?? Additional surgery ??

66 yo 34 weeks post mod.radical mastectomy with no lymph node involvement and no follow-up treatment. Scar revision is being considered in the axillary area at this time. Mild lymphedema has been present since approx. 8 weeks post-op. The condition is well controlled by self massage, specific exercises and wrapping which is a treatment plan developed by Physical Therapist specializing in the CDP program. I am very dedicated to the program and intend to continue to follow it forever if necessary. In the surgeons opinion, will a scar revision have any adverse effect as far as the lymphedema is concerned? The main area of edema now is concentrated in the upper arm and shoulder (posterior).The revision is being considered for a small area that needs to be "smoothed out" so as not to interfere with comfortable wearing of bras. Thanks for the helpful advice/opinions concerning my past postings.

[CCF-RN,MSN-rf]

Dear japdip:  This is a difficult question.  A scar revision is a fairly superficial and uncomplicated operation but it is surgery nonetheless.  In theory, any trauma to the arm could impact the lymphedema.  It may get no worse than it is right now but the possibility exists that it could worsen.  It may depend on the extent of the surgery.

[surgeon]

It could make it worse: it's not very likely, assuming the procedure will be superficial. However, if the only issue is the proper fitting of a bra, I'd consider trying several styles -- perhaps with the help of an experienced fitter (there are places that specialize in prosthetics for breast cancer, some of whom have lots of tricks up their sleeves) -- before deciding surgery is the only option.

[japdip]

Thanks ...... I do have several styles and it doesn't seem to matter. It appears that the last stitch (axillary end of the incision) was pulled through from the back (I know better -- just trying to illustrate how it appears) leaving a tennis ball size glob of fatty tissue that hangs over whatever bra I wear. Most uncomfortable!! The scar revision was suggested by my surgeon as a rather simple solution to the problem. I have thought about having a consult with a Plastic Surgeon before I make a final decision. Whatcha think?????

[surgeon]

Removing the glob is not a big deal; I've done it many times as an office procedure, in fact. I don't recall doing it when there's been lymphedema, but that sort of thing won't get very deep and isn't very likely to make edema worse, I'd think. If your surgeon is comfortable with it, a plastic surgeon probably isn't necessary.