Preparing for mastectomy/lymph node removal

My sister has Stage IV bc with mets to the spine. She just finished chemo (six cycles of Taxotere plus A/C) and will be having bilateral mastectomies in the next month or so. (No reconstruction because she'll be having radiation and the doctor says it would "shrivel 'em like raisins."

From what I've read here and elsewhere, it seems that mastectomies aren't too bad in terms of pain and recovery time. But how do they remove the lymph nodes? Can they get at them through the mastectomy incision, or do they need to make another incision in the armpit? Does this procedure add to the pain and/or recovery time? Will she need assistance with day-to-day activities, like getting dressed? If so, for how long? Any first-hand experiences welcome.

Katie Henry (The other Katie)

It's a brand new thing that a doctor here in Michigan made himself.
Can't remember the name of it.

My wife just had bilat mast. Just before she had them she got an IV does of vitamins from a clinic here (alt medicine I think) which greatly contributed to her recovery. I'm not sure the oral supplements are doing much but she got out of the hospital after 3 days instead of
5.

The mast involves cutting away the first layer of muscle on the chest, so I'm curious that the other 2 repliers did not have too much discomfort. The recon involved taking muscle from below the belly button, making a flap, and pulling that flap under the skin to the chest where the other muscle was removed. Other skin and tissue was also used to remake the breast.

Yes, she will need help 24/7 for the first 2 weeks at least. A lot of complications can occur and she will not be able to get up and get to a phone. Lifting her arms will probably be very difficult the first week, and she can't lift anything the first 2 weeks, then nothing over
5 lbs the next 2-3 weeks. This means, a gallon of milk weighs more than 5 lbs (about 8 lbs).

As far as lymph nodes, it appears they went through the incision under the breast (which went all the way towards the armpit) and did not make a new one.

My wife had reconstruction at the same time (ok, just after mast the same day) and had 4 tubes for draining fluids. The top 2 tubes came out after a week, the bottom 2 a week after that. She will need help draining the tubes and changing dressings. The drains are tubes that go into bulbs strapped to the waist. Every 3-4 hours she had to drain the bulbs and measure the liquid that came out.

Be aware, I'm not generally sqeamish and like to watch those surgery and ER shows on tv, but when I saw her cuts it really bothered me emotionally. I love her so much I felt really bad about what she had to go through. But I help her change her dressings and such and the doctor gave us some cream to make the scars go away. It is supposed to work much better than the cream at the store, which is $30us for a small tube.

No, a mastectomy (or bilateral) isn't bad physically. I didn't even require an aspirin thereafter, although there was stiffness for a few weeks. Reaching up into cupboards may require assistance, for instance, but this resolves fairly quickly. -- Breasts are mostly 'fatty tissue' without major nerve endings so it isn't nearly as painful as the imagination might project.

Removal of lymph nodes CAN be (but aren't always) a problem. Removal 'can' add discomfort, but isn't a l ong-term thing with regard to day-to-day activity or getting dressed. It's mostly uncomfortable as there are some nerves cut which will need to heal. -- Even at that, it isn't bad.

Nodes are usually done at the same time as the mast. although it may depend on the surgeon whether there's a separate incision. (There WILL be drains to help the healing process, and she may need help with them, or may not -- I didn't, but some women prefer to have help.)

If your sister has already been diagnosed at Stage IV, I'm wondering WHY the node removal, since it isn't done to enhance patient survival, (nor does it)
but only to 'stage' the cancer itself for medical identification, and that's already been done. Any pathology will be done from the major tumor itself.