Mastectomy questions

[breastpain1]

Having mastectomy done soon because lumpectomy could not get clean margins. My tumor is estimated at 6.1 cm, with negative sentinel nodes. Pathology report:  "The tumor extensively involves the anterior resection margin and focally involves the posterior margin...no tumor is seen in the muscle, however, tumor is focally present an area of cauterized deep margin where muscle is not present."  It was also noted"  "foci of squamous metaplasia are noted"  I think that is a benign condition--didn't see that part to ask my surgeon so I googled it but want to double check.

. My question:  obviously, this is a big tumor.  How likely is it that this could have extended beyond the breast into muscle and how likely is it the mastectomy can get all the cells?  The reason I ask is that my type of cancer (ACC/breast) is not proven to respond to radiation or chemo.

Any input?

[kcsusan]

I recently had a Modified Radical Mastectomy on August 20th of this year, 11 days after surgery my incision opened up in two places and had alot of bleeding.  After several visits to both my surgeon and the hospital where the surgery was performed, the doctor said there was a bleed and  sewed up the two areas and gave me antibiodics for 7 days.  Apparently the two areas had finally healed, but a third area opened up and has bled now on a daily basis since labor day Sept 3rd.  I change the bandage twice a day and the doctor says it is old blood, yet continues bleeding.  Last time I was in the office the surgeon said he may need to open the incision up and pack it, if the bleeding does not stop.  I had 11 lymph nodes removed at the time of surgery, and very luckily all are clear, even with all the pain and complications it was good to hear the news.  In the pit of my arm by the end of the day I experience pretty bad pain, tightness and some swelling, and have pain coming from my chest where the incision area opened up.  I have never had a pain free day since the surgery.  The doctor prescribes vicodin 7.5/700 and I take it 4 times a day to keep pain free. The incision itself feels very hard, it is pretty numb yet I feel the chest pain from deep inside and mostly just feel very uncomfortable,  I keep hoping the bleeding will stop.  The surgeon mentioned there could of been an abscess, he took a culture and will get the results hopefully when I see him again this thursday. He said he may need to open up the incision and pack it to stop the bleeding.  Can you tell me is this a surgical proceedure or one done in the office ? I am very numb so would not panic if this is required, I will do anything to get this thing to heal up properly. MY job involved working at a PC all day and so far I am unable to sit at the PC and type for more than 2 or 3 hours at the most.  Is there a time frame with a complication such as mine.  I was also told I had dishesence, probably not spelling that correctly, where my body reacted to the desolvable stiches like a foreign body and desolved them before it was time, causing this bleeding problem.  I know some people report not having any pain at all from this surgery, yet I had the most pain in my life from it.  They gave me 700 mg of fentanyl, and 3 shots of morphine to get my pain under control.  He did say he nicked the nerve and so it caused a whole lot of pain and only stayed one night in the hospital.  Guess the insurance company determines when you go, yet I felt like in no shape to go home after hurting so bad , hope others do not have anything like I had.  I picked a good surgeon with lots of experience with mastectomys, he has been gracious and trying his best to take care of things.  Sometimes we just have bodies that respond in a different manner than the general population.  I am 63 years old and no spring chicken, and sure has made a whimp out of me, I expected to come flying through this surgery, so much to my dismay on the long long road to achieve comfort and healing.  I am concerned about getting lymphadema with the underarm swelling.  Is it normal to have this swelling from MRM and lymph node disection or could it be the start of lymphadema.  You know knowledge is king, I don't react in a panic, I just like lots of facts and options to help with the whole process.  Thank you for your time with my problem, any help is very much appreciated.

[breastpain1]

Thanks.  I appreciate this site and what you do.

[Cleveland Clinic]

Dear breastpain1,   Squamous metaplasia  describes a change in one type of tissue into an appearance associated with another type of tissue and can occur in association with cancer and with benign conditions.  Squamous cells are mainly found in skin or in the linings of certain organs within the body.  Adenoid cystic carcinoma (ACC) of the breast is a rare, well differentiated, and usually slow growing malignant tumor, accounting for less than 0.1% of all breast cancers.  It commonly starts in the glandular tissue of the breast as a firm, sometimes tender or painful, movable mass.  This cancer generally has a better prognosis than most forms of breast cancer.  Without more information it is impossible to say how likely it has extended into muscle or that mastectomy will remove all cells.