple prior abdominal surgeries, history of multiple bowel surgeries, severe cardiopulmonary disease, or extreme obesity.
Laparoscopic surgery is generally not indicated in the setting of advanced disease. In other words, when patients have wide spread of disease the indicated approach is a laparotomy. This means an open abdominal incision. Typically, only patients with early cervical or endometrial cancer are candidates for laparoscopic surgery. It is important to emphasize that patients with advanced-stage ovarian cancer are not candidates for laparoscopic surgery.

There are other potential contraindications to laparoscopic surgery. These include multiple prior abdominal surgeries, history of multiple bowel surgeries, severe cardiopulmonary disease, or extreme obesity.

I personally recommend Chunyi Lin's CD "Small Universe". It's a CD from Spring Forest QiGong. Google It. It's a very powerful CD for balancing and healing the entire body.

Hope that helps Yes, there are CDs with guided meditations that are extremely helpful. Comprehensive pain management approaches including pre-emptive analgesia with nerve blocks and the use of pain pumps is also very beneficial.

In 1992 I was told I would be bedridden for the rest of my life. I had my lymph nodes removed during a malignant melanoma surgery. My leg was as wide as my waist when I woke up from the surgery. I was told not to exercise for a full year. (I waited 9 months and just HAD to start exercising again!) The swelling went down very slowly. Twenty years later, I still deal with lymphedema on a daily basis. I maintain it well... sleep with my leg elevated, wear compression stocking, and I know which exercises reduce or increase the swelling. I recently published a book on my experience as a cancer patient and the twenty years since. Sentinel lymph node biopsy has revolutionized melanoma surgery, staging, prognosis, and aids in the decision for adjuvant therapy after definitive surgery. However, like all things there is some down side including pain and restriction of motion (usually limited to post operative period), numbness/paraesthesias (which can be permanent) and most problematic - lymphedema. The cause of post sentinel lymph node biopsy lymphedema is poorly understood but does not appear to be related to the number of lymph nodes removed (average sentinel node biopsy has 2-3 nodes). Complicating the issue further is the actual method of deciding if lymphedema is present. The methods vary from circumferential measurements above and below the elbow/knee at specified distances, perometry (measuring shadow size of each extremity), water displacement (volumetric analysis) and bioeimpedence (as extracellular fluid increases the ability to transmit electrical charge through the limb decreases). With all of those caveats, the risk of lymphedema after sentinel lymph node biopsy is ~5-10%; after a full lymphatic dissection, it is ~15-60% (and above that if the nodal area is radiated).

The pathologist always checks the edges of the wide excision to ensure there is no melanoma present (implying that if they see it at the edge then it is also present on the other edge that was left behind). Fortunately, this is very rare (<1%) for melanoma - unlike breast cancer lumpectomy which has a positive edge (margin) ~10-40% of the time. The pathologist always checks the edges of the wide excision to ensure there is no melanoma present (implying that if they see it at the edge then it is also present on the other edge that was left behind). Fortunately, this is very rare (<1%) for melanoma - unlike breast cancer lumpectomy which has a positive edge (margin) ~10-40% of the time.

The width of the wide excision is determined by the melanoma thickness and by the location on the body. Non-invasive or melanoma-in-situ is excisied with 5 millimeter margins. Non-cosmetically sensitive (face, ears) or funcitonally sensitive (hand, genitals) will generally have 1 cm of radial width per millimeter of thickness of melanoma up to 3 cm. This is typically cut in half for cosmetically/functionally sensitive areas. Rarely the margins will be positive and will require more excision. This is usually for melanoma-in-situ at the margin. The width of the wide excision is determined by the melanoma thickness and by the location on the body. Non-invasive or melanoma-in-situ is excisied with 5 millimeter margins. Non-cosmetically sensitive (face, ears) or funcitonally sensitive (hand, genitals) will generally have 1 cm of radial width per millimeter of thickness of melanoma up to 3 cm. This is typically cut in half for cosmetically/functionally sensitive areas. Rarely the margins will be positive and will require more excision. This is usually for melanoma-in-situ at the margin.

