Seeking your perspectives on what factors led you to choose lumpectomy or mastectomy

eshuk
eshuk Member Posts: 7
edited March 2014 in Breast Cancer #1
Hello. My name is Elyse and this is my first post. Here is some info about me: I am 33, and was diagnosed with Stage IIA at the end of March. My tumor was 1.5 cm and I had one positive lymph node. My cancer itself is aggressive--poorly differentiated, Her2 neu positive, progesterone negative; the cancer is estrogen positive.

I had a lumpectomy in April and had clear margins. A recent breast MRI came up fine. I just completed 8 rounds of chemo (AC and taxol). I was originally planning on just proceeding with radiation, so that I could conserve my breast. My surgeon feels comfortable with this, but she wants me to carefully weigh the pros and cons of lumpectomy/mastectomy to make sure I am comfortable with my decision.

My main concern is that if I proceed with radiation now and if the cancer recurs in the same breast, requiring a mastectomy, would I be able to have reconstruction at that point. Does anyone know whether it would be at all possible to have reconstruction after radiation?

Also, if you would feel comfortable, I would love to learn the factors that led you to choose lumpectomy or mastectomy, if you had a choice. I realize that this decision is an extremely personal one, but I am deeply curious about how other women have made this decision.

I would greatly appreciate hearing back from you.

Thank you so much.
Elyse

Comments

  • SusanAnne
    SusanAnne Member Posts: 245
    Hi Elyse, welcome. I did not really have a choice considering the fact that my tumor was very large, 8cm, so I had a mastectomy. I also opted to have radiation, I had one lymph node positive. I am also Her2 positive so I entered a clinical trial to receive herceptin. Reconstruction was not considered at the time of my surgery, so I just had a delayed TRAM flap done in May, so yes, it is possible to reconstruct after radiation. My plastic surgeon said that was the best option in my situation. I do know of women who have had immediate reconstruction, one with TRAM and one with implants. They both went on to receive radiation afterward. I don't know if that compromised their result long term yet since it was within the last two years. I suggest you meet with a plastic surgeon to discuss your specific conditions so you can make an informed decision. Good luck to you.
    Susan
  • eshuk
    eshuk Member Posts: 7
    SusanAnne said:

    Hi Elyse, welcome. I did not really have a choice considering the fact that my tumor was very large, 8cm, so I had a mastectomy. I also opted to have radiation, I had one lymph node positive. I am also Her2 positive so I entered a clinical trial to receive herceptin. Reconstruction was not considered at the time of my surgery, so I just had a delayed TRAM flap done in May, so yes, it is possible to reconstruct after radiation. My plastic surgeon said that was the best option in my situation. I do know of women who have had immediate reconstruction, one with TRAM and one with implants. They both went on to receive radiation afterward. I don't know if that compromised their result long term yet since it was within the last two years. I suggest you meet with a plastic surgeon to discuss your specific conditions so you can make an informed decision. Good luck to you.
    Susan

    Hi Susan. Thanks so much for responding. I appreciate it. It's good to hear that it can be possible to reconstruct after radiation. My surgeon told me that it isn't possible, that radiation "seals the deal." I have met with a plastic surgeon and I'll be meeting with him again to get more definitive information on this topic. Congratulations on your reconstruction. Thanks again for welcoming me to the community, and for sharing your story.

    Elyse
  • DeeNY711
    DeeNY711 Member Posts: 476 Member
    Hi, Elyse! I did not have reconstruction following bilateral mastectomy, but have always kept an eye out for information on reconstruction after surgery, chemo and radiation therapy. It seems that there are many physicians (oncologists, surgeons, radiologists) with very strong opinions on the before radiation or after radiation reconstruction debate. My breast surgeon said that in the future, she would be happy to hook me up with the plastic surgeons because I had such great material to work with for tram flaps. It made me very happy, because many months earler, the radiologist had painted the more bleak "seal the deal" picture shared by your surgeon. Weighing the variety of opinions is an activity shared by all of us here on the message board. Many people on the board opted to have reconstruction following radiation. Many had it immediately after mastectomy. Hope this helps.
    Hugs,
    Denise
  • krisrey
    krisrey Member Posts: 194
    Hi Elyse,
    Welcome to the board, I am sure you will get tons of valuable information here. There are a lot of wonderful women here with lots to share.
    I have the same dx as you but am ER and PR postive but HER2 neu postive like you. Also very aggressive. Even our time frames are the same, I also had my lumpectomy in April of 2003, but did not have clear margins until my third surgery. I also had one positve node like you and my last MRI came out OK...(thank god!) This past February I did feel another small lump in my other breast, which led to another biopsy, that is why they finally did the MRI (at that time I did wonder if I should just have both breast removed???!!!)After surgery I had 8 rounds of chemo...4 A/c AND 4 Taxol every two weeks, which was followed by 38 rounds of rads.
    I choose a lumpectomy because having a mastectomy did not increase my survival rate.
    Feel free to email me if you would like.
    Take care and good luck!
    Kris
  • eshuk
    eshuk Member Posts: 7
    krisrey said:

    Hi Elyse,
    Welcome to the board, I am sure you will get tons of valuable information here. There are a lot of wonderful women here with lots to share.
    I have the same dx as you but am ER and PR postive but HER2 neu postive like you. Also very aggressive. Even our time frames are the same, I also had my lumpectomy in April of 2003, but did not have clear margins until my third surgery. I also had one positve node like you and my last MRI came out OK...(thank god!) This past February I did feel another small lump in my other breast, which led to another biopsy, that is why they finally did the MRI (at that time I did wonder if I should just have both breast removed???!!!)After surgery I had 8 rounds of chemo...4 A/c AND 4 Taxol every two weeks, which was followed by 38 rounds of rads.
    I choose a lumpectomy because having a mastectomy did not increase my survival rate.
    Feel free to email me if you would like.
    Take care and good luck!
    Kris

    Thank you Denise and Kris for writing me back. I appreciate it. Getting your perspective helps a lot.

