Double or single mastectomy and DIEP reconstruction?
Hi there, I wonder if anyone has any guidance for a decision that I realize is mine alone but is nevertheless a difficult one. I was diagnosed with invasive lobular carcinoma in August last year after discovering a lump in my left breast. I had a clear mammogram less than 12 months prior. Ultrasound showed it 4.5cm but subsequent MRI showed it 6 cm.I had very large breasts .At the first meeting with the surgeon (when we thought it was 4.5 cm) he discussed options of either breast conserving surgery or mastectomy on the affected breast.I was leaning toward BCS until we found it was 6 cm and he explained that there was a greater likelihood of not getting clear margins where it was lobular and given the size of the tumour I might need a mastectomy in the end anyway.I opted for a mastectomy and it turned out it was 5.5 cm .Also it extended right up the top of the breast so mastectomy was the right choice.I was lucky there was nothing in the lymph nodes.I opted to go DIEP flap surgery with the plastic surgeon inserting a tissue expander at the same time as the mastectomy and also doing a reduction on the right breast. I have since had radiotherapy and started on letrazole as the cancer is ER positive. It all happened so quickly and I had no one else in my family or even a friend who had ever had breast cancer so I was not that well educated at that time. I have since realized how many women have a double mastectomy,/reconstruction even where they don't have any family history of breast cancer or other high risk factors. I am planning to have the second stage of the reconstruction in June where the tissue expander is removed and replaced with my tummy fat .I didn't want to get an implant as I hate the idea of something foreign in my body and also the potential to have further surgery down the track to replace the implant.I realize that decision is very personal for every woman and also understand the DIEP surgery is much bigger surgery . When I saw my breast cancer surgeon last week he asked had I considered having the other breast removed and reconstruction in the same operation as the DIEP could only be done once and many of his patients opted for a double for that reason and also the peace of mind of not worrying about having cancer treatment again if it came back in the other breast. He wasn't necessarily recommending it but said it was something I needed to decide as it would be too late after the operation in June. I have got over the fact that it would have been nice to have this conversation before the first operation, and just want to make the right decision. I do have quite a bit of anxiety which has been heightened by all of this, and am leaning towards the double (I am 62, never considered myself as defined by my breasts, have an amazingly supportive husband who says "I just want you alive and will support whatever decision you make " and already will have one "foob" so why not two).On the other hand, it will add to the length of the surgery, have extra potential complications and recovery time and may not be necessary. Does anyone have any advice?
Any advice pls - local recurrence 2..5 years post mastectomy - advised to have radiation/tamoxifen
Hi everyone - in 2017 I had stage 2 HR positive/HET2 negative tumor removed in lumpectomy. Before I started radiotherapy I decided to have bilateral mastectomy and hence no radiotherapy given. I had reconstruction with implants and advised to take tamoxifen but I only took for a couple of months and stopped as I put on weight and thought I was low risk of recurrence due to mastectomy. I have now had a local recurrence (pea size stage 2 tumor) removed last week in lumpectomy. MDT meeting advised radiation and that I must take tamoxifen. If I can't commit to compliancy with Tamox then I need to have chemotherapy. I am a public patient and I have requested an appointment with a medical oncologist to discuss pros and cons of both. Do any of you have any thoughts? Thanks Kate