The wide excision part of your surgery to to remove any melanoma cells that are in the vicinity of your primary (original) melanoma. The amount of skin that is removed varies somewhat by location for cosmetic (face) or functional (hand) reasons but generally for melanoma thickness <1mm - 1 cm in all directions is removed, for 1-2mm melanomas- 2cm in all directions and >2mm melanomas -= 3cm in all directions. These excisions usually create a circle of skin missing. Circles can't be closed into a straight line so a 'flap' must be created to fill the space. This 'flap' is either an elongation of the circle wide excision into an ellipse (the ellipse must be 3 times as long as it is wide to close properly) or a rotation flap (where skin from beside the wide excision is elevated and rotated into the defect). The incisions are always longer than you expect so don't worry that it was 'too long' - it is only as big as is necessary to remove the melanoma. The wide excision part of your surgery to to remove any melanoma cells that are in the vicinity of your primary (original) melanoma. The amount of skin that is removed varies somewhat by location for cosmetic (face) or functional (hand) reasons but generally for melanoma thickness <1mm - 1 cm in all directions is removed, for 1-2mm melanomas- 2cm in all directions and >2mm melanomas -= 3cm in all directions. These excisions usually create a circle of skin missing. Circles can't be closed into a straight line so a 'flap' must be created to fill the space. This 'flap' is either an elongation of the circle wide excision into an ellipse (the ellipse must be 3 times as long as it is wide to close properly) or a rotation flap (where skin from beside the wide excision is elevated and rotated into the defect). The incisions are always longer than you expect so don't worry that it was 'too long' - it is only as big as is necessary to remove the melanoma.

Obesity is a risk factor. In terms of the surgery itself, lymphedema rates are reduced with sentinel node biopsy (2-5%) compared to full axillary dissection (20-35%). Radiation to the axilla and supraclavicular nodes increases lymphedema risk. Obesity is a risk factor. In terms of the surgery itself, lymphedema rates are reduced with sentinel node biopsy (2-5%) compared to full axillary dissection (20-35%). Radiation to the axilla and supraclavicular nodes increases lymphedema risk.

Image-guided biopsy is preferred. This can be done with a core biopsy using the stereotactic table or under ultrasound. There are many different biopsy needles available, but for all a small knick is made in the skin after injecting local. The devise is then inserted into the breast, and several cylinders of tissue are removed and placed in formalin then sent to pathology. Image-guided biopsy is preferred. This can be done with a core biopsy using the stereotactic table or under ultrasound. There are many different biopsy needles available, but for all a small knick is made in the skin after injecting local. The devise is then inserted into the breast, and several cylinders of tissue are removed and placed in formalin then sent to pathology.

Generally lumpectomy is offered for unifocal (one site of disease), and the patient is willing to undergo radiation. If the tumor is large relative to the breast size, neo-
adjuvant (up-front) treatment may be given to shrink the cancer before lumpectomy.

Questions to ask would be:
How large is the cancer? Can clear margins be obtained? Should I receive chemotherapy or endocrine therapy prior to surgery to shrink the tumor? How will the incision lines be placed? Will oncoplastic techniques be used? How much deformity will there be? Is there a reason not to preserve the breast?
Generally lumpectomy is offered for unifocal (one site of disease), and the patient is willing to undergo radiation. If the tumor is large relative to the breast size, neo-
adjuvant (up-front) treatment may be given to shrink the cancer before lumpectomy.

Questions to ask would be:
How large is the cancer? Can clear margins be obtained? Should I receive chemotherapy or endocrine therapy prior to surgery to shrink the tumor? How will the incision lines be placed? Will oncoplastic techniques be used? How much deformity will there be? Is there a reason not to preserve the breast?

It depends on the patient and if reconstruction is performed, and what type of reconstruction. If a mastectomy without reconstruction is performed, usually a 24-48 hour hospital stay is required, and a patient is discharged with drainage tubes in place. The drains are usually removed after about 7-10 days, but may stay in place longer depending on the amount of fluid that is being produced. Overall recovery in terms of return to work and other normal activities can take anywhere from 2-3 weeks up to 6-8 weeks.

If reconstruction is performed using tissue expanders or implants, the recovery is similar to that of a mastectomy without reconstruction but the initial pain is usually more as the tissue expanders or implants are placed underneath the pectoralis muscle. If reconstruction using muscle or fatty tissue is performed, the hospital stay is usually 3-5 days, and may include an intensive care unit stay; overall recovery is typically 6-8 weeks and sometimes longer. It depends on the patient and if reconstruction is performed, and what type of reconstruction. If a mastectomy without reconstruction is performed, usually a 24-48 hour hospital stay is required, and a patient is discharged with drainage tubes in place. The drains are usually removed after about 7-10 days, but may stay in place longer depending on the amount of fluid that is being produced. Overall recovery in terms of return to work and other normal activities can take anywhere from 2-3 weeks up to 6-8 weeks.

If reconstruction is performed using tissue expanders or implants, the recovery is similar to that of a mastectomy without reconstruction but the initial pain is usually more as the tissue expanders or implants are placed underneath the pectoralis muscle. If reconstruction using muscle or fatty tissue is performed, the hospital stay is usually 3-5 days, and may include an intensive care unit stay; overall recovery is typically 6-8 weeks and sometimes longer.

Full preparation includes review of all imaging studies such as mammogram, ultrasound, and MRI, as well as consultation with appropriate specialists such as the medical oncologist, radiation oncologist, and plastic surgeon. Of course reviewing all options with the patient and making sure she is understands her treatment options and is comfortable with her decision is of utmost importance. Full preparation includes review of all imaging studies such as mammogram, ultrasound, and MRI, as well as consultation with appropriate specialists such as the medical oncologist, radiation oncologist, and plastic surgeon. Of course reviewing all options with the patient and making sure she is understands her treatment options and is comfortable with her decision is of utmost importance.

There's a saying about New York that applies to the breast-cancer community too: There are 8 million stories in the naked city.

Every woman with breast cancer has a specific set of factors she must consider in making decisions about her treatment. For some women, the choice is clear. For others, the decision-making process is the most stressful part of the breast-cancer experience.

My decision to undergo a bilateral mastectomy after having a lumpectomy and re-excision on my right breast was based on a unique set of circumstances: There was disagreement between my first- and second-opinion doctors about whether the margins around the re-excision were clear. My tumor was an unusually aggressive kind of lobular cancer, and women with lobular cancer are somewhat more likely to get a tumor in the other breast. My tumor hadn't shown up on the mammogram I'd had a couple of months before I was suddenly able to see and feel it, so I was concerned that a new tumor wouldn't be found by mammography either. Both breasts were dense and had areas of micro-calcifications—risk factors for breast cancer—so I was going to require frequent monitoring of various kinds.

All those concerns, plus the fact that I'm a worrier by nature, led me to choose the most aggressive surgery.

I actually didn't have much trouble deciding to have both breasts removed. But a friend suggested that I make a list of pros and cons so that if I ever felt regrets, I could look at the list and remember why I chose that course. I haven't felt regrets, as it turns out, but making the list was reassuring because I realized how certain I was about my decision.

Another woman in my situation might make a completely different decision. She might choose to keep one or both breasts. And I can understand that. After all, even my well-trained, experienced and talented doctors disagreed in their advice. But I feel confident that my decision was right for me. There's a saying about New York that applies to the breast-cancer community too: There are 8 million stories in the naked city.

Every woman with breast cancer has a specific set of factors she must consider in making decisions about her treatment. For some women, the choice is clear. For others, the decision-making process is the most stressful part of the breast-cancer experience.

My decision to undergo a bilateral mastectomy after having a lumpectomy and re-excision on my right breast was based on a unique set of circumstances: There was disagreement between my first- and second-opinion doctors about whether the margins around the re-excision were clear. My tumor was an unusually aggressive kind of lobular cancer, and women with lobular cancer are somewhat more likely to get a tumor in the other breast. My tumor hadn't shown up on the mammogram I'd had a couple of months before I was suddenly able to see and feel it, so I was concerned that a new tumor wouldn't be found by mammography either. Both breasts were dense and had areas of micro-calcifications—risk factors for breast cancer—so I was going to require frequent monitoring of various kinds.

All those concerns, plus the fact that I'm a worrier by nature, led me to choose the most aggressive surgery.

I actually didn't have much trouble deciding to have both breasts removed. But a friend suggested that I make a list of pros and cons so that if I ever felt regrets, I could look at the list and remember why I chose that course. I haven't felt regrets, as it turns out, but making the list was reassuring because I realized how certain I was about my decision.

Another woman in my situation might make a completely different decision. She might choose to keep one or both breasts. And I can understand that. After all, even my well-trained, experienced and talented doctors disagreed in their advice. But I feel confident that my decision was right for me.

For me this was not a difficult decision. When I learned that there was no survival benefit for mastectomy in my case, I decided to keep my breast and have radiation therapy. The prospects of a smaller surgical procedure as well as my appearance and sensation all seemed positive.

However, if I had carried the BRCA gene or if any other medical situation had made mastectomy an appropriate choice, I would not have hesitated to choose it. For me this was not a difficult decision. When I learned that there was no survival benefit for mastectomy in my case, I decided to keep my breast and have radiation therapy. The prospects of a smaller surgical procedure as well as my appearance and sensation all seemed positive.

However, if I had carried the BRCA gene or if any other medical situation had made mastectomy an appropriate choice, I would not have hesitated to choose it.

The further down the leg the harder it is for wounds to heal - so the foot is often the slowest to heal. Elevation can help and fastidious attention to cleanliness is critical. First signs of infection - typically redness around the wound, drainage, foul smell should be reported promptly to the surgeon and will usually require a visit for culture of the wound and a prescription for antibiotics. The further down the leg the harder it is for wounds to heal - so the foot is often the slowest to heal. Elevation can help and fastidious attention to cleanliness is critical. First signs of infection - typically redness around the wound, drainage, foul smell should be reported promptly to the surgeon and will usually require a visit for culture of the wound and a prescription for antibiotics.