How do you choose?

mavinbook
mavinbook Member Posts: 4
in Breast Cancer #1
I've never posted anything, and really I haven't even read a whole lot on the discussion boards, but what better group of women to ask then those that have faced my choice. I've chosen to have a mastectomy because my "breast size to tumor" ratio would not have a "good cosmetic outcome" and the radiation onco. doesn't like to do rads on a someone under 40 (i'm 36).

Today I met with the plastic surgeon and was once again reminded how small my breasts are. I am now considering just going with a prosthesis. Has anyone else made this choice? My other choice is the smallest implant on the planet with a piece of skin and fat from my back. He indicated that he could do just an implant, but then we'd do expanders and there would be a second surgery. I'm really not ok with that idea--this whole surgery thing has me pretty stressed out in the first place.

Any advice would be much appreciated.

Sarah

Comments

  • MAJW
    MAJW Member Posts: 2,510 Member
    #2
    What..
    What is the size of your tumor? I have small breasts...my tumor was 2.2 cm. That's less than an inch...I had a lumpectomy...I'm older than you and what my breast would look like afterwards didn't matter to me or my husband....and honestly, it is only a bit smaller, smaller but not a huge difference...

    It's such a personal decision between you and your physicians....do you know what type of bc you have and stage? All of this can come into play...
    I hate the reason you found this board but you'll be glad you did...it's full of first hand experiences....keep reading and posting any and all questions...

    Wishing you the best in making your decisions....
  • mavinbook
    mavinbook Member Posts: 4
    #3
    MAJW said:

    What..
    What is the size of your tumor? I have small breasts...my tumor was 2.2 cm. That's less than an inch...I had a lumpectomy...I'm older than you and what my breast would look like afterwards didn't matter to me or my husband....and honestly, it is only a bit smaller, smaller but not a huge difference...

    It's such a personal decision between you and your physicians....do you know what type of bc you have and stage? All of this can come into play...
    I hate the reason you found this board but you'll be glad you did...it's full of first hand experiences....keep reading and posting any and all questions...

    Wishing you the best in making your decisions....

    The tumor is 1.1 cm, the
    The tumor is 1.1 cm, the cancer is IDC with lobular features--another reason the radiation onco leaned towards the mastectomy, apparently the lobular stuff is hard to see. The plastic surgeon very politely informed me that I'm not at 34B, more like a 32 or 34 A.

    Thank you so much!
  • Miss Murphy
    Miss Murphy Member Posts: 302
    #4
    Welcome
    Welcome to this board, Sarah.

    Your choice is such a personal one and no one can make the decision for you. I can only tell you my choice. I was also told that if I did a lumpectomy the results would be very unsatisfactory plus I'd have to do radiation - didn't want to deal with another doctor and more appointments. So I did the mascetomy and did not have reconstruction. Again, didn't want more unecessary surgery. I was way older than you when dx - I was 57 and I've been married to the same guy like forever! He said he loved me no matter what and I can honestly say that it bothers me having only one breast way more than him. I wear the prothesis and don't think anyone can tell. There are times I do consider having reconstruction and know it's an option but I've never followed thru and doubt I ever will. I just don't want to deal with the doctor apointments and surgery issues. BTW, I was dx a little over 3 years ago.

    I'm sure you will hear from others who have gone with the reconstruction and there are others like me who opted not to. Good luck in making your decision and with your surgery. Keep us posted and hang in there. Hugs, Sally
  • butterflylvr
    butterflylvr Member Posts: 944
    #5
    Awww .. Sarah,
    First of all, I am the extreme opposite. But with the size of my tumor I went with a mastectomy for the same reason (cosmetic). I also opted to remove my healthy breast as well since I didn't want to go through this whole process again. I am currently wearing tissue expanders and will have to have a implant exchange surgery in about 6 months.

    I guess my question to you would be this... because of your age are you willing to tolerate a prosthesis for the rest of your life? If you're comfortable with the idea, I say go for it why do anymore surgeries. With me (age 49) and married to a wonderful man, we made the decision together to remove and reconstruct both breasts but I had my expanders put in right after my breasts were removed, one less surgery later on. I was one of the lucky ones that this was a viable option for.

    Good luck in your decision, sorry I'm not much help.

