Node Testing for Prophylactic Contralateral Mastectomy?

morchella

Hello! I am so grateful this board exists!

I was just diagnosed with high grade, hormone receptor positive DCIS in my left breast (by mammogram and biopsy.)

In hopes of avoiding radiation and hormone therapy, and for symmetry, I am wanting to do a bilateral mastectomy with aesthetic flat closure.

I was told my surgeon would do a Sentinel Node Biopsy on the left side, in case invasive cancer was found during the surgery.

But what about the nodes on the right side? Should I have a Sentinel Node Biopsy on that side as well in case invasive cancer is found in the right breast after surgery?

I have heterogeneously dense breast tissue and am worried that there could be undetected cancer in the right breast. I would rather have a proactive Sentinel Node Biopsy than have to go back for an Axillary Lymph Node Dissection if it could have been avoided.

Or would an MRI of my right breast be an option to help determine whether a Sentinel Node Biopsy is needed?

Thank you in advance for any guidance!

RocDocVic

https://csn.cancer.org/discussion/327340/node-testing-for-prophylactic-contralateral-mastectomy

I have Invasive Ductile Carcinoma in my left breast. After biopsy and typing of ER/PR- and HER2 3 positive, grade 2, stage 2a, I had complete MRI of both breasts and entire chest area including lymph nodes. At that time there was no spread, and nothing in the right breast area. I'm on chemo now in hopes it shrinks the tumor so I can have a lumpectomy. I'd ask for MRI but that's me.

LifeInBloom100

https://csn.cancer.org/discussion/327340/node-testing-for-prophylactic-contralateral-mastectomy

Hi there:

First of all, I'm so grateful you too found this board. I too was recently diagnosed with Invasive Ductal Cancer, grade 2 in the left breast. I don't know whether my experience will be ACCURATE in answering your question, but it may give you some specific questions to follow up with your surgical oncologist for assurances about:

It appeared from both a core biopsy (10 days before surgery( and breast MRI (two days prior to surgery) that my right breast was healthy, but my left showed 2 larger tumors and a couple "satellite" lesions - all in the left breast. It did not appear from high resolution imaging that lymph nodes were involved.

I opted for bilateral mastectomy with immediate - 2-phase w/tissue expander - reconstruction, incidentally.

I had the lymphocintigraph prior to surgery, which injects a nuclear dye to illuminate the lymph system just on the left breast so the left sentinel could be biopsied. It turned out there was a small amount of cancer cells in the 1st (sentinel) node. My surgeon removed an additional 3 nodes and they were clear, which seemed to her to be enough to clear, rather than continue with the axillary nodes.

This next bit of info. may be useful in some way: pathology DID test the tissue of BOTH BREASTS FULLY, including both left and right nipples for malignancy. My right breast proved to be without malignancies, and I awoke without any dissection of nodes in my right armpit, whereas on the left I had that incision and a total of 4 removed. It may make sense in your case to ask your surgeon if it would be determined that the sentinel node in your right breast would undergo biopsy DURING SURGERY in the event it was determined there was an invasive malignancy in the right. OR whether he/she thought it'd make sense to have a dual lymphcintograph procedure prior to surgery.

By the way - I echo your hesitation about radiation and hormone therapy (you hadn't mentioned chemo; I had an oncotype test done and the results indicated chemo would provide a 2% benefit toward recurrence risk reduction - because I am premenopausal. I am choosing to forgo chemo and am having ovarian suppression and aromatase inhibitor. Radiation is additionally recommended because I had one positive node and because of the grade-2 tumors. I am seriously weighing that (as there are supposedly low-risk but serious potential longer-term health implications from radiation to the left side of the breast, let alone there is the potential for reconstruction complication or failure) and have limited time to make a decision. It is a very personal decision to make, with no peaceful resolution one way or the other (at least for me). BUT, I will say that mindset, diet, lifestyle and whatever brings you peace, joy or stress reduction is going to be key to healing, too.

It does sound like they're catching this early for you, and I will keep your little happy-face icon in my prayers for a clean node biopsy and the best prospects for full speedy recovery.

By the way, a bilateral mastectomy is no walk in the park, but let me tell you from just MY personal experience, that the physical aftermath was incredibly manageable after the first two days. I think I even took 1 pain med for a whole day by day 5, and then rarely after the first week. If you have any questions about that part of it, you're welcome to DM me. I had mine last month.

All the best to you!

LifeInBloom100

https://csn.cancer.org/discussion/327340/node-testing-for-prophylactic-contralateral-mastectomy

Woops - I see you're doing a contralateral- not bi! I misread. Maybe that changes things with regard to suggestions based on my experience, as they may not be extracting breast tissue from the right side...?

morchella

https://csn.cancer.org/discussion/comment/1710799#Comment_1710799

Thank you so much for your kindness and for taking time to respond in so much detail -- it is greatly appreciated!

I am planning to do a bilateral mastectomy (if I did just a unilateral on the DCIS diagnosed breast, they would recommend Tamoxifen, which I would like to avoid if possible.)

I will definitely ask my surgeon about the possibility of a pre-surgery MRI, and whether they will be examining the removed breast tissue during the surgery.

At this point, the diagnosis is just DCIS in the one breast, and I'm wondering if maybe they don't do certain things proactively for this diagnosis. But I've read enough stories of invasive cancer being found in the DCIS breast upon surgery, or even in the prophylactically removed other breast. I would hate to have missed my chance for a Sentinel Node Biopsy if there turns out to be invasive cancer in the prophylactically removed breast.

LifeInBloom100

https://csn.cancer.org/discussion/comment/1710816#Comment_1710816

I'm going to write back as a stream of consciousness here (warning!), as I honestly don't know how else to broach the topic of treatment avoidance if at all possible - which you and I are in the same school of thought, it would seem. And I hesitate to state some of these things here, because treatment choices are VERY personal to individuals, and criteria for making decisions can be vastly different for each of us. Also - I have written on this forum about my concerns regarding recommendation radiation to the left breast particularly in hopes of some personal experience thoughts or guidance and have noticed I've received little to no response at all. I hope it's not because I have frightened anyone - I do my research to factor in the benefits and risks of anything being advised for my health (given my overall health and that of my family) and so I feel more solid in my understanding of them - not to automatically go against care providers' expertise:

Please don't be shocked if Tamoxifen is a recommended treatment course even following a bilateral mastectomy. It may depend on a few factors, some of which include your hormone receptor status (which you noted is positive; are you also HER-2-NEG?), whether you are pre- or menopausal and whether there is any indication of spread to the circulatory system -- either with evidence in a lymph node or breast tissue surrounding your tumor (which at the time of your biopsy results may indicate that your DCIS has not become invasive- good). Your med onc may want to suppress your estrogen levels longer-term with that treatment, as this hormone may be what's fueling your cancer cells, and recommend additional ovarian suppression if you are premenopausal.

Depending upon the pathology results following surgery, your oncological surgeon may request an Oncotype test to determine the benefit of certain treatments and your risk of recurrence.

I'm not in love with my reproductive system being abruptly shut down this coming week and the onset of immediate menopause symptoms my body would have otherwise gradually revealed. But I also want to live.

Radiation to the left side is my major grapple for a variety of reasons I'll share with anyone privately if the topic and research is also of interest or use in asking questions of their own care team. I go for a second opinion on that (with the same hospital) Tuesday and will a 3rd if I feel I need to. I may also ask about the possibility of a voluntary axillary dissection surgery if that will help determine where I stand, to avoid radiation.

Don't know if any of this helps, but I'm grateful for any dialogue we all feel comfortable with. This is serious hooplah for us all to go through. Sheesh!