Expert: Claes-Gustaf Nordquist, M.D. - 1/7/2011

Question
Dear Dr Nordquist,
I sincerely hope your treatment for prostate cancer is going well as your antigen levels are healthy. I have a painful seroma post BC surgery [wide local excision May 2010]. It has negatively affected daily life eg., I have put on 10 kgs since surgery as I cannot do my usual 1-1.5 hours of vigorous exercise per day - any jiggling of affected breast against even soft bras or T-shirts too painful. I know I can have the seroma aspirated, but I am overly susceptible to infections - I catch anything going around - and I was told seromas often return anyway, and if aspirated regularly, this would increase my risk of infection. Seroma size changes. At the moment seems less intrusive than last month. My problem is I will have to soon have a mammo as part of my breast surveillance regime. I am worried the mammo compression could burst the seroma and if it contains infected cells, spread the infection around my body. I am also concerned because in Australia even for women with extremely tender breasts or even wounds, NO pain relief is offered for mammos.I have access to some Endone, EMLA cream as well as Tramedo, so let me know if you think any of them are sufficient to kill the pain of mammo compression and what quantities. I have no idea why this issue of breast compression pain is not taken seriously by the medical community and mandatory pain control protocols are not in place. I find it barbaric that its not. In Australia every "weekend warrior" sporting club have those pain killer inhalers sporting players suck on when injured. Inhaled opiate of some sort. Immediate and effective pain relief for sports injuries is considered a sacred right, but not for women with painful surgical scars or other breast problems such as seromas needng mammos. It profoundly disturbs me that women's breast pain from mammo compression is so trivialised and ignored. I meet women who will not have mammos because of the severe pain. First, what do you recommend for alleviating breast pain from mammo compression? I know a local anethetic injection works for me, but does it interfere with the mammo itself - or do you have another pain relief combination you think does the job? Second, is there any danger whatsoever of the mammo compression causing my seroma to burst?
Best Wishes for you in 2011.

Answer
Thanks! Yes it seems to have gone well - so far! With regards to your seroma, well I'm not a surgeon so you have to discuss that with a surgeon (here?) as that is outside my area of expertise here. Compression is NECESSARY for technical reasons in mammography. But there is nothing that forbids the use of prophylactic pain killers when doing it. You must however discuss that with your own local doctor since I do not know what is available and under what conditions in Australia - where I have not been since 1982 (Sydney, Melbourne, Brisbane). Good luck!



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