[Debbie L.]

Nora, I'm sorry to hear you've been so sick. It would take anyone awhile to bounce back from 8+ days of diarrhea -- try to be patient with your body. I don't think many people have longterm GI effects from chemo, so let's hope that this was a nasty bug, and that it's gone. It can be hard to culture out the bugs, especially once you've begun treatment. And then treatment wipes out both good and bad bugs so it can take awhile to recover the beneficial "flora" (bugs) that help your digestive system function. Some recommend yogurt (with active cultures) to help with this. Your GI doc should be up on best ways to heal your gut.

Radiation after mastectomy. There is not a lot of evidence to go on, and what there is, is by definition -- old (based on older techniques of radiation). There are several studies showing a smallish benefit to survival with radiation after mastectomy for breast cancers with >3 positive nodes. And one more recent (but small) study showed an overall survival benefit (30-50%) for those with fewer (1-3) positive nodes.

Radiation is usually thought of as preventing only local/regional recurrences, so a survival advantage at 5 years, as that second study showed -- is hard to explain. The other bit is that a local recurrence after mastectomy carries a considerably worse prognosis than does one after lumpectomy, so logic tells us that survival would be better with radiation that prevented some of those local recurrences -- but still -- it seems that would typically take longer than 5 years to show up.

A few abstracts, without enough detail (but it's PPV to see the whole thing, maybe someone has access?):

http://cs.astro.org/blogs/astronews/...-survival.aspx

http://www.sciencedirect.com/science...53429609000460

As for reconstruction questions, I think that is an area still under investigation, with much variation between surgeons, in their opinions and preferences about the details. I don't think there are any standards that are accepted as gospel by all plastic surgeons. To add to the confusion, each person's tissue heals (from radiation) differently and and at different speeds. Here's one review study that seemed to prefer autologous tissue (flaps vs. implants) after reconstruction, at least in the abstract:

http://journals.lww.com/plasreconsur...tion__A.9.aspx

It seems like your first step is to give yourself time to recover from the GI stuff. Then when you're feeling stronger, you can tackle the decisions about rads and reconstruction. Gather information and recommendations from both your plastic surgeon and your radiation oncologist, keeping in mind that their recommendations may tend to be somewhat biased in favor of what they have to offer (smile). If possible, get a second opinion in both arenas. Ask for numbers -- specific studies (evidence) that support what each provider recommends. Especially for the plastic surgeon, ask how many of the recommended surgeries this person has performed.

I think it's hard to make decisions about two TOTALLY separate issues that are linked to each other. But it might help to keep them separate in your head, if possible. Your radiation decision should be made based upon cancer and survival concerns, first and foremost -- right? And then the reconstruction decision (although the outcome is affected by the radiation decision) is a separate quality-of-life decision.

As they say, in order to have quality-of-life, you first have to have life. So the first question is how much of a difference doing radiation might make to survival. When you have that information in hand, then only you can decide if the benefit, weighed against the downsides, is enough for you, individually.

Good luck, keep us posted. You'll be in my thoughts and prayers.

Debbie Laxague