Breast removal after lumpectomy & radiation

[mts]

After my lumpectomy and radiation, my breast diminished in size compared to the "good" breast. I know this is vanity speaking, but I was wondering if anyone has had a lumpectomy and rads and then pursued mastectomy on the affected breast as well as a prophylactic mastectomy on their good breast... I would have reconstructive surgery to follow. I finished rads in June 2005.
I have visited many sites that talk about the pros and cons of reconstruction, yet nothing with conclusiveness.
I am hoping that the experiences of the many women on this board could help me figure out my next move.

maria

I feel I must declare that I am a man and not a sufferer. I had previously some saved material on breast conservation BCT v masectomy which I attach below. (rewrite I had just finished and lost my reply).

I have also today done some research on the risks of masectomy surgery and reconstrution surgery and options which I attach below.

This would be my view point based on a quick assessment of the links below. I am not an expert in any sense. Ultimately as you are no doubt very well aware it is your life and they are your breasts.



1. If there is a family history there is a higher risk of contrallateral reoccurence. It is suggested that this does not necessarily impact on long term survival. The risks are covered below in the links.

2. The trials posted suggest that there is little difference in overall survival between BCT and masectomy, which if correct removes an argument for any future treatment gain out weighing the risks.

3. The masectomy surgery for one and a half breasts is not minimal.

4. There appear to be very significant potential side effects of a masectomy if things do not work perfectly - long term nerve pain etc. (see posts on "Cancer Lynx" sites which make salutory reading).

5. In a masectomy there are the issues of loss of ability to breast feed - loss of sensations - complications of nipple retention etc, which must have a big impact from a mental standpoint, sensation being part of the nuturing process both from the point of view of child rearing and sex (breast attention without a any sense of possible pleasure - mental response?).

6. There appear to be some serious risks in the tram flap / adominal / muscle surgery etc. I was taken aback by the figures and scope of risks. Some procedures appear fairly new which would be a concern if it was me - what are the long term implications for muscular skeleture - strength - posture.

7. Double implants even ignoring the nipple complications would seem to carry their own risks, in addition to significant general surgery and specific masectomy risks. Saline do not from what I have read does not provide a perfect solution, and the risks even if low from silicone to presumably a recovering immune system must be considered, both from reaction to the implant and the unlikey possibility of leakage.

8. The surgery is not minor. If you are still recovering possible chemo herceptin etc the possibility of a less than 100 % immune system recovery and the additional strain of the body of recovery / possibility of implant rejection etc. must surely be considered.

9. It has been postulated on this site that the operations involved in masectomies / BCT might by virtue of exciting the bodies infamatory repair response cause increase of levels of Cox 2 wich several trials have suggested is implicated in both local and distant BC.

10, If it were me I would want reassurance that the options of imaging spect/ct/pet MRI etc are not compromised.

11. What ever you have - nothing to full bilateral masectomy and reconstruction the result is not going to be perfect and has long term consequences as to different changes over time in each breast, or both depending on the options chosen.


My perspective would be based on the links below that unless there were pressing arguments on grounds of familly risk, the potential risks and complications of a masectomy and reconstruction are simply not tenable, the outcome uncertain, the result imperfect, with loss of potential ability to breast feed, sensation, self image etc. The option of a small saline implant in one breast if it is absolutely necessary is the logical preferred option (whichever of silicone or saline provides the best match a present the situation will change and will the match be perfect in either option?) ( possible caution- I saw a documentary where a girl had an immune reaction - I have no idea how common they are or why it happened - and had to have the implants removed which it seems to me would be potential bad news for a recovering immune system.).

At the end of the day with an appropriate bra who except you and you partner are going to know, and you could always reassess once you have a bit more distance from your treatment
- and so back to where we started its your life and their your breasts.

A "bloke's" perspective if that helps.

I would stress I have no expertise and you must read it all for yourself.

I hope everything works out for you, and this external contribution helps your consideration of your decision which is very obviously of some significant concern to you.

RB



Reconstruction options risks side effects outcomes etc.

http://www.cancer.org/docroot/CRI/co...stectomy_5.asp

http://www.mayoclinic.com/health/mastectomy/WO00113

http://www.cancerhelp.org.uk/help/default.asp?page=3351

http://www.nlm.nih.gov/medlineplus/e...cle/002919.htm

http://hcd2.bupa.co.uk/fact_sheets/html/mastectomy.html



BCT v reconstruction


http://www.obgynsurvey.com/pt/re/obgynsurv/abstract.00006254-200405000-00018.htm;jsessionid=CyQ9S3EUeLIZc5krsUWHxdxSglhpH 0TTO5Pn6n0JmR31NGoico9Q!1988335901!-949856145!9001!-1

http://content.nejm.org/cgi/content/...ct/347/16/1233

http://www.jco.org/cgi/content/abstract/16/6/2045

http://www.breastcancer.org/research_surgery_young.html

http://www.thedoctorslounge.net/onco...ditary_breast/

http://www.obgynsurvey.com/pt/re/obgynsurv/abstract.00006254-200405000-00018.htm;jsessionid=CyQ9S3EUeLIZc5krsUWHxdxSglhpH 0TTO5Pn6n0JmR31NGoico9Q!1988335901!-949856145!9001!-1

[Michelle]

Maria,

Is there any reason why you are not considering reduction and lift? I ask only because I'am also considering reconstruction of some kind too. I have to ask why so many of us feel guilt over having some vanity now. Heck , people go in everyday with perfectly healthy breast, and have reconstruction. I think it's wonderful they can do the same for us.
Michelle

Here is a recent news post on the risk of contralateral BC where family risk factors. It deals with contralateral occurence but not survival.

