Forum Discussion

Skbr's avatar
Skbr
Member
5 years ago

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

breast-reconstruction
lumpectomy
new-diagnosis
surgery
young-women
  • FLClover's avatar
    FLClover
    Member
    5 years ago
    Hello @Skbr 🙂
    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. 
    I don’t think I’d try to save my breast tissue at any cost. It would depend on a number of factors: tumour size and grade, breast size, importance of aesthetic outcome to you etc. I chose to have a nipple/skin sparing mastectomy because I had multifocal and simultaneous bc, so there was a lot of activity going on in there. I thought just take it all away to ease my worry. But there was the possibility of needing radiation, so I had tissue expanders inserted. They are great for radiation. So Dr Rippy’s suggestion sounds better for me. After radiation, if you take a break of about 6 months, that should give your skin enough time to heal so that putting implants in would be more successful. Radiation does change the skin and shrinks it, but implants are still successful in lots of ladies, especially with a fat transfer. 
    Of course you could try and save your natural breasts with a mammoplasty, then you could still have radiation. Def an option I think. 
    In regards to surgeons, I’d strongly recommend Eva Nagy. She’s very well trained in all these procedures, especially breast conserving surgery (mammoplasty). I know a few ladies who are very happy with her work, myself included. She’s a bright spark in the bc world. She also works with Dr James Southwell Keely for DIEP procedures. You pretty much can’t go wrong with her. Feel free to PM for more info if you’d like.
    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 ♥️
  • lrb_03's avatar
    lrb_03
    Member
    5 years ago
    Such a personal decision
    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 

  • Julez1958's avatar
    Julez1958
    Member
    5 years ago
    Sorry I didn’t read you post fully/ properly.
    I am in Sydney  and my breast cancer surgeon is Dr Davendra  Segara  my plastic surgeon is Dr James Southwell - Keely.
    Both excellent.
  • Julez1958's avatar
    Julez1958
    Member
    5 years ago
    Hi sorry you have to be here.
    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.



  • MicheleR's avatar
    MicheleR
    Member
    5 years ago
    Hi @Skbr,

    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