Post-Mastectomy Axillary Lump: Is It Fluid or Cancer Recurrence?

A lump in the axilla approximately one and a half years after breast cancer surgery?

Hello Dr.
Tsao, about a year and a half ago, I underwent a total mastectomy due to breast cancer.
During follow-up visits, the doctor drained fluid from my axilla once due to seroma.
Approximately six months ago, during an ultrasound examination, the doctor mentioned that there was still fluid present, but since it did not affect my daily life, no further drainage was performed.
Recently, I have noticed that the lump in my axilla has increased in size.
It appears similar to accessory breast tissue, but when I raise my arm and palpate it, there is a slight hardness.
Occasionally, I feel a foreign sensation in my axilla, and during brisk walking, I experience a burning pain.
Could this condition indicate cancer metastasis, or is it still related to the fluid accumulation?

Alina, 30~39 year old female. Ask Date: 2024/02/05

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, please consult a breast surgeon.
Wishing you good health.

Reply Date: 2024/02/05

More Info

Post-mastectomy axillary lumps can be concerning, especially for patients with a history of breast cancer. Given your history of breast cancer and the recent changes in your axillary area, it is essential to approach this situation with careful consideration and appropriate medical evaluation.

Firstly, the presence of fluid accumulation (seroma) in the axilla after a mastectomy is not uncommon. Seromas can occur as a result of surgical trauma, and they may persist for months or even years. However, the fact that you have noticed a change in the size of the lump, along with the development of hardness and discomfort, raises the possibility of other underlying issues, including the potential for cancer recurrence.

The symptoms you describe—such as the lump feeling hard, the sensation of an "object" in the axilla, and the heat and pain during physical activity—are concerning. While these symptoms could be attributed to a seroma or scar tissue, they could also indicate the presence of lymphadenopathy (enlarged lymph nodes) or even local recurrence of breast cancer.
To differentiate between these possibilities, further diagnostic imaging is warranted. An ultrasound is a good initial step, as it can help assess the characteristics of the lump. If the ultrasound shows solid components or suspicious features, a biopsy may be necessary to determine whether cancer cells are present. In some cases, a CT scan or MRI may be recommended for a more comprehensive evaluation of the axillary region.

It is also important to consider the timing of your follow-up appointments. Regular monitoring is crucial for early detection of any changes that may indicate recurrence. If you have not had a follow-up appointment recently, it would be advisable to schedule one with your oncologist or surgeon as soon as possible. They can perform a physical examination, review your symptoms, and order the necessary imaging studies.

In terms of management, if the lump is determined to be a seroma and is not causing significant discomfort or functional impairment, it may be monitored without intervention. However, if there is evidence of recurrence or if the lump is causing pain or other symptoms, treatment options may include surgical intervention, further imaging, or additional therapies based on the findings.

In summary, while it is possible that the changes in your axillary area are related to fluid accumulation, the new symptoms you are experiencing warrant a thorough evaluation to rule out cancer recurrence. Prompt consultation with your healthcare provider is essential to ensure appropriate management and peace of mind.

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