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Mastectomy vs Chemo first

swim1mom
Posts: 4
Joined: Nov 2008

I was just recently dx with breast cancer with positive nodes....stage 3. My plan was to do chemo (to shrink the tumor),lumpectomy, radiation and hormone therapy. I had to do an MRI and showed other suspicious areas in my left breast. I had another breast bx which should maglinancy. Now my choice is no longer lumpectomy but mastectomy with node removal. I have a chocie to do mastectomy with reconstruction first and than chemo or chemo first than mastectomey with reconstruction. (I already know I want to do reconstruction immediately) Any thoughts on which is the best route?

My second question is reconstruction do I use my own tissue to build or use a implant? This is my first time using this site.....Thanks to all of you.....

artizan's picture
artizan
Posts: 60
Joined: Oct 2008

Sorry to hear of your diagnosis. I can't help with your questions. I have heard of chemo first with other cancers but don't know of anyone who did chemo first with breast cancer. Hugs!

young_one's picture
young_one
Posts: 71
Joined: Nov 2008

I did it. Neo-adjuvent chemo, then surgery, then more chemo then radiation.

Do you have specific questions or just looking for an overall feeling on it?

swim1mom
Posts: 4
Joined: Nov 2008

Looking on overall feeling.....I know each person is different...but it helps to read what others have went through...what worked..what they would have changed.

mmontero38's picture
mmontero38
Posts: 1532
Joined: Dec 2007

Sorry to have to welcome you to this site, because it means you are also fighting the Beast. But, you will find a great group of women and men who are battling just like you. We will all give you our opinions and experiences and hopefully we will be able to answer all your questions. I had mastectomy first, chemo then reconstruction using my own tissue. I am very happy with my reconstruction. If you have more questions, write back. Hugs, Lili

Marcia527's picture
Marcia527
Posts: 2735
Joined: Jul 2006

I had to have chemo first. My tumors were too large and the surgeon said if we didn't try to shrink them first, he wouldn't have enough skin to close with and would have to do skin grafts. So I had 4 cycles of chemo first and it did shrink them. After surgery he said the chemo had changed me to stage 2. I was stage 3a before. He removed 15 lymph nodes and there was still cancer in 2 of them. He said he couldn't tell me how many was infected before chemo. He told me I couldn't have reconstruction at mastectomy surgery time because I also needed radiation. After my mastectomy he told me I'd need 4 more cycles of chemo. I was not happy but did it and then had the radiation.

My surgeon told me by having chemo first it would clean out any roaming cancer cells but it also meant he couldn't do a sentinel lymph node biopsy(where they check the first lymph node and a couple around it and if they are clean, they spare the rest). Ask your surgeon about this. I wanted this done but needed the chemo first.

young_one's picture
young_one
Posts: 71
Joined: Nov 2008

I did immediate reconstruction and radiation. Can I ask why your surgeon or onc. told you that?

Marcia527's picture
Marcia527
Posts: 2735
Joined: Jul 2006

It was my surgeon that told me this. I was overwhelmed and didn't know any better. I didn't know about message boards at that time and we had just moved to a new state and I didn't have anyone to ask. I did do searchs for various info on surgeons. I ended up having to switch. This one was the second surgeon I had seen. The first one said she didn't know what to do with me. I won't go into the sad details. I trusted him and thought he knew what he was doing because I was referred by two different people and I looked at his background. So I didn't think to ask anyone else or check on it. At the time I didn't think I was going to survive anyway. My odds weren't too good. So I guess I thought it didn't matter.

young_one's picture
young_one
Posts: 71
Joined: Nov 2008

My odds are not what the cancer world is holding up as "proof of progress" either. I am sorry that you and I have won that particular door prize at this party.

As to the reconstruction aspect of it... did you end up doing any?

And to swim1mom- i did the neo-adj chemo because they wanted to shrink the cancer as well. I did have a bilateral mastectomy following it. So, the neo-adjuvent chemo is not exclusive to breast conservation (lumpectomy). I had expanders placed during surgery and was fully expanded prior to radiation. I did the radiation (lots of it) and now I am waiting a couple more months to exchange my expanders for implants. I was not a good candidate for using my own tissue and I am definitely fine with that.

Marcia527's picture
Marcia527
Posts: 2735
Joined: Jul 2006

To say something positive first, I'm still here five years later. That's the mark everybody measures by, it seems.

I never got reconstruction. I'm a surgery baby. If he could have done it at the same time I would have but I'm not a bold person. As it was I did think about it a year after. Fate stepped in. I trusted him and was going to ask about it but he had a heart attack and had to quit. I just couldn't go to anyone else.

