Lump seven months after surgery

[Twocapes]

I am seven months post lumpectomy, finished chemo, radiation, and have been on Arimidex.  I have been feeling a "lump" underneath my scar.  A mammogram done before radiation (June) stated, "3 cm stellate density corresponding to the lumpectomy site and probably represents postoperative change - follow-up recommended".  What is the probability that this could already be a recurrence?  The word "stellate" worries me.  The surgeon got clean margins and lymph nodes were negative. I don't think the surgeon was too happy that the radiation oncologist ordered a mammogram only four months after surgery.  Thanks for a wonderful website.

[longnose]

A related discussion, breast conditions was started.

[Looking4Answers]

I have a related question. I am a 34 yr old male. Had breast tissue under left nipple (slightly off centre, one-inch diameter, and spreading to the left toward my armpit) from my mid-teen years on. In my teens, a couple of doctors told me it was breast tissue, which some males get, so I never bothered to do anything about it. However, the appearance always bothered me, and after my sister developed breast cancer (when she was 34, two years ago), I decided to have the tissue removed.

So 18 months ago I had surgery. The healing didn't go well. I developed a hematoma (sp?), which had to be drained, and was left with a hard mass of scar tissue underneath. In a post-operative visit, the surgeon told me they tested the breast tissue for cancer cells and it came back negative. I felt good about that, but now I'm becoming increasingly worried about the area again. The area under my nipple is tender and it seems like a new lump is forming (i.e., if I isolate the area it seems round and protrudes more than the scar tissue did before). I'm pretty sure it's growing and it hurts when I massage it lightly.

I had a mammogram and ultrasound about six months ago and went for a follow up recently. The radiologist said I have what appears to be a swollen "benign lymph node" in my chest not far from my nipple and didn't have much to say about the lump itself, although he did have a second look after his assistant did the initial scan (always worrisome!). But my doctor has not followed up to discuss the radiologist report (it's been a month), so I assume there was nothing alarming in it. Also, recent blood work suggested all is well.

Unfortunately, I'm still worried. My family history encourages the anxiety (mother died of brain cancer when I was 14, aunt of breast cancer, and sister mentioned above), so I'd like a definitive answer. So should I request a biopsy, or pay for an MRI, or get this new lump/scar tissue removed, or what? If it is likely just scar tissue, what causes the soreness?

One other thing that might be relevant to changing lump: I've done quite a bit of upper body conditioning in the past year (100 push ups/day). Could this affect the scar tissue?

I'd post this as a new topic, but the system never seems to allow me to do it.

[CCF-RN,MSN-rf]

Dear twocapes:  In the context of recent surgery, it is difficult to clearly define the "density" seen on mammogram.  It is not uncommon for post operative changes to appear as densities.  Given that you had clear margins, it is unlikely to have a recurrence this quickly.  Unless this looks highly suspicious, it probably makes the most sense at this point to follow this.

[surgeon]

You highlight a common and not easy problem: how to assess and follow post op changes after lumpectomy. Scar tissue very often looks like cancer on xray, stellate shape and all. It's always been my practice to get a new baseline mammogram around 3-6 months after finishing radiation; one done after surgery but before radiation, if that's what you had, would be of questionable value in my opinion. It's quite common in that first post-treatment mammogram to have shadows that would otherwise be of concern, had there not been such treatment.

A lump in the surgical field may be present for many months, or even permanently. It becomes a matter of judgement if and when to biopsy such a lump; the downside is that healing in a heavily radiated site may be slow, leading to infection, etc. It's highly unlikely, given clear margins, to have a recurrance so soon. Having the surgeon re-assess the area might be useful; but unless there's something really unusual about the findings, I'd guess followup without biopsy would be suggested at this stage.

[Twocapes]

Thanks so much for responding quickly and putting my mind at ease.  I have already scheduled a follow-up mammogram which will be at the five-month point after radiation.