Anyone have experience with APBI (Partial Breast Irradiation)?

@ritalu First surgery in 2022, smaller seroma internal left breast, radiation to LOQ right breast only. Second surgery 2 years later on right breast. Two seromas along suture line - that skin was in the radiated area. It’s been 15 months since that surgery. There are no breaks in the skin.
The surgeon never said to put compression on it, but I did go to PT for a while. She suggested this really interesting bumpy silicone pad that can be put in the bra. I bought it from Amazon, Amoena Lymph Flow Silicone Pressure Pad - Compression Pad. The bumpy side is intended to break up the fluid, help it flow - at that time I did not know what I had was a seroma. PT was prescribed to soften the sutures and reduce chance of developing ridged lines. She also suggested Roylan mini massager, it has a nice small surface and light vibration to press along breast area. Not very expensive, also available on Amazon.
@susanmfc The decisions are difficult especially because the true outcome is pretty unknown. I’m on tamoxifen, have mixed feelings about it, but not many issues with the 5 mg.

@triciaot How long have you been waiting? If the surgical area hasn't opened, you should be ok. Did you have radiation before or after surgery?

@susanmfc Yes, this process means learning a whole new vocabulary! Seroma, what!?
I am able to view the full mammograms and MRIs and first noticed a round “something” kind of in the middle of the breast on the left non-cancer side that they surgically matched to right. Seems that when the various tissue was cut and brought together a pocket formed. It’s still there - hope is that it won’t harden.

I’m not sure what they’ll recommend for the large seroma, and smaller one on the right. So far it doesn't seem to have absorbed any. From yours and others comments, draining isn’t necessarily a permanent fix.
The surgeon and radiologist had said they prefer not to stick a needle in it because of chance of infection. So it’s a waiting game.

@susanmfc Yes, this process means learning a whole new vocabulary! Seroma, what!?
I am able to view the full mammograms and MRIs and first noticed a round “something” kind of in the middle of the breast on the left non-cancer side that they surgically matched to right. Seems that when the various tissue was cut and brought together a pocket formed. It’s still there - hope is that it won’t harden.

I’m not sure what they’ll recommend for the large seroma, and smaller one on the right. So far it doesn't seem to have absorbed any. From yours and others comments, draining isn’t necessarily a permanent fix.
The surgeon and radiologist had said they prefer not to stick a needle in it because of chance of infection. So it’s a waiting game.

@triciaot It’s amazing to read about different procedures and protocols relative to breast cancer surgery. None of us really knows what all to ask until particular issues arise, which is after the fact.
Case in point, I developed an axillary (armpit) seroma that has given me more issues than any other part of my surgery. It’s been drained once and is taking its own sweet time resolving while I ponder my next treatment steps.

I’m 4 1/2 weeks post op lumpectomy with sentinel node biopsy. Surgery went great; negative margins and nodes clear. I’m one of the very lucky ones who caught ER/PR+ HER2- cancer early at 6 mm and had a 0 oncogene score. So I have much easier decisions to make than most who are dealing with a cancer diagnosis. But radiation and hormone therapy do require thoughtful consideration and I’m trying to learn as much as I can to make the best decisions and yield the best outcomes for me personally.

Thank you for taking the time to explain what you’ve been through. Always something to learn in each person’s experience. Interesting that you also have had to deal with seroma issues. It was a term I didn’t even read about until I got one. Take care and thanks again for responding.

@reeno I had a 16 mm cancer in my left breast - had lumpectomy and 6 weeks later 5 days of partial breast radiation. My radiation oncologist assured me that they would be able to avoid my heart and lungs. Went well with skin issues. At my 6 month diagnostic mammogram a good sized seroma was seen. My surgeon recommends waiting and re checking in another 6 months. I agreed to that plan. Has anyone else developed a seroma post lumpectomy/radiation? It is intermittently sore/achy/burny.

@susanmfc

@triciaot It’s amazing to read about different procedures and protocols relative to breast cancer surgery. None of us really knows what all to ask until particular issues arise, which is after the fact.
Case in point, I developed an axillary (armpit) seroma that has given me more issues than any other part of my surgery. It’s been drained once and is taking its own sweet time resolving while I ponder my next treatment steps.

I’m 4 1/2 weeks post op lumpectomy with sentinel node biopsy. Surgery went great; negative margins and nodes clear. I’m one of the very lucky ones who caught ER/PR+ HER2- cancer early at 6 mm and had a 0 oncogene score. So I have much easier decisions to make than most who are dealing with a cancer diagnosis. But radiation and hormone therapy do require thoughtful consideration and I’m trying to learn as much as I can to make the best decisions and yield the best outcomes for me personally.

Thank you for taking the time to explain what you’ve been through. Always something to learn in each person’s experience. Interesting that you also have had to deal with seroma issues. It was a term I didn’t even read about until I got one. Take care and thanks again for responding.

@susanmfc
I did have a second surgery that was cosmetic only.
Before the first surgery, I met with the plastic surgeon and he said I had 3 options. Lumpectomy, mastectomy, or lumpectomy with tissue rearrangement to fill the space, which would essentially be a breast lift, and surgery on the other breast to match. Lesion was in LOQ which may have been the reason it was a “lift”.
At the cancer center I was at, plastic surgery was just part of the lumpectomy. The oncology surgeon cuts out the lesion then the plastic surgeon steps in and closes.

I chose to do both breasts, At the time I did not know how much radiation would be recommended, I had a general understanding, but pathology after surgery often drives that decision.
When I met with the radiologist after surgery I brought with me the research from an Italian study showing 5 days may be enough. Protocols at that time were still for multiple weeks of radiation. She said 5 days would be appropriate for me, so I had partial breast radiation, great!! But the plastic surgeon had expected me to have whole breast radiation for extended weeks - and made that breast larger. I can’t fault him really, as it was the expected length of treatment in early 2022.
The radiated breast never shrunk (expected 15-20%), and was 148 cm3 larger. The surgeon said the difference in size fell within the size difference they thought was acceptable, but he was willing to reduce the size. Two years later I had it reduced.

In this forum, with so many women dealing with much bigger issues, life threatening decisions, I feel uncomfortable that I put so much interest on cosmetics. But reducing the size did bring the nipples into alignment and I no longer need an insert on one side.

The takeaway, if it will help anyone else, is have a VERY detailed discussion prior to surgery about what ifs! I thought I had covered everything, and asked a ton of questions. But I didn’t think that I needed to consider length of radiation treatment as part of the surgery plan.

The other takeaway is that the radiated skin is not as pliable. The first surgery pre-radiation the shape and feel of the breast was softer. After radiation I thought my breast skin still felt fine - but it was different with the new sutures and rearrangement of tissue. It is still going through a softening, but the suture line is “tighter” (hard to explain) it kind of reminds me of sewing leather. So a discussion on “how might results be different” in terms of tissue quality and esthetics might be helpful if having multiple surgeries - and trying to make decisions.
I am satisfied with my results; I did go to PT to work on softening the suture line; and my next scan will be an MRI to view the 7 cm seroma that I have along the suture line, probably a result of the thickened skin (the location means part of it not visible on a mammogram).

I apologize this is so long - difficult to explain in a few words.