I'm glad I was wrong about the radiation and reconstruction so you were able to have both.

swim1mom
Posts: 4
Joined: Nov 2008

My original plan was to do chemo to shrink the tumor than lumpectomy (but found more cancer and is to large to do lumpectomy anymore)so now it is mastectomy. Actually it was one of my nurses that told me they could do chemo than surgery.....but knowing that I have more than what they originally thought....Decisions, decisions.....

young_one's picture
young_one
Posts: 71
Joined: Nov 2008

I did the neo-adj chemo and many have told me that they wish they could have. Sounds strange, huh? Their logic was that if they had been able to do so, they would have at least known whether chemo worked for them. If you do the surgery, then chemo, you don't actually know if that chemo was effective or not. If you do chemo then surgery, you can gauge whether it was responsive to chemo. Your hormone status is also something to consider. If you are triple negative, you don't have hormonal treatment and chemo is important.

If I didn't explain this well, I apologize. Please ask questions if I need to clarify.

Joycelouise's picture
Joycelouise
Posts: 493
Joined: Nov 2007

Please check with your onc. One thing I heard about chemo first is that it allows the doctors to guage how affective the chemo is against your particular cancer. They can also then make adjustments and monitor the progress...something that is not possible after the tumor is removed.
Regarding reconstruction, if you are thin, you will probably have to do implants. That is what two surgeons have told me (5"7", 125 lbs.). The choice that I had was wether to try to expand my radiated tissue (a little difficult compared to unradiated tissue) or transplant the tissue from my back and put in implants. I am going for the expanders. Doc said less healing issues with this and if it doesn't work they can still do the back flap. No one told me that I could have had reconstruction at the time of my masectomy though.
Lastly, in the beginning, as you chart your course, it is useful to speak with your surgeon who will do the operation AS WELL AS the onc. who will be doing the chemo. Possibly even the radiation doc. too. Wish they would all agree to a joint meeting where everything could be discussed...wouldn't that be great!
In the meantime, nice to meet you and I hope I can be of help and friendship as you go through this journey. Love, JOyce

cabbott
Posts: 1046
Joined: Aug 2006

If you do chemo first, then you can see how effective chemo is with your particular cancer. That can be helpful and a lot of doctors these days give it a try. Then they operate and usually do a bit more chemo afterward. There are lots of different choices when it comes to reconstruction. Most large towns have doctors that can manage implants or perhaps tram flaps. If you go to a breast clinic in a large hospital, DIEP or SIEP flaps (where the surgeon removes body fat from your abdomen without removing hardly any muscles) can be used. The advantage of implants is that they are faster going in and don't need a blood supply to work. The disadvantage is that they may only last 5 years and then need replacing. The advantages of body tissue transplants are that they grow and shrink with the body, they feel more natural, and they don't have to be replaced once they are in place. However the recovery time is longer with tissue transplants, sometimes the blood supply isn't sufficient and they fail, and they are more costly if you are footing the bill. The DIEP and SIEP flaps are only done by specialists of the highest order and you can't find those guys just anywhere. Insurance will often pick up the tab for all of costs, but you have to check to make sure before you sign the dotted line. You also have to talk frankly with all the doctors involved. A friend of mine was all lined up for the DIEP flap operation. The plastic surgeon and the regular surgeon got in a fight while she was being prepped. It seemed that her cancer was too close to her armpit and the surgeon was insisting that she would need radiation afterward which would doom the tissue transplant operation. She ended up not getting them, but the worst thing was dealing with a conflict just before the operation. The Susan Love Website has actual photos of women who made various reconstruction decisions along with their stories. You might read their stories to decide what is right for you. No decision is wrong as long as you and your doctor think it will work for you. Good luck!

C. Abbott

seof
Posts: 826
Joined: Jun 2007

The other responses you have recieved are all good. I did chemo first to see what particular drugs would work on my body. I had a lump like a boiled egg, so it was pretty easy to tell. Doc. got it right on the first try...great results, few side effects. I did surgery and radiation and am now finiship up Herceptin (supposed to prevent the cells from being triggered to reproduce at a crazy rate and start it all over, now that I have been proclaimed cancer free). I am planning reconstruction with my own tissues (DIEP is my preference, if I am a candidate) primarily because I do not want the probability of doing it again. I live in a big city, but it still is not easy to find a surgeon to do the procedure bilaterally. There is a lot to think about. I ordered a book from the ACS bookstore called "A guide to breast reconstruction" (or something close to that) which I have found very useful.

Make the choice that's best for YOU. seof

TammyLouBob
Posts: 18
Joined: Nov 2008

This is a decision that you could delay.