    Lorrie
  • skipper54
    skipper54 Member Posts: 936 Member
    #6
    Big busted but still debating
    I had a mastectomy in December, right before Christmas but my plastic surgeon wouldn't do anything until after rads, in case I was going to do rads. So I have been debating since then what to do. It's a very personal decision and needs to be made with much discussion with your doctors. My PS isn't sure my skin will support expanders and an implant so wants to do a latissimas (sp?) flap - skin and muscle from my back to support an implant - and a lift on the other breast. I'm not sure I want to sacrifice my muscle and strength. I'm also not sure though if I want to deal with a prosthesis for the years to come either. All this probably hasn't helped you much except to know that others are dealing with the same decisions.

    I'm sending prayers for peace in your decision, whatever it may be.
  • carkris
    carkris Member Posts: 4,553 Member
    #7
    butterflylvr said:

    Awww .. Sarah,
    First of all, I am the extreme opposite. But with the size of my tumor I went with a mastectomy for the same reason (cosmetic). I also opted to remove my healthy breast as well since I didn't want to go through this whole process again. I am currently wearing tissue expanders and will have to have a implant exchange surgery in about 6 months.

    I guess my question to you would be this... because of your age are you willing to tolerate a prosthesis for the rest of your life? If you're comfortable with the idea, I say go for it why do anymore surgeries. With me (age 49) and married to a wonderful man, we made the decision together to remove and reconstruct both breasts but I had my expanders put in right after my breasts were removed, one less surgery later on. I was one of the lucky ones that this was a viable option for.

    Good luck in your decision, sorry I'm not much help.

    Lorrie

    I have had a prosthesis
    I have had a prosthesis since I was 35. I sometimes wish I had been able to have the reconstruction. If I had it to do over again, I would have both breasts removed and small implants. Not the back or abdomen surgery which is more extensive. I now have two as I was diagnosed in the other breast in 2009. I think its hard when you are in your 30's. Its easier for me in my 50's. I cant tell you I like it, but I only think about it when I get dressed, and sometimes i have dreams.
  • jk1952
    jk1952 Member Posts: 613
    #8
    skipper54 said:

    Big busted but still debating
    I had a mastectomy in December, right before Christmas but my plastic surgeon wouldn't do anything until after rads, in case I was going to do rads. So I have been debating since then what to do. It's a very personal decision and needs to be made with much discussion with your doctors. My PS isn't sure my skin will support expanders and an implant so wants to do a latissimas (sp?) flap - skin and muscle from my back to support an implant - and a lift on the other breast. I'm not sure I want to sacrifice my muscle and strength. I'm also not sure though if I want to deal with a prosthesis for the years to come either. All this probably hasn't helped you much except to know that others are dealing with the same decisions.

    I'm sending prayers for peace in your decision, whatever it may be.

    Sarah, I'm so sorry that you
    Sarah, I'm so sorry that you have to make these decisions. It's so hard to know what to do. When I was first diagnosed, in 2000, I had small breasts also, between an A and a B. I had invasive lobular cancer with DCIS, and I had a lumpectomy and radiation. That was the right thing for me to do at the time. I wasn't prepared to have a mastectomy. The lumpectomy and radiation did leave my breast a bit smaller than the other one, but it was fine when I had clothes on. Over the years, the radiated breast didn't age quite like the good breast, but I considered myself fortunate to have both breasts. In 2009, I was diagnosed with DCIS in the same breast, and I had a bilateral mastectomy and DIEP reconstruction. I've been pleased with the results, but my guess is that you probably don't have enough abdominal tissue to do this reconstruction.

    Even though I've had a mastectomy, I've never had a time when I had no breasts, and I'm very grateful for that. I think that the immediate reconstruction helped me with my overall recovery. I love to boat and swim, and it's been great not to have to worry about a prosthesis.

    But, it sounds like your doctors are really only giving you one choice, a mastectomy without reconstruction. If you are having any second thoughts about this, you might want to go for a second opinion, to see if another surgeon might give you other options.

    Joyce
  • linpsu
    linpsu Member Posts: 747
    #9
    Tough decision
    Af the time of my first mastectomy in 2008 (left side only), I had an expander put in and reconstruction surgery (implant) a few months later. Two years later the cancer came back under the mastectomy scar, so I had the implant removed (plus lots more surrounding tissue) and decided not to reconstruct this time. I figure I've had enough surgeries, and I'm 59. I've had a prosthesis since January, and it's fine, although the whole deal with finding a swimsuit and buying another prosthesis that is waterproof just doesnt' appeal to me right now, and I'm leaving for the beach in 2 weeks. I don't think insurance will cover another prosthesis.
    Good luck making your decision - it's not easy. Linda
  • jk1952
    jk1952 Member Posts: 613
    #10
    skipper54 said:

    Big busted but still debating
    I had a mastectomy in December, right before Christmas but my plastic surgeon wouldn't do anything until after rads, in case I was going to do rads. So I have been debating since then what to do. It's a very personal decision and needs to be made with much discussion with your doctors. My PS isn't sure my skin will support expanders and an implant so wants to do a latissimas (sp?) flap - skin and muscle from my back to support an implant - and a lift on the other breast. I'm not sure I want to sacrifice my muscle and strength. I'm also not sure though if I want to deal with a prosthesis for the years to come either. All this probably hasn't helped you much except to know that others are dealing with the same decisions.

    I'm sending prayers for peace in your decision, whatever it may be.

    Sarah, I'm so sorry that you
    Sorry. Double post.
  • mavinbook
    mavinbook Member Posts: 4
    #11
    linpsu said:

    Tough decision
    Af the time of my first mastectomy in 2008 (left side only), I had an expander put in and reconstruction surgery (implant) a few months later. Two years later the cancer came back under the mastectomy scar, so I had the implant removed (plus lots more surrounding tissue) and decided not to reconstruct this time. I figure I've had enough surgeries, and I'm 59. I've had a prosthesis since January, and it's fine, although the whole deal with finding a swimsuit and buying another prosthesis that is waterproof just doesnt' appeal to me right now, and I'm leaving for the beach in 2 weeks. I don't think insurance will cover another prosthesis.
    Good luck making your decision - it's not easy. Linda

    Thank you
    I really appreciate all of the advice and support you have shown me.

    Sarah
  • jendrey
    jendrey Member Posts: 377
    #12
    mavinbook said:

    Thank you
    I really appreciate all of the advice and support you have shown me.

    Sarah

    ...
    Hi Sarah and welcome!

    You've chosen to have a mastectomy or you got talked into it?

    I had a 5.5cm tumor. It wasn't particularly noticable that I had a lumpectomy and my tumor was a good deal larger than yours. My breast, size 34B, wasn't obviously smaller as far as I was concerned. (I could've been in denial! But, hey I've got pics if you wanna see for yourself? =) However, my tumor was deep along the chest wall at about the 10 o' clock position. So, um the top outer quadrant (closest to my arm). Where your tumor is located will likely have a different viewpoint.

    I, too, was told that very same thing: my "breast size to tumor" ratio would not have a "good cosmetic outcome" Oh, but it did!!!

    Your plastic surgeon's job is to make you look and feel better. Not to make you feel inferior about the size of your breasts. His job is not to second guess that you'd be unreceptive to a second proposed surgical procedure down the line. (expander exchanged for implant surgery -- which is so quick that it's actually an outpatient procedure)

    In my case, I did go on to have a mastectomy. I wish that I had not. My oncologist, who has since left due to the commute, basically talked me into it as I had a 1mm clear margin. My radiologist has since told me the mastectomy wasn't necessary.

    A tissue expander was placed at the same time as the mastectomy, and it was gradually filled about every two weeks. The second surgery to replace the expander with the actual implant went very well. I was only at the hospital for about 3½ hours.

    I think you should get a second opinion before you decide to do anything anything else. Usually, all insurance types will spring for a second opinion.

    Personally, I'd go with a lumpectomy. You can always go on to have a mastectomy if need be; but you cannot ever have your natural breast back.

    I can send you pics if you like.

    .
    On the top left of this page, where the tan/orange box is you should see where it says CSN Email.

    Hope this helps. =)
  • ms.sunshine
    ms.sunshine Member Posts: 707 Member
    #13
    jendrey said:

    ...
    Hi Sarah and welcome!

    You've chosen to have a mastectomy or you got talked into it?

    I had a 5.5cm tumor. It wasn't particularly noticable that I had a lumpectomy and my tumor was a good deal larger than yours. My breast, size 34B, wasn't obviously smaller as far as I was concerned. (I could've been in denial! But, hey I've got pics if you wanna see for yourself? =) However, my tumor was deep along the chest wall at about the 10 o' clock position. So, um the top outer quadrant (closest to my arm). Where your tumor is located will likely have a different viewpoint.

    I, too, was told that very same thing: my "breast size to tumor" ratio would not have a "good cosmetic outcome" Oh, but it did!!!

    Your plastic surgeon's job is to make you look and feel better. Not to make you feel inferior about the size of your breasts. His job is not to second guess that you'd be unreceptive to a second proposed surgical procedure down the line. (expander exchanged for implant surgery -- which is so quick that it's actually an outpatient procedure)

    In my case, I did go on to have a mastectomy. I wish that I had not. My oncologist, who has since left due to the commute, basically talked me into it as I had a 1mm clear margin. My radiologist has since told me the mastectomy wasn't necessary.

    A tissue expander was placed at the same time as the mastectomy, and it was gradually filled about every two weeks. The second surgery to replace the expander with the actual implant went very well. I was only at the hospital for about 3½ hours.

    I think you should get a second opinion before you decide to do anything anything else. Usually, all insurance types will spring for a second opinion.

    Personally, I'd go with a lumpectomy. You can always go on to have a mastectomy if need be; but you cannot ever have your natural breast back.

    I can send you pics if you like.

    .
    On the top left of this page, where the tan/orange box is you should see where it says CSN Email.

    Hope this helps. =)

    Hello Sarah
    If in doubt or confused please get a second opinion. See another oncologist, and surgeon. Also I'm a firm believer in listening to your inner voice, your spirit. Whatever you decide, be at peace with it.

    I wish you well. Let us know what you decide. There are many wonderful women here that can help you along your journey. We have walked where you are now, we know how difficult this decision is.
  • mavinbook
    mavinbook Member Posts: 4
    #14
    ms.sunshine said:

    Hello Sarah
    If in doubt or confused please get a second opinion. See another oncologist, and surgeon. Also I'm a firm believer in listening to your inner voice, your spirit. Whatever you decide, be at peace with it.

    I wish you well. Let us know what you decide. There are many wonderful women here that can help you along your journey. We have walked where you are now, we know how difficult this decision is.

    Many thanks
    I really appreciate all the sound advice. I reread all the information I was given last night and then slept on the decision. This morning I scheduled my mastectomy, no reconstruction, for June 1. I know if I change my mind I can always have the reconstruction later--with someone other than the surgeon I saw yesterday. I feel as at peace as I can about such a major decision and I'm really looking forward to getting this proverbial show on the road!

    Thanks again!
    Sarah
  • Heatherbelle
    Heatherbelle Member Posts: 1,226 Member
    #15
    exchange surgery experience
    Hi Sarah :)
    Just wanted to share my experience - i was 34 at diagnosis last summer, and was given the choice between lumpectomy and mastectomy, and for health as well as cosmetic reasons I chose to have a bilateral mastectomy. I did not have a flap procedure, but I had the tissue expanders placed at the time of my mastectomy, every 2 weeks I would get a "fill" on them until I reached my desired size, and then I had the exchange surgery. Neither of my breast surgeries were half as bad as I had anticipated. I've had c-sections with my daughters and that surgery was WAY worse. For my mastectomy I did stay overnight in the hospital, but for my implant exchange surgery I went home the same day. Recovery was fairly quick with both, especially with the exchange. Keep in mind that if you have the flap surgery, the recovery is quite long and painful, since they are taking muscle from another part of your body. Im in NO WAY trying to sway you one way or another, just sharing my experience with one type of surgery that was not bad at all. And if you are wanting small implants, the expander process won't be very long for you at all. I was very large busted to begin with, and went with the largest size implant available, 800ccs. It took a good 3-4 months to get them expanded big enough for me to have my exchange surgery. I've spoken with several women who got very small implants who only had to have 1 expansion, so it is different with every person. I also have a friend who was diagnosed with stage 3 breast cancer when she was 24. She had a mastectomy on the affected breast and had no reconstruction, and is happy with the prosthesis she's had since then. Best of luck to you in your decision Sarah!
    *hugs*
    Heather

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