Fat Necrosis

In Oct 99 I was diagnosied with Stage I ductal ca and LCIS.  I went through chemo and radiation.  In Dec of 01 I had a biopsy of two calcified areas which were benign.  In May of 02 I had a hardened area under needle biopsy site removed (lumpectomy) due to changes in area.  It was fat necrosis.  Since that time I have had a harden area approx 6cm develop under incisional area, with heat reddness, pain, swelling, more retraction of nipple and drainage from nipple.  There is a significant amt of drainage.  I have seen a surgeon who started me on Keflex 500mg TID and I am to return to him this week. The options given to me were antibotic (antibiotic) therapy and heat or mastectomy.  There has been minimal improvement and increased drainage.  I am scared that there is a secondary ca.  I know the odds are in my favor, but why am I having this type of problem two years post radiation treatment, if the fat necrosis is r/t to that?  Surgeon has recommended a double mastectomy because of hx of LCIS.  Reconstruction is ify because of the problems I have had in relationship to healing post surgical proceedures.  He (surgeon) stated that he has never seen a pt with this type of reoccuring problems with breast.  How untypical is this and am I at a higher risk for additional ca with this breast?  What are the odds that I already have ca again?  Pls help I am scared.  Thanks

[CCF-RN,MSN-JS]

Dear Sweetp, It is a complicated problem that you are describing. There are different issues that decisions need to be made about.  First is this initial situation.  The question is what is causing the symptoms you are experiencing?  Infection, abcess (abscess), cancer, a side effect of past radiation therapy? More information needs to be obtained in order to correctly focus on  treating this situation.  For example, are the antibiotics improving the symptoms? Perhaps an ultrasound or mammogram may help to clarify further.  The next question would be based on these findings what is appropriate to treat the current situation?  The third question would be - what should be done regarding the increased risk for breast cancer occurring in the opposite breast taking into account your hx of LCIS, current problems, past treatment ie. radiation therapy, your overall health and situation.  These questions all require further discussion between you and your surgeon.  Once you've seen your surgeon and discussed these issues, if you are still questioning you may want to seek a second opinion.