Frankly, bi-lateral cancer is not so good.

That means that the priority of your team has to be first on saving your life and second on managing your cosmetic condition.

Sorry, honey. It's brutal, but that's what it is.

What is the pathology of these cancers?

I can't help it...it's an issue. ER+ cancers can be "blocked"...follow on hormone blockers can reduce your risk of recurrance. Us ER neg gals have to rely on chemo, surgery and rads.

The bi-lateral thing really means that you have an increased risk of getting breast cancer again. To my knowledge it doesn't mean that you MUST have mastectomy.

But, you certainly need to seriously consider having the bi-lateral. Seriously.

It is possible...my best understanding...for you to take a portion of the chemo...let's say 4 rounds of AC. Then, have surgery with placement of expanders. Then, do more chemo...let's say Taxotere and rads.

After everything heals, you could exchange the expanders. (6 months after rads.)

The advantage to doing some chemo first is that it may shrink the tumors and possibly reduce the amount of axillary dissection. (Usually, this "translates" to reduced risk of lymphadema.)

IF your efforts with implants don't work out...and there's a possibility that they won't, then you could go back (after all treatment is completed) and do flaps.

I know that things can change.

In January 2005...at initial diagnosis, I had cancer wrapped around my chest wall. It was inoperable. So, neo-adjuvant chemo wasn't OPTIONAL. It was mandated.

The cancer shrunk significantly. After the chemo, I was a candidate for breast conservation, but I elected to do bi-lateral mastectomies. After rads, I had reconstruction (flaps.)

Please keep us posted.

Tammy Lou

babs49242's picture
babs49242
Posts: 197
Joined: Jan 2006

I had a unilaterail mastectomy followed by 8 rds of chemo and 35 rads. i was dx'd Stage3a with node involvement. I opted not to have reconstruction... I didn't want anymore surgeries. I'm happy with my choice.
from ladies in my local support grp they used their own tissue.

Sorry you need to join our sisterhood BUT very pleased you found us. This is a GRAND group of ladies/men( can't forget the men...hahaha)

Sending hugs of healing and calm.

Cindie from GA

sweetirishjo
Posts: 3
Joined: Nov 2008

Wow, I am so sorry about your diagnosis. My personal opinion is a mastectomy asap, then have chemo. Your oncologist should be able to tell you how long your chemo will be held until you are healed. I think you will probably be advised to have radiation too, so then I wonder if you will need to hold off on reconstruction until you have finished with that. Only your oncologist can tell you that, but I would also speak with a good plastic surgeon.
It is so hard to think and make decisions at this time. Talk to the professionals and then chose.
I had the same type scenario as you have. I am 2.5 years out now and I am finally going for breast reconstruction in a month (had to wait due to some unfortunate cardiac side effects). But, things are looking good. It's very scary but somehow you get through it. Lot's of help out there.
Best to you,
Joan

gemsa's picture
gemsa
Posts: 33
Joined: Feb 2004

These ladies make a great point regarding chemo first, the benefit being that you can see what type of affect that particular drug had on your cancer. I had neoadjuvant chemo to shrink my tumors, then a mastectomy with a TRAM flap. My TRAM ended up failing due to having radiation so soon after the surgery, I'm told. So I had a LAT flap later. I guess I can't really tell you that using your own tissue is better, it was not for me. But there are supposed to be fewer complications when using your own tissue compared to an implant.

Good luck as you make all these tough decisions.

swim1mom
Posts: 4
Joined: Nov 2008

Oh my gosh......a special thanks to all of you.....for your responses. Since I have posted this comment I have met with my surgeon, oncologist, genecist and still pending rad oc MD.
The plan is to undergo bi-lateral mastectomy with expanders, 16 weeks of chemo after surgery, radiation after that...I haven't met with Rad Oc as of yet to determine how long I will need that, hormone therapy as I have positive receptors and lastly the reconstruction using saline implants. Your comments and support have really been a help to me. Can't thank each of you enough...I will keep you informed after surgery to let you know how things are going....Good luck to each of you and again many thanks for helping in my decision making....

mayo
Posts: 12
Joined: Nov 2008

you have probably made your decision already but i just found this website today so im a little late here. I was diagnosed in jan stg to with pos nodes. i had a mastectomy in march with immediate reconstruction then started chemo in june i am still undergoing chemo.....So far so good but i never regretted my decisions since the breast had to be removed anyway i didnt see the point of chemo first if i was hoping to stop growth or shrink a tumor i could see chemo first but since it was coming off anyway i went surgery first and look at the chemo as just fighting against recurrance

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