Need info please

Texylin said:

Hi TereB, I'm not exactly sure what your question is but I have had a mastectomy and tramflap reconstruction. I did not have to have chemo at that time. That was 5 yrs ago and my cancer metastasized in Apr of 2007. I have been thru 8 rounds of taxotere this time. Did you have chemo right after the reconstruction or are you trying to find out if they can do this? I would not think that you could have chemo until you were completly healed from any surgery because of the wbc. As far as the ovