Anyone have experience with APBI (Partial Breast Irradiation)?

@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.

Your diagnosis is exactly what I had, and I chose to skip everything almost! I decided to radically change my lifestyle, and so far, so good! That was three years ago! I do take Raloxifene for severe osteoporosis, and that does have some breast cancer protective properties.

@maymore—I forgot to mention that I did have a lumpectomy.

@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

@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.

I have post-radiation surgery dehiscence (2 surgeries 1 before radiation and 1 six months ago ..1st surgeon had poor margins and missed some of the DCIS). Six months after surgery I still have drainage. I had two infections which = two trips to the ER and one overnight hospital visit due to the fact that the infection required IV antibiotics. I had no idea how radiation can change the surgery and cause so much complications to the skin. I have two seromas that are draining so slowly. My surgical breast looks completely different and I am considering plastic surgery - but not for another year or two. I am so afraid it will not heal for months and months! I am a dance instructor and university supervisor. I had to put everything on hold - my whole life has changed .Rubyslippers | @triciaot - thank you for sharing your cosmetic history and advise. It might not be important to others however, some of is need to know all of our options.

@reeno - Seromas seem to take forever to collapse. Most of them ususally get smaller, but in my rare situation, I might have to have it drained or surgically removed. I have learned not to wear a tight, compressed bra as it will aggravate the seroma and could cause inflammation triggered by compression, activity, pressure, and/or posture. Wear whatever is comfortable and you could also softly massage the area where the seroma is.
My story is in this feed somewhere. I wish you the best.

@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 So it does seem to be getting better veeeery slooowly. I’m still wearing an ace bandage wrap w/a soft pad against the seroma 24/7. The nerve pain has also improved a lot. When I took compression off for a day, the seroma flared up and surgeon advised me to keep it on until it resolves. Now I’m told there is another small seroma at my breast incision site, but I have no pain there. The radiation oncologist found it but is not concerned and said it should resolve on its own and will not affect radiation. I’m still a bit leery and would like all seromas to be gone before I start radiation (5 day course) but that might not happen. I’m still considering skipping radiation (a viable choice in my particular case) but that would force me to take AI or Tamoxifen for 5 years and I don’t know how my body will react to that. The decision making is exhausting.