Bilateral, or just one?

ericajean

Hello, I've just been diagnosed and am trying to decide on surgical options. I have invasive ductal carcinoma on the right and would definitely prefer to have the breast removed instead of choosing a lumpectomy with chemo.

I had been thinking that the most efficient decision would be to have my left breast removed as well so that I could feel safer and have symmetry.

Yesterday I was excited to hear that my insurance would approve the bilateral mastectomy.

But then last night I was reading Susan Love's Breast Book and was very surprised to learn that a mastectomy does not guarantee safety, and that a lumpectomy with radiation is actually more aggressive than a mastectomy.

Maybe my insurance will cover recontruction on the left for symmetry. There is some question about a lump in the left as well, but it's most likely an adenoma.

Still...that's another biopsy and more time to wait.

A big part of me just wants to get on that surgical table and get on with my life!

I'm not very attached to "the girls" and have wanted them to be smaller for a long time now.

But I will miss feeling in the nips.

I just don't know what to do and it feels like I need to make a decision...right now!!

What are your thoughts?

seof

Dear ericajean,
First: You have come to the right place to hear from folks who have "been there, done that" on this website.

Second: There are no guarantees with cancer...but Doctors are learning more every day and the number of survivors is growing.

Third: I was diagnosed in May '07 and I originally felt exactly the same way..."get rid of it as fast as possible and move on". Time and reason have prevailed since then. My Oncologist and surgeon recommended 6 months of chemotherapy first, then surgery. I had a very large tumor (like a boiled egg) and the Onc. said doing chemo first would let us know for certain whether the chemo would be effective on my individual body. If they removed the tumor first, they would not know. 15 weekly treatments later, the tumor is gone, leaving some shady areas throughout the breast tissue. We know the chemo is working on the cancer they can see, so presumably it is working on any cancer that may be there that can't be seen. The plan now is to continue chemo till December, then they are talking about unilateral mastectomy. I have been in a quandary about unilateral vs. bilateral since the original diagnosis, so I surely do know what the fear and indicision feels like. Drs. say there are "no indicators that would lead them to recommend bilateral mastectomy", but I think reducing the chances for recurrence, and increasing the chances for symmetrical reconstruction are worth doing bilateral. My sister had unilateral mastectomy and recurrence on the other side and was a survivor for 5 years. I am sure that much of my fear comes from her situation. I know that each indiviual is different, but the thought lurks in the back of my mind. I would say ask your Dr. as many questions as it takes for you to feel comfortable with the information you have, and don't panic. Take the time you need to make your own mind up. It is your life, after all.
Do not be discouraged and stay in touch! seof

muse23

I faced the same decision last November. Had a mastectomy (required) did the chemo and was ready for reconstruction/implant. The 2nd breast had been lifted and reduced in Nov. During the year and looking towards the future, for me, I realized I didn't want to go thru chemo for breast cancer again. Most women I spoke with wish they got both removed. So last Saturday I added a mastectomy to the surgery. It was covered because of the symmetry issues. I am in mid divorce and suddenly thought of how uneven I'd look in a few years...decades. I would opt for the bilateral first time around. That's my opinion at this point. Good luck...not easy decisions.

jackiemanz

muse23 said:

I faced the same decision last November. Had a mastectomy (required) did the chemo and was ready for reconstruction/implant. The 2nd breast had been lifted and reduced in Nov. During the year and looking towards the future, for me, I realized I didn't want to go thru chemo for breast cancer again. Most women I spoke with wish they got both removed. So last Saturday I added a mastectomy to the surgery. It was covered because of the symmetry issues. I am in mid divorce and suddenly thought of how uneven I'd look in a few years...decades. I would opt for the bilateral first time around. That's my opinion at this point. Good luck...not easy decisions.

It's a hard decision to make but you have to do whats right for you. When I was diagnosed back in Feb. 07 I had to make the same decision. For me it was take them both that way I want have to go through this again 10/20 years from now.

24242

I like you wanted the same after finding out I had stage 3 with 11 out of 21 nodes positive. I was 36 at the time and my grandmother had only made it 8 years before her bone cancer.
I had wanted bilateral mastectomies but was advised against it since it is so traumatic for the body to recover from. My mother who is a nurse and the surgeon both didn't want me to have both done at the same time though he would if I really wanted it. Sometimes concentrating on the cancer side is more important especially when I was already a stage 3.
After a year of treatments I had the second mastectomy to minimize the risks of another occurance knowing there is nothing to stop it from happening in just one cell let alone a whole breast full of cells.
It has been 10 years now and I have to say there are no regrets. I didn't have reconstruction done due to the problems and side effects that I encured. One has to be comfortable with their choices and I certainly was with mine thanks to my mother's help and knowledge since being a palliative nurse.
I think the best we can do is minimize risk factors for our futures.
Best of luck to you
Be good to yourself always,
Tara

Kathh

Hi - This is my first time writing on this site. I've been appreciating all of the info and now want to share.

I was diagnosed in 2001. My surgeon at the time indicated that a mastectomy would be a severe treatment for what I had (DCIS, LCIS and hyperplasia). I ended up going with a lumpectomy and 6 1/2 weeks of radiation.

I have since had many call-backs on my mammograms, 2 biopsies, including one in the irradiated breast that revealed hyperplasia. I've had it!! Given my family history with breast cancer, I've decided to get a bilateral mastectomy. My current surgeon says my chances for a recurrence will be about 4%. My oncologist says that mastectomy means my chances of recurrence are virtually impossible, but the surgeon cannot get every cell of breast tissue, so they cannot say 0%. I would talk to your oncologist about your own chances of recurrence; family history, age at first diagnosis and other factors can alter your chances for recurrence. Lumpectomy and radiation are not necessarily as safe an option to avoid recurrence as mastectomy in some cases.

My own primary care physician had an invasive cancer, so had a mastectomy and chemo. After a year, she had the other breast removed and said that it was a relief, not only so she did not have to worry about recurrence, but also because her symmetry had been restored.

I'll be meeting with a plastic surgeon soon to discuss reconstruction, so I don't yet have much more info than you'll find on the ACS site for that aspect of the surgery.

I hope that this helps. Good luck!