Lymph node removal is not often spoken about when a mastectomy or lumpectomy is performed on breast cancer patients. When breast cancer is detected, surgery is often called for to remove the whole breast or both breasts depending on the extent and presence of the tumour or tumours. This is called a mastectomy of a double mastectomy if both breasts are removed.
When surgery is called to remove the tumour only, and not the whole breast, it is called a Breast Conserving Surgery or a partial mastectomy or a lumpectomy and other names.
During a mastectomy or lumpectomy, the surgeon may also remove one or more of the lymph nodes from the armpits if cancer is detected in the lymph system. This is because lymph nodes are often the first place breast cancer cells spread to outside of the breast. Cancer often spreads to other parts of the body through the lymphatic system ─ a large network of lymph, vessels, nodes, organs and tissues that are part of the circulatory and immune system. Therefore, removing some or all of the lymph nodes is one way to stop the spread of the cancer to other parts of the body.
Another reason why the lymph nodes may be removed in a breast cancer surgery is that the doctors want to find out if the cancer has spread since lymph nodes are likely to catch or filter out cancer cells that may be in the fluid that drains away from the cancerous area of the breast.
One such breast cancer survivor who has done a lumpectomy with lymph node removal is Teo Shu Ru, a 26-year-old, who was diagnosed with breast cancer as recently as October 2020. This is her journey.
1. How and when did you find out you had breast cancer? What stage was the cancer when you found out? How did your family take the news?
Teo: In October 2020, I found that my chest often felt painful. I thought it would be a temporary physical discomfort. But the pain went on for about two weeks. So I went for a scan and found a 2cm tumor in my chest. It took about two hours in the government hospital to learn that it was breast cancer. I notified my family members and they quickly inquired around and found that Mahkota Medical Centre had a good cancer centre. I had a consultation with Dr Ho who informed me that I had Stage 2 breast cancer. Although the tumor was newly discovered, in the short span of two months, it had grown to 5cm and my lymph nodes were also affected.
Unfortunately, lymph node removal comes with a host of uncomfortable side effects such as infection, nerve pain, fever, undrained fluid collecting under the skin (seroma), stiffness in the shoulder, trouble moving or lifting the arm and numbness in the hands and fingers.
2. Was a mastectomy recommended?
Teo: Dr Ho said as I am still young, I could undergo chemotherapy to kill the cancer cells first. It would thus reduce the tumour size and then have surgery to remove the tumour, thus preserving the breast.
3. So you did not have a mastectomy but a lumpectomy?
Teo: I did not undergo a mastectomy although when I was diagnosed with breast cancer, I mentally prepared myself to do a double mastectomy followed by a breast reconstruction. However, after consultation with the doctor, only the tumour and affected lymph nodes were removed.
4. Were you given preparation and counselling before the surgery? How long was this preparation period?
Teo: In the three weeks of chemotherapy, I kept myself updated about the other breast cancer survivors’ experiences. I also asked for the doctor’s opinions and understanding of the situation and always maintained an optimistic attitude. It took about a week to make adjustments.
5. How long did the surgery take? Were there side effects?
Teo: The surgery itself was relatively fast, and I was able to keep my breast. The surgery removed both the tumour and lymph nodes. Initially, I was very uncomfortable because removal of the lymph nodes affected the sensation in my hand. It felt numb. My whole arm felt paralysed and I could not lift it up. However, rehabilitation treatment has helped to improve my arm and hand movement.
6. Did you receive post-operative care, instructions and counselling? What were some of the things you were taught?
Teo: Yes, I learnt how to self-examine my breasts. I also learnt about keeping a healthy diet and lifestyle.
7. With the lymph nodes removed, how did you deal with the drainage tube? Did you have to empty the tubes? How did you go about daily life like sleeping, bathing, eatingand so on?
Teo: It was very painful immediately after the operation but I followed the advice of the nurse and did my rehabilitation exercises everyday even though it hurt. After three weeks I felt much better. Now my arm can be raised like before.
All the drain tubes were removed from my body on the second day after the surgery. But the post operative wounds need time for recovery. My family took care of me and helped to clean me so that I could recuperate well.
As for sleeping, I could only lie on my back as that is what is recommended for breast surgeries. I felt uncomfortable with the pillow as I had to raise my head and arms so that I could eat as normal. But the arm and hand felt numb. It took a while to lose the stiffness in my arm and regain sensation in my fingers but they got better gradually over time.
8. Were you psychologically and emotionally affected by the physical changes after the surgery? How did you feel when you looked at yourself in the mirror?
Teo: I had a negative self image when I looked in the mirror after the operation because the breasts on both sides are now different in size, and there is a scar.
But looking at it another way, I feel that I am very lucky to be given a second chance in life. I am very grateful to my family, friends and doctors who have always encouraged me. In time, I slowly regained my confidence.
9. How long did you take to heal from cancer?
Teo: It took approximately eight months from chemotherapy, surgery to radiotherapy with a total of eight therapies. I am currently on medication with eight courses for about six months.
10. Did you opt for reconstructive surgery?
Teo: I did not go for reconstructive surgery as the doctor said that my breast can be preserved thus only the tumour and affected lymph nodes were removed.
11. Do you have advice for breast cancer patients who are about to undergo a mastectomy?
Teo: For patients who are required to undergo a mastectomy or double mastectomy, they need to know that they can opt for breast reconstruction after two years. The doctor suggested that the breast can be preserved, without having a mastectomy or a double mastectomy as breast cancer can recur even after removal of both breasts.
12. Are you cancer-free today?
Teo: I am cancer-free at present, but you need to take care of your lifestyle to avoid the risk of recurrence.
13. What would your advice be for anybody else out there?
Teo: I would strongly suggest that all women to screen their breasts regularly to detect the occurrence of breast cancer. Perform breast self-examination daily, and seek medical attention immediately should you discover any abnormality.
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