Mastectomy and radiation which order?

Hi, I don't know if I can help or not. I had lumpectomy, chemo, rads. I actually had a recurrence and that's when I had my mastectomy. Is your surgeon going to take more nodes due to the positive node?  I actually had a positive node but the surgeon used the term it looked like a "hot node" during surgery and so took what he thought was a second node, on pathology they dicovered it was another 6 small nodes. All the remaining ones were negative. At mastectomy he took another 6 nodes which were all clear.  

I guess I haven't helped re what to do,first, just thought asking about the remaining lymph nodes might be a question to either ask yiur surgeon or oncologist/rad oncologist. 

I hope I haven't confused you more. I remember how overwhelming it was at the time for me. 

 

Hugs

 

paula xx

Hi Christel,

I am also TNBC.  My treatment was surgery first, followed by chemo, followed by rads.  There was no node involvement but my tumour was very aggressive (between mammograms) so  I did everything possible.  That was 4 years ago. It seems rads is usually last, but every case is individual so be guided by your surgeon.  All the best. xx Michelle

Hi Christel:

I don't have any advise on your specific situation.  I do wonder why you are after a bilateral mastectomy if you had disease in one breast and a node (with possible others??) and you are BRCA negative.  I understand you are concerned about other nodes, did you have a breast MRI or other studies done prior to your lumpectomy?  

Now is a great time to sort through all of this as you are in chemo for the next several months.  I spent my chemo time (last one tomorrow!!) learning so much about my treatment and disease.  

I have Grade 2b TNBC in my left breast with one positive node (MRI appears clean on others but will have to wait until surgery to know) and am BRCA1 negative, BRCA2 negative with two unclassified variants on BRCA2.  My tumor has shrunk significantly during chemo (4x AC and 12x Taxol/Carboplatin) and will be removed next month.  My surgeon is very happy with lumpectomy and would prefer to conserve as many nodes as possible depending on what she finds when she removes the sentinel node.  

Good luck with the rest of your chemo and sorting through all your best options for surgery.  My surgeon was only ever agreeable to mastectomy in the event I was BRCA positive.

Cheers,

Yvette

Thanks ladies I appreciate you responding.

my sentinel node procedure was done during my lumpectomy. The pathologist was the one post surgery who has raised concerns.

I only had a CT post surgery, no MRI.

I guess everyone's BC journey is different based on type, timing, age, and specialist teams recommendations. But I like being armed with info prior to going to my specialist appointments so I can ask question.

I am leaning towards bilateral due to the aggressive nature of my tumour, my age, my no further need for these breasts (I'm not interested in reconstruction and my daughter is an IVF baby so not going back for seconds!), risk mitigation. I think it is very psychological for me, but I will take my specialist teams recommendations prior to making a final decision.

Like you Yvette I am using this chemo time to research, so thank you for the link, it has heaps of info.

Surgeon appointment in two weeks to start planning what next, so I am starting to write all my questions down ready.

Thanks again.

Christel

xx

 

Hi Christel,

I have just finished all active treatment for TNBC, BRCA 2 positive. I had lumpectomy and sentinel node biopsy - 1st sentinel node +ve, 2nd SN & lymph node -ve. Followed by chemo (4 cycles AC, 12 paclitaxal and carboplatin), bilateral mastectomy & left axillary clearance then radiation.

The plan was to have mastectomy with immediate reconstruction after radiation but you have to wait a minimum of 6 months to allow skin to heal. Didn't want to risk leaving them there for that long so opted to have them removed before radiation.

Even without reconstruction you will have to allow time for skin to heal before mastectomy. My bs & ps explained that if done to soon after radiation there is a higher risk for infection and wound breakdown.

Ask for a referral for radiation oncologist, I had my first appt during chemo which allowed plenty of time to research and make my decision. It also allows time for extra appts if more questions pop up. Everyone's treatment plans will differ depending on tumor size, grade, lymph node involvement, what your specialist recommend and what you want.

I am 2 weeks post finishing 25 doses radiation, I had bad burns and 2 small blisters. My skin has stopped peeling and has/is healing nicely.

Jodie xx ??

Hi Christel,

I found out i had tnbc from the initial biopsy. I had neoadjuvant chemo,then bilateral mastectomy,then more chemo then radiation. Also BRCA negative. Best wishes with your decision making. Its a difficult time but you need to take the time to work out whats right for you and your specialists will help.  Hugs to you Anne

Hi Christel, are you having a reconstruction? In my case I am having chemo first like you, and also want double mastectomy. I have spoken to the genetics councillor and will have testing down the track a bit, but my feeling is that as I have already developed breast cancer at 41, I am at higher than usual risk of developing it again whether I have the gene or not. We have many genes that we do not yet know the function of. I have seen the plastic surgeon that will do my immediate reconstruction at the time of my mastectomy. The plan for me is a left mastectomy with implant reconstruction initially, followed by radiotherapy. After radiotherapy, I will have the implant removed, and right mastectomy with Diep flap (my own tissue from my tummy) reconstruction on both sides. This is because the radiotherapy can affect the tissue reconstruction and I don't have enough tissue to do it again if ther are problems. All the best to you, hopefully you will get a clear plan from your treatment team and feel a bit better once you know what's happening. We are all here for you
Kate x

From what I have read it ofcthe locely ladies on this site, it is normally surgery 1st then radiotherapy. It heals a bit quicker that way. If you decided on reconstruction they put expanders in and fully inflate prior radiotherapy so the skin is already stretched prior radiotherapy. Hope all goes well with treatment.

Thanks ladies, I decided to go straight to radiotherapy, 33 sessions. The surgeon told me that in a years time if I want a mastectomy he will do it, but in my case the quicker we did radiotherapy the better.
all went well and I am now building up my strength through a group fitness trainer and am feeling so much more myself.

thank you for all your advise and support