Hi @RR - it's so difficult when you're getting mixed messages!
I agree with @kezmusc that your surgeon is recommending whatever is best for your situation. I was exactly where you are now, just a few months ago. I was never recommended to have neo adjuvant (pre-surgery) treatment even though I chose to delay my surgery by a few weeks. My cancer was lobular, very slow growing and very hard to detect - I probably had it for over a year without realising it.
There was no way of knowing exactly what kind of treatment I would need until the breast tissue had been removed and we had the pathology results back. From the biopsy, they knew that my cancer was ER & PR + and HER 2 -ve and that information didn't change, but all the scans suggested that there was no node involvement and it was only during surgery that two sentinal nodes on my left side came back positive for cancer. That meant that I had a full axillary node clearance on the left, during the mastectomy. If I would not have had any node involvement, I probably wouldn't have to have chemo.
In addition, the tumours in both breasts were much larger than anticipated prior to surgery. So in my case, everything they learned during surgery and from the pathology after my double mastectomy, has informed the treatment that's been recommended to me.
What really helped me in the decision stage was to get information through consultations with other doctors. The decision I had to make wasn't the same as yours ie whether or not to have chemo first or surgery first - I had to make decisions about reconstruction options ie whether to go for immediate reconstruction or expanders first. Like you with the chemo uncertainty, I had radiation uncertainty, so before I made my final decision I booked in for a consultation with the Radiation Oncologist. She was absolutely amazing. She explained all about radiation, how it's done, what the side effects are, how it impacts on different kinds of reconstruction, and most importantly, what the indications were at that stage, as to whether or not I would need radiation. Even though radiation is far down the line for me, she was invaluable in helping me make the decisions that I needed to make right then and there, at the time of surgery.
Is there a possibility of asking your surgeon to refer you to a medical oncologist to get this kind of information? He/She would be able to explain the difference between neo adjuvant and adjuvant treatment and the pros and cons of each, directly related to your diagnosis. In my case, my pre-surgery radiation consult gave me the affirmation that what my breast surgeon and plastic surgeon were recommending to me were absolutely spot on and I went into surgery confident that I was doing everything that was 100% right for my situation. It gave me enormous piece of mind and comfort.
Sending you lots of hugs! xxx
