Decision - Breast conserving lumpectomy OR Mastectomy with Immediate DIEP. Any words of wisdom?

Mij

Hello,
I have just finished chemo which has made 2 tumours undetectable on follow up mammogram and ultrasound - YEAH and the third has reduced by a third. Cancer is only in right breast. I am trying to decide between a lumpectomy reduction ( I'd go from DD to small C)with the left made to match or mastectomy with immediate DIEP reconstruction (I have enough to keep my DD as only need one). Would then require radiation. Just wondering if anyone had the same decision and their pro and cons list. I've read so much and just want to be me at the end of this, but have a small fear of what if the cancer comes back?

Sister

Hi @mij I think in the end, it is up to you (based on medical advice) to decide what you can live with.  I started with a lumpectomy but then, based on the path results, had to have a mastectomy followed by chemo and radiation.  My surgeon said at the time that the only recon he would consider for me was a DIEP but not until after rads as it affects the skin.  At my last appointment, 8 months after rads, my skin was still too tight.  (However, I don't know if I will ever want to go down the recon path.)  So, a question to ask your doctor - how will rads affect the recon if it's done straight away?  Another thing to remember is that this particular surgery can only be done once so you may want to discuss the stats around a possible recurrence in the other breast or how anxious you may be down the track about that possibility.  What happens if you decide to go with mastectomy but wait for recon?  Or lumpectomy but wait for size correction (you can get partial prostheses)?  Or would you prefer to be a smaller cup size anyway?  Can you get a second opinion?

I'm not sure I've given you any useful answer - maybe one of the other ladies here with experience of recon can help more.

Mij

Hi Sister, thank you for the extra questions to consider. I've been told radiation can cause skin tightness and possible changes in the fat in the recon. And you are right - it can only be done once and recurrence needs to be considered. BS has said statistically I'm at the same risk of recurrence as anyone who has never presented with breast cancer (I will triple check this at my next appointment). Until this (lovely) journey started I never considered changing my breast size or any part of my body. Not that I've always been confident about my body, its just that this is me. I think that maybe why going smaller (and seeing more tummy even though it hasn't changed) is playing on my mind. I've noticed on a few posts lumpectomy can lead to revisions or mastectomy. follow up mammogram and ultrasound aren't showing lymph involvement but I assume only the node test will confirm that. I will keep working on my pro and con lists for both options.

Anne65

@Mij That is a decision I faced early on & it is HARD! Do you play the odds, what are the statistics &percentages of getting a recurrence. It totally does your head in! I ended up taking the advice of my surgeon which was a lumpectomy. I had DCIS, stage 1 but aggressive. As I am small breasted, she decided that during the surgery, she was going to take tissue from below my breast to fill in my "gap" & then both would look the same & she did an amazing job. Talking to her before surgery gave me confidence that a lumpectomy was the right choice for me as a mastectomy was too massive. Like chopping off your leg when you have a sore toe!! I came out with clear margins & then it was my decision on whether to even have rad or not as the surgery was such a success. I decided to have rad only because my DCIS was aggressive. One thing as mentioned above by @Sister , is that you need to consider rad treatment in conjunction with mastectomy/recon. My rad onc didnt want to start rad treatment on me before i had my BRCA gene test done. If my gene test came back positive & then I decided I may want to have a mastectomy followed by recon, then rad treatment would make the recon very difficult as it effects the skin so much & certain recon doesn't work after rad. I was lucky as my test came back negative so my rad treatment went on as planned. If you have a family history of breast cancer then you may be eligible for the gene test so that may be something you want to consider doing first.
Some procedures need to be done in the correct order & i'm glad I found that out when I did. At the end, you do have to weigh up everything that your medical team says but the decision is yours & it is difficult. i decided to just deal with what I knew & not what may happen in the future but everyone is different. Good luck & let us know what you decide. Love & strength. xx

dodg113

HI ,I am 50 and have just been diagnosed with a 2nd breast cancer.

My first was high grade DCIS 5yrs ago and treated with lumpectomy and radiation.

I now have Grade 1 invasive but small growing cancer, oestrogen,prog + HEr2 Neg in opposite breast.

Needless to say I am completely devastated .Radiotherapy is not an option this time as I had a severe reaction to radio last time and am left with chronic pain in breast and chest wall which is being managed by a pain specialist .

My Breast surgeon feels that lumpectomy and tamoxifen should be OK but I definitely want to try and reduce my risk of this happen a 3rd time!

Am still waiting for gene testing .

I am pretty much happy to have a skin,nipple sparing mastectomy with implant for new cancer.

As I had radiotherapy cant have the same on previous breast, would need a DIEP flap and implant.

As my chronic pain is an ongoing issue and also have chronic pelvic pain, surgeons are keen to be as minimally invasive as possible, however agree that mastectomy on new side is fine but feel that should leave side that had radio alone and hope that wont get another cancer in that one. I am torn between wanting to reduce my risk of another cancer as much as I can and having to have major surgery with risk of ongoing pain Would really help talking to others who have been down this path before as feeling v scared and lonely

Sally_AS

Hello there, I’m following posts on surgery too. I have been recently diagnosed (with TNBC) and am currently undergoing chemo.  Chemo is reducing size of lump (yay) and my Breast Surgeon has advised lumpectomy & lymph node clearance followed by radiation.  

However, I’m awaiting results of genetic testing and research is showing I’m at high risk for reoccurrence or to other breast / ovaries if I am BRCA positive. So, if that’s the case, I’ve already decided that I’ll go double mastectomy (& ovaries). 

dodg113

HI sally
yes i agree if gene testing + will def go with dble mastectomy +ovaries..I have had kids and am menopausal so losing ovaries not such a big deal for me - already having hot flushes..in a way having + gene will be a relief and explanation why have got 2nd breast ca but downside is ripple effect on family and esp my kids w 1 in 2 chance of inheriting..I have no family history so drs are wondering if i am a spontaneous mutation - guess has to start with someone!!
Hope yr chemo goes Ok,i have dodged that one fortunately take care