[Lani]

If you don't do the therapy before the surgery you will lose the opportunity to find out if the treatment is effective (by seeing the tumor shrink) and be left to wait and wait to see if you break a bone, get short of breath or get liver involvement because that treatment was not effective, by which time changing to another more effective therapy may be too late to do much but gain you some months. Treatments are most effective when given when there is not a lot of bulk of disease and before the cancer has spread widely to other organs. It might be helpful find out if your bone marrow is clear, but this is usually only possible in Germany or with some clinical trials like I-Spy.

In addition her2+ tumors are usually quite angiogenic and there is at least a theoretical argument to do a smaller than a lesser surgery to minimize chances of spread/recurrence.

I am not advising you go one way or the other, just to get as many options as you need and read as much as you can to help decide between the options with your eyes wide open

Best of luck with your decision

Lani