    Thanks again,
    elyse
  • Mbladet
    Mbladet Member Posts: 12
    Elyse,

    My BC was also Her2 3+ positive, ER/PR -, high grade. I am older (60). I can't imagine having to make such a decision at such a young age. I decided on a bilateral because my mother had Paget's disease and I already had some calcification (benign) on my left side. I am larger and didn't want to be "lopsided". I was supposed to have reconstruction with my mastectomies but that did not happen. I am four weeks out and have consulted with a plastic surgeon regarding reconstruction. I am blessed in that I don't need chemo or radiation because of the double.

    I wish you luck. I too have read many postings from women who have had reconstruction post-radiation.
  • inkblot
    inkblot Member Posts: 698 Member
    Hi eshuk:

    I had lumpectomy w/sentinel node in '01. Tumor (1 cm) was also aggressive, Her2/neu (3+), hormone neg..

    I had the choice of lumpectomy or mastectomy.
    Most every woman has this choice unless their tumor is very large and the breast would be deformed by so much tissue being removed. Typically, larger breasted women can have lumpectomies, even with larger tumors, with a good end result. My breasts are average and my tumor was small and the end result is a small, half moon shaped scar on the left breast, which has continued to fade. Also have a small scar in the left axilla. I'm comfortable with the scars and don't even notice them anymore.

    I carefully considered both options, initially. My surgeon said that either would be appropriate for me, with the same survival rate, but the choice was mine. We discussed the pro's and con's in detail on several occasions, I did a lot of research and talked with other women and decided that I'd prefer the lumpectomy. I did give the surgeon permisson, prior to surgery, that if more cancer was found in the breast at surgery, then the call would be his as to whether to proceed with the lumpectomy or mastectomy. I only wanted to keep the breast if it would have a somewhat "normal" appearance after surgery.

    I had 4 rounds of A/C followed with rads. My understanding is that if one experiences a local recurrence in the radiated breast, then mastectomy is the only option at that point. I'm ok with that knowledge for my future.

    It just depends upon what you're comfortable with after educating yourself to the facts and the variables. I personally think it's difficult to plan our futures around what may or may not come down the pike in later years. I do understand wanting to keep one's options open though.

    With reconstructs and the use of expanders, much of the surrounding skin (which is stretched) used to form the new breast is skin which received little radiation originally. Everyone's body is different and it stands to reason that while one woman may be a good candidate for reconstruct, post radiation, w/later recurrence and mastectomy, another one may not be.

    Radiation effects us all differently. Some of us have permanent discolouring of the breast skin, the breast can retain fluid and become a bit larger than the healthy one and the breast can also shrink becoming smaller than the healthy breast. Lingering pains in the breast are a very difficult side effect for some. These are all unpredictable factors. Just as some of us burn more badly than other's during rads, some of us have few remaining, obvious side effects of having had rads, which may leave us as a good candidate for future mastectomy w/reconstruct or not.

    For myself, I feel happy with the choices I made and don't worry about what the future may bring for the ole left breast. For now, it's here, healthy and looks pretty good, considering all it's been through! LOL I honestly think I'd have chosen not to have reconstruction, if I had chosen mastectomy, simply because it's not a simple procedure and I'm a wimp when it comes to OR rooms and I'm the one on the table! LOL

    Keep in mind that if you decide to forego the rads, it may have some bearing on your prognosis? Lumpectomy almost always requires rads to attack any stray cells within the breast and axilla region, so discuss this with your team thoroughly before you make your final decision.

    Some women I know chose mastectomies because they wished to avoid radiation and/or chemo and with their particular diagnosis, it became a difficult choice for them to make. Usually, these women would be older, with very slow growing, hormone positive cancers (usually DCIS at dx.). Oodles of reasons for why women choose one procedure over the other.

    Best wishes to you and keep us posted on your decision. In the end you will do what is just right for yourself and don't look back once you choose. Be confident in your choices and your reason's for having made them.

    Love, light and laughter,
    Ink
  • sandyk
    sandyk Member Posts: 7
    Elyse, I had removal of non-cancerous tumor 2/02. Diagnosed w/bc 12/02. I decided to have bilateral masecotmies which were performed 12/02. My reason being that I didn't want to keep on having to go through w/fear and upset again and again. I'm glad that I did as 2 other undetected spots found - 2 in right breast 1 in left. All cancerous. I'm ER&PR + HER2NEU- 6 lymph nodes + stage III. Another sugery performed 1/03 as margins in r breast not clear. Now I have a golf size divit which was covered by skin graft. 8 chemo & 37 rads. Questionable if I canhave reconstruction but may be able to down the road using latisimus doris flap and implant r side, implant on left. Time will tell. I wanted to preseve as muc of the tissue and skin but in my situation not possible. Each of us has very different reasons for our course of direction. I desperatly miss my nipples but am very glad to be here today. I imagine in my mind that I can feel them. Sometimes I think that I can. I think that your decison for a lumpectomy was the right one for you. Consult a good plastic surgon w/references who speicalizes in breast reconstruction. The doc will be honest w/you and work toward your best interest. I wish you the best. Sandy