Urgent Surgery advice

Hi everyone. I’m in need of some urgent advice about breast surgery options. I have been given two different opinions by two different surgeons and I need to decide ASAP, which to go with (surgery April 16th).
I’m 36, with grade 2 & grade 1 invasive ductal carcinoma 2-3 lumps in a line at 10 O’clock(in line with underarm), ranging over a 5cm area, no children/Small C cup.
Dr Cindy Mak initially recommended a nipple sparing right mastectomy, with immediate implant and radiation. I was afraid of capsular contracture because I heal poorly/radiation.
She now wants to try removal of the cancer in one large lumpectomy (scar from under arm, along side of breast).
Then a second surgery to perform a LICAP flap reconstruction (I think they take a flap of fat from under the arm to fill the void?). I’ve lost weight over the last few weeks so I don’t have a huge amount of fat. She said I’ll be at least one cup size smaller and my nipple may be off centre. She could try fat transfer to help at a later date.
Dr Elisabeth Rippy suggested that in trying to keep my breast, I may end up with a less desirable shape/aesthetic result. She recommended a full nipple sparing mastectomy (scar hidden under breast fold) with an expander. Then radiation, followed by a second surgery for implant placement and fat transfer.
I was wondering if, given your decision again, you’d try to keep your breast tissue at all costs? And if unhappy with the size and shape, have a breast implant/augmentation at a later date? Is it even possible to have a breast implant after LICAP and breast radiation? Does radiation change the texture of a natural breast so much that an implant is impossible afterwards?
Or because the cancer is so large, is a mastectomy safer?
I’ve read that your initial surgery & shaping is very important in relation to future aesthetic outcomes. I really don’t know how to make a decision this important with so little information.
I would really love any advice (or even other surgeon suggestions in Sydney, for a final opinion). X
Comments
Sorry you are here and have this difficult decision. I cant personally help you with this as i havent been reconstructed. There is a group on here that the admin @Giovanna_BCNA may be able to sort you out with.
One of the other very knowldgeable ladies will probably come on here and give their experiences so hang in there.
Hope you are ok. Its a bit shocking at this point i know and rushed.
My tumour was large and i had a mastectomy but different kind of cancer so I cant advise there either. What i will say is that a mastectomy wasn't as bad as i thought. I didnt react badly to seeing the end result. Will having a lumpectomy allow you to breast feed if you want to have children? Is that a consideration?
Hugs
Michele
I was diagnosed with a 5.5 cm lobular cancer in my left breast.
At the first consult with my ( very experienced) breast cancer surgeon he talked about a choice between lumpectomy and mastectomy but that was when we thought the the cancer was 4.5 cm.
At the second consult he said it was my choice but that it might be he could not get clear margins with a lumpectomy given the extent of the tumour and then I would need a mastectomy anyway.
I am 62 and that may have been a factor but I decided to go the mastectomy route.As it turned out the cancer was more extensive through the breast ( apparently that’s a lobular thing) so the mastectomy was the right choice.
I had a skin sparing mastectomy with insertion of tissue expander ( plastic surgeon operated with breast cancer surgeon) and will have a DIEP flap surgery in the next few months.
its a lot to take in and not an easy decision to make, I asked my surgeon what he recommended and he said “ it’s your choice, I can only give you the pros and cons”.In my case my breasts were E cup so there was the possibility of still having enough breast tissue with a lumpectomy.It would have been a lot easier decision if I was a smaller cup as it would have leant much more towards a mastectomy then.
I got a reduction in my other breast and don’t regret my decision at all.
It might be worth joining the “Choosing Breast Reconstruction group here to see other people’s stories. Hope that helps.
I am in Sydney and my breast cancer surgeon is Dr Davendra Segara my plastic surgeon is Dr James Southwell - Keely.
Both excellent.
I will say that my surgeon recommended lumpectomy, and I went with her recommendation. I ended up with a re-excision as margins weren't clear even after chemo. 5 years down the track, some additional breast shrinkage post radiation and my treated breast is at least 30% smaller than the other. Significant enough that I wear a partial breast form. I'm waiting for some revision surgery that's been delayed by Covid, then other health reasons.
If I'd known all that then, I probably would have pushed harder for a mastectomy. I didn't have to think about it so I still don't know what I'd do about reconstruction
Tbh, I’m surprised Cindy Mak would’ve suggested an implant at the time of mastectomy, knowing you’d need radiation. I’m not a doctor, and even I know radiation damages implants, so it’s very odd that she’d suggest that.
Anyway, good luck with your decision. Just please do more research in the time you have to be sure you’re happy with what you choose ♥️
I should say that I had ILC, which is sneaky, but to my limited knowledge, even with IDC they won't know for sure how big it is until they go in. For me, I ended up with a beautiful lumpectomy only to have a mastectomy a week or so later - but that is lobular. Do I regret the mastectomy? I regret the need to have it but I don't regret the decision to excise any suspect tissue.
I can't answer your questions about future recons and I'm nowhere near expert enough to make judgements about the processes but if you're keeping the breast, aesthetics will be important I would think. And be aware, I doubt you will have much sensation from the nipple (though again, I could be wrong).
Good luck with whichever you choose.
"Types of surgery | Breast Cancer Network Australia" https://www.bcna.org.au/understanding-breast-cancer/treatment/surgery/types-of-surgery/
@skbr
A couple more links for you to read and garner questions from
Within the Reclaim Your Curves website is a pdf " Questions to ask your Surgeon " link I put up earlier
We are all different in diagnosis and treatment and if there are underlying health issues et cetera
You mentioned implant. Check to see if that is a Temporary Expander first and implant weeks or even months later. I was 6 months between.
There's no right or wrong! It is what is best for you
Take care
Wow, our situations sound almost exactly the same! It’s a relief to hear you had a good experience with Dr Rippy - I was worried because I couldn’t find much info/reviews. Did you go via Mater or North Shore Private?
Obviously beating the cancer is my priority, but I think maybe focusing on the aesthetic side is helping me cope/distract from the whole situation.