Nothing wrong with vanity "looking after yourself" dental work, reconstructive surgery etc. It carries risks. It has wider social and cultural implications.

The suggestion above would resolve the long term symmetry issue depending on personal circumstance and proportions.

My point was risk overall risk assessement v cosmetic improvement and timing and the impact on somebody if still in the "recovery stage".

RB


http://www.medpagetoday.com/Hematolo...Cancer/tb/2660

[Maggie]

I had quite a large lumpectomy with chemo and rads. After my surgery, I went to a speciality bra shop and was fitted with a partial breast form. You place it wherever you need it in your bra. When I had healed enough to wear it, it worked out just fine.
From rads, my breast became swollen and to this day it still is and I finished rads 12/23/04.. I now wear the form in the other (good) side of my bra, to make it them equal and it's working fine!!!!
For me, this is not a problem at all. In fact, it's so simple and easy.
I look quite good, too!

Maggie

[mts]

Michelle-
Its just that having dense breast tissue worries me. My 1st lumpectomy was based off mammo and ultrasound. I had a breast MRI AFTER my lumpectomy and more cancer was found adjacent to the lumpectomy site...leading to another lumpectomy! Both lumpectomies showed clean margins. I was also checked for the BRCA gene and I am not a "carrier".
Anyway, my thoughts regarding removing them altogether stems from the fact that I have dense breast tissue and the breast MR is the only modality that works for me. I feel that any scar tissue from a lift would mimic cancer on a MRI... With all ther other caca going on, I want one less thing to worry about. In this case two less things...

I know this boils down to personal choice -it's just so difficult trying to figure out what choice is the right one. Ya' know what I mean?
maria

[Ginagce]

Dear Mts,

I was diagnosed with bilateral LCIS and DCIS in left breast in 1997. I had lumpectomies and radiation on left breast. After that my left breast was misshapen and smaller than right. At the time I was so happy that they had found cancer early I didn't care much about breast shape.

In 2004, I was diagnosed with tumor in right breast, no node involvement. My oncologists recommended a lumpectomy and radiation to right breast. Nothing showed up in my left breast at that time.

I tossed and turned and did a lot of research and finally came to the conclusion that against recommendation, I wanted bilateral mastectomies with same day DIEP reconstruction. My oncologisy team thought that I was going overboard with the bilats and that I would be just fine with lump/rads.

But I too had dense breasts and every time I went for a mammogram, there seemed to be some question about what was seen. Additional tests were often required and it was all very unsettling.

It was a difficult decision to make, and one of the factors was that I knew I was giving up the protection of mammograms. Ultimatley, I decided I didn't want to be doing this dance for the rest of my life and I wanted to just be rid of them. But for me, having breast was important too so I researched reconstruction methods. Ultimately I decided that the DIEP method was for me.

DIEP is like tranflap but no stomach muscle is used at all. it is done by using microsurgery to reattach blood vessels in breast versus tunneling tissue along with muscle through body.

For me it was the best decision I could have made. When they did the mastectomies, I requested biopsy of the "unaffected breast" and my surgeon also did a sentinel node biopsy.

Well it turned out that not only did I have a small tumor in my left breast, it was very aggressive and had spread to my lymph nodes on that side.

The reconstruction went fine but it did take me a while to heal as I started chemo about 8 weeks after surgery. Obviously the chemo was a surprise to all and I would not have had reconstruction at the time had I known.

I live in Philadelphia and went to Baltimore for my DIEP surgery as I found a Plastic Surgeon there who had substantial experience in this type of surgery....something noone in Philadelphia had.

A year later I am happy with my decision. Yes, I need additional surgery to refine my breasts but I will have that when and if I decide that it is not too dangerous.

I know how hard this decision is. In fact, for me, making the decision to have the bilaterals was harder than having them.

I am glad I did what I did and at peace with my decision. Obviously I am deeply thankful that I made the decision I did or we would not have found the left breast tumor when we did.

So, I can only say that sometimes we have to do our research, make the tough decisions, and then just pray that we have chosen well and move on with our decision.

My wish for you is that whatever you decide to do, you are at peace with it.

Prayers for you on your path.

Ginagce

[lu ann]

look at my reply to mastectomy vs. lumpectomy, feb. 16, 2006. lu ann.