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!