Recurrence of Breast Cancer : A Management Dilemma

There is always a word of advice on the management of early breast cancer, locally advanced breast cancer as well as metastatic breast cancer. Not much is spoken or written about Locally Recurrent breast cancer.

Recurrence is a unique case scenario where it is not possible to have clear-cut guidelines. Precise and personalized treatment is the need of the hour.

Patient Concern

Mrs. N Sampat (name changed), a 55-year-old postmenopausal lady, diabetic and hypertensive presented with a 3 x 3 cms hard lump in her right breast.

Mammography was done  & confirmed it to be a BIRADS V (malignant) lesion; also another 2 x 2 cms, BIRADS V lesion was also seen. FNAC confirmed it to be ductal carcinoma.

She underwent modified radical mastectomy (removal of the breast and axillary nodes). On her final histopathology report, she had hormone receptor-positive, multicentric Infiltrative ductal carcinoma of the breast with four positive nodes.

As an adjuvant treatment, she received 6 cycles of chemotherapy followed by radiation therapy over four weeks.

She had been taking Tab Letrozole for last 5 years. Now after a disease-free interval of 5 years, at the age of 60 years in April 2020, she noticed a swelling just below the clavicle.

Within three months this swelling rapidly increased to 7 x 7 cm. A pet scan showed it to be an isolated tumour recurrence site.

A core biopsy confirmed it to be hormone receptor-positive recurrent breast cancer. A local MRI was done, which showed involvement of Pectoralis major and Minor muscle, and tumour-causing compression of the axillary vein with 90-degree contact. The axillary artery and brachial plexus were free.

Patient Concern

She was concerned about the inoperable and incurable status labelled to the disease by the local doctors.

Treatment Offered

On the scan, the tumor mass appeared to be operable with adequate margins. Wide excision of this lump was planned.

Wide excision of tumour mass with adequate margins was done and sent for final histopathology.

On histopathology, it was confirmed to be Recurrent Infiltrative ductal carcinoma with positive ER, and PR receptors. The patient is planned for further chemotherapy and hormonal therapy.

Clinical pictures are shown below:

Core Message

It is possible to offer safe and curative treatment for recurrent breast cancer. Recurrence of breast cancer needs a patient-tailored treatment approach.

Also let’s look at another case study, where 30 year old lady who had multiple lumps in her breast & pain for more than 6 months. It was not cancer but treated successfully with surgery.

Let’s Fight Like A Girl!

    Contact the breast cancer treatment center in Mumbai today. Schedule a consultation!





    About Author
    Dr. Jay Rashmi Anam

    Surgical Oncologists

    15+

    Year Of Experience

    MMC- 2006031309 (2006)

    Dr. Jay Anam is one of the best surgical oncologists & breast cancer specialist in Mumbai.

    Dr. Jay Anam has Completed his M.Ch. Surgical Oncology training from Tata Memorial Centre. He did his Fellowship in Breast Oncology from Centre Oscar Lambret, Lille, France.

    As a breast cancer specialist, he believes in world-class cancer care for all patients.

    More About Doctor

    Let’s Fight Like A Girl!

      Contact the breast cancer treatment center in Mumbai today. Schedule a consultation!





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      Facing breast cancer surgery is a brave step, and we know the recovery process may feel overwhelming at times. One aspect of recovery many patients encounter is managing surgical drains.

      While these medical devices play a crucial role in your healing, they can be intimidating at first. But don’t worry. With the right knowledge and tools, you can manage them confidently and focus on feeling better.

      This guide is here to walk patients and caregivers through every step of drain care—from the basics to troubleshooting to emotional support. By the end, you'll feel prepared to tackle this part of your recovery with ease.

      How to Reduce Drainage After Mastectomy?
      Author
      dr-jay-anam-favicon

      Dr. Jay Anam

      Breast Cancer Surgeon and Oncoplasty specialist in Mumbai

      Introduction

      Why are surgical drains important after breast cancer surgery? These small, plastic tubes help remove excess fluids that can build up in your body as you heal. Getting rid of this fluid reduces swelling, prevents complications like infections, and helps your body recover faster.

      We’ll cover everything you need to know, including how to empty and clean your drains, spot signs of infection, manage discomfort, and return to daily life with confidence.

      Understanding Surgical Drains

      To start, it’s helpful to understand what surgical drains are and why they’re used.

      What Are Surgical Drains and Why Are They Necessary?

      After surgery, your body produces fluid as part of its natural healing process. Sometimes, this fluid needs help draining so it won’t pool under the skin. That's where surgical drains come in.

      Types of Drains

      There are a few kinds of surgical drains commonly used:

      • Jackson-Pratt (JP) drain – Often shaped like a small bulb, this popular option collects fluid that you can measure and empty.
      • Hemovac drain – A slightly larger round container, often used for higher drainage needs.

