Post-Surgery Concerns: Pain and Hardness After Mastectomy

Post-operative care after breast cancer surgery?

Hello, my mother was diagnosed with stage II malignant breast cancer on September 23.
We quickly performed a total mastectomy on September 30.
Since then, she has been experiencing frequent pain in the surgical area, even radiating to her arm.
Now, as of December 31, it has been three months, and the area around her incision is completely hardened, and there is a large, hard lump that is getting bigger.
We consulted with her doctor, who said this is normal, but we are really anxious.
We can also feel a round, hard mass in her armpit.
What should we do? Are we being overly concerned, or is this phenomenon abnormal? Thank you for your response.

Ms. Chen, 30~39 year old female. Ask Date: 2015/12/31

Dr. Li Zhonghuai reply Surgery

Hello! First, it's important to know what type of surgery your mother had.
Stage IIA includes T1N1 and T2N0, while IIB includes T2N1 and T3N0.
What is her staging? Did she undergo a sentinel lymph node biopsy or an axillary lymph node dissection during her total mastectomy? Generally, for patients with smaller breasts, a total mastectomy can result in tighter skin flaps, and post-surgery, local blood flow and lymphatic drainage may be impaired, which can make the area feel firm initially.
Over time, it should gradually soften.
Regarding the hard lump you mentioned, first confirm whether you are feeling the rib.
As for the round, hard object in the axilla, please check if a sentinel lymph node biopsy or axillary lymph node dissection was performed, and then discuss it with the physician.
Worrying unnecessarily will only increase your mother's anxiety.
Wishing her a speedy recovery! Changhua Hospital cares about you!

Reply Date: 2015/12/31

More Info

Post-surgery concerns, especially after a significant procedure like a mastectomy, can be quite distressing for both the patient and their family. Your mother's experience of pain and hardness around the surgical site, as well as the presence of a lump, is not uncommon, but it does warrant careful consideration and monitoring.

After a mastectomy, it is typical for patients to experience pain and discomfort as part of the healing process. The surgical procedure involves not only the removal of breast tissue but also the disruption of surrounding tissues, nerves, and lymphatic systems. This can lead to a variety of sensations, including pain, tightness, and hardness in the area. The hardness you describe around the incision site may be due to scar tissue formation, which is a normal part of the healing process. Scar tissue can feel firmer than the surrounding tissue and may take time to soften.

However, the presence of a lump, especially one that is increasing in size, should be taken seriously. While it is possible that this lump is a benign condition such as a seroma (a pocket of fluid that can develop after surgery) or a hematoma (a collection of blood outside of blood vessels), it is essential to rule out any complications, including the possibility of recurrence of cancer or other issues related to the surgery.

Here are some steps you can take to address your concerns:
1. Follow-Up with the Surgeon: It is crucial to maintain open communication with your mother's surgical team. If you have concerns about the lump or the pain, request a follow-up appointment. The surgeon may recommend imaging studies, such as an ultrasound or mammogram, to evaluate the lump further.

2. Physical Therapy: Sometimes, physical therapy can help alleviate pain and improve mobility in the affected area. A physical therapist can provide exercises that promote healing and reduce discomfort.

3. Pain Management: If your mother is experiencing significant pain, discuss pain management options with her healthcare provider. This may include medications, physical therapy, or alternative therapies such as acupuncture or massage.

4. Monitor Symptoms: Keep a close eye on any changes in the lump's size, shape, or consistency, as well as any new symptoms that may arise. Documenting these changes can provide valuable information for her healthcare team.

5. Seek a Second Opinion: If you feel that your concerns are not being adequately addressed, it is perfectly acceptable to seek a second opinion from another oncologist or surgeon. This can provide peace of mind and additional insights into her condition.

6. Support Groups: Consider connecting with support groups for breast cancer survivors. These groups can provide emotional support and practical advice from others who have gone through similar experiences.

In conclusion, while some post-operative pain and hardness are expected after a mastectomy, the presence of a growing lump should be evaluated further. It is essential to advocate for your mother's health and ensure that her concerns are taken seriously. Open communication with her healthcare providers and proactive monitoring of her symptoms will be key in managing her recovery and addressing any potential complications.

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