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Had tissue expanders placed for breast surgery,8 nodes removed. Found capsule formation around expander. Can the node be present again ?

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Oncologist, Surgical
Practicing since : 1986
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1. breast ca late 2010. stage 2a.had bilat/mastec,. 8 nodes removed all negative. had chemo/herceptin. first PET before surgery ok. finished chemo had second PET and ok in july 2011 before tissue expanders were placed
2.Had tissue expanders placed august, a week later ruptured pect muscle and had surgery again on same breast. so 2 surgeries in 1 week
3. after expanders placed,developed healing problems in an area about 1.5 inch along incision, area was bad skin, red/thin and several times had to be restitched and many times oozed clear lymph , no infection and was sent for hyperbaric for 1 month, expanders were umcomfortable,and almost exposed from that poor skin area heavy etc. it never healed as the rest of incision did.
4. last december, finished herceptin and a week later had 3rd PET in preparation for final silicone implants and port removal. PET showed "bilateral implants in place with 1.4 suv right and 1.0 left most likely from inflammation. There is a focus of activity of an isolated lymph node above mastectomy in the axillary region. THIS NODE IS NOT ENLARGED and has 4.5 suv. node is not diagnostic for neoplasm or inflammation in origin". everything else was fine in PET
5.I asked my onco if that node could be cancer and she said no, that it was too early a week after herceptin, and that was caused by all inflammation around the expander and non healing area which was black the day of surgery in january. she said metastatic nodes are usually enlarged. she said as soon as you have your final surgery all these problems will resolve.she was happy and ok final surgery and port removal
6. had final surgery january 11, plastic surgeon found capsule formation around expander which was thickend and red and sent it to pathology and was bening (capsule only) node was not eve mentioned.this was all on the breast that had the cancer.
7.I look back and wonder how was she so sure this node was not BC and went ahead with port out and final surgery. no biopsy or any other test new implants look wonderful, all healed up x 2 months, no soreness or redness and at palpation of axilla, no lumps.plastic surgeon and others agreed with inflammation as the cause for the node. I read node negative rarely recurs just in an isolated node, specially with the obvious problems I had around and the expanders and that being not enlarged argues against mets. this node was not present on 2d PET before the expanders were placed
8.I feel great but this node is worrying me, i'm afraid a biopsy should have been done before final surgery. how can they be so sure and went ahead? is 4.5 too high do you think she was correct? maybe I'm paranoid. she told me it was too hard and will see me in 4 months for bloodwork only and that everything is ok and forget last year . thanks

Posted Mon, 21 May 2012 in Colon Cancer
Answered by Dr. K. Harish 15 hours later


Thanks for the query.

I understand that you are very worried about the node.

Let me start the answer with this statement. In medicine nothing is 100% sure. Be very clear on that. For example a negative PET does not guarantee no metastasis. So the general working pattern is that we evaluate things based on high probability.

In your case, in view of your previous PET scans being negative, the chances of spread to node (after histopathology showing no nodal disease) are very less. In fact, if sentinel node biopsy were to be done for you, if the node were negative, axillary dissection itself would not have been done.

You should also understand that if 100 cases like yours (exactly similar) were biopsied for the node - like you wanted, then most of them would be negative for cancer. So we as doctors would not be subjecting a majority of patients for an invasive procedure without any benefit and only associated complications.

Hence, when the probability of disease pick up is less, we do not advice evaluation. This is probably the reason why your doctor has not evaluated.

In addition, please also understand that if that node were to be cancerous (extremely rare), removal of that node would not cure you. If cure were to happen it would be because of herceptin and chemotherapy and not because of node removal.

After having read through your detailed history, from my understanding, I think your doctor is on right track.

Hope I have clarified your doubt. Let me know if you have any other concerns.

Wish you good luck

Above answer was peer-reviewed by
Follow-up: Had tissue expanders placed for breast surgery,8 nodes removed. Found capsule formation around expander. Can the node be present again ? 3 hours later
so you think that it was a reactive node? even with 4.5 suv? i thought it was high, my only concern was that she ok to take port out and do final without biopsy first, but i guess there was obvious cause around it to cause this isolated node, do you think it would have been more suspicious if there had not been inflammation? thanks, you are great
Answered by Dr. K. Harish 1 hour later

I agree. It would be very suspicious had you not undergone the breast implant with resultant inflammation.

Again, there is no way to categorically say that the node is not metastatic till a biopsy is done. I suppose that since metastasis is unlikely, the biopsy has not been done.

The chemoport if implanted can be retained for 2-3 years. Speak to your doctor about that.

Above answer was peer-reviewed by
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