      Your surgeon will determine the best type for you based on your surgery.

      How Long Will They Stay in Place?

      The timeline varies. Most patients have their drains for 7 to 14 days, but it depends on how much fluid they produce. Don’t worry; your doctor will remove them once output slows down.

      Step-by-Step Drain Care Guide

      Drain care is manageable if broken down into steps. Let's cover the essentials.

      How to Empty the Drain Properly

      1. Wash your hands thoroughly with soap before touching the drain.
      2. Unplug the bulb or container, holding it upright.
      3. Carefully pour the fluid into a measuring cup.
      4. Record the amount and time in a log to share with your doctor.
      5. Squeeze the bulb to reset the suction before plugging it back in.

      💡 Tip: Empty the drains 2-3 times a day, or whenever they’re about half full.

      Cleaning & Infection Prevention

      • Gently clean around the drain site with soap and water or antibacterial wipes. Avoid tugging or rubbing the area.
      • Watch for signs of infection, such as:
        • Redness or swelling around the site
        • Fever above 100.4°F
        • Foul odor or colored drainage

      If you notice these, call your doctor.

      Best Sleeping Positions

      Finding a comfortable position can be tricky. Try:

      • Sleeping on your back with pillows under your arms for support.
      • If you’re a side sleeper, place a small cushion around the drains for padding and avoid putting pressure on them.

      💡 Tip: A drain-friendly post-surgery pillow with built-in pockets can make rest easier.

      Showering & Hygiene Tips

      Ask your surgeon if showers are allowed. If so:

      • Cover your drains with a waterproof dressing or use a surgical drain belt.
      • Limit water exposure to avoid infections.

      If showering isn’t an option, stick to sponge baths until your doctor gives the green light.

      Recognizing and Managing Complications

      Sometimes, issues arise. Here’s what to keep an eye on:

      When to Call Your Doctor

      • Drainage suddenly increases or stops altogether
      • Severe pain or swelling
      • Fever or signs of infection

      Dealing with a Clogged Drain

      A frequent issue is a clogged drain. If you notice reduced suction:

      1. Milk the tube by gently squeezing it to dislodge the blockage.
      2. If this doesn’t help, notify your healthcare provider promptly.

      Signs of Seroma (Fluid Buildup)

      Once drains are removed, some patients develop a seroma. Symptoms include swelling, tenderness, or a feeling of liquid under the skin. While many seromas go away on their own, consult your doctor for advice.

      Pain & Discomfort Management

      • Pain is part of recovery, but you don’t have to suffer unnecessarily.

        Medication vs. Non-Drug Relief

        • Use prescribed painkillers as directed.
        • Non-medical options, like a cold compress or heating pad (with your doctor’s approval), can help with aches and stiffness.

        Gentle Exercises

        Simple arm stretches or shoulder rolls can prevent tightness, but avoid anything strenuous. A physical therapist can provide guidance.

        Relaxation Techniques

        Practice deep breathing or try mindfulness exercises to cope with discomfort.

      Diet & Nutrition for Faster Healing

      Fueling your body helps tissues heal faster. Focus on:

      • Protein-rich foods, like lean meats, tofu, beans, and eggs.
      • Anti-inflammatory options, like berries, leafy greens, and nuts.
      • Drink plenty of water every day.
      • Consider supplements, like zinc or vitamin C, but check with your doctor first.

      Physical Activity & Movement Guidelines

      Movement helps, but balance is key:

      • Begin with light stretches or short walks to prevent stiffness.
      • Avoid lifting anything heavier than a few pounds in the first week.
      • Your doctor will guide you on when you can resume driving or house chores.

      💡 Tip: Use a supportive bra to minimize any strain during recovery.

      Emotional & Psychological Support

      Caring for drains can feel isolating. It’s okay to have mixed emotions.

      Coping with Anxiety

      Deep breathing, journaling, or talking to a friend can help manage stress.

      Find Support Groups

      Connect with others who’ve been in your shoes. Online breast cancer recovery forums or local groups can make you feel less alone.

      Mental Health Resources

      Don’t hesitate to reach out to a counselor or therapist to process emotions during your recovery.

      Emotional & Psychological Support

      Caring for drains can feel isolating. It’s okay to have mixed emotions.

      Coping with Anxiety

      Deep breathing, journaling, or talking to a friend can help manage stress.

      Find Support Groups

      Connect with others who’ve been in your shoes. Online breast cancer recovery forums or local groups can make you feel less alone.

      Mental Health Resources

      Don’t hesitate to reach out to a counselor or therapist to process emotions during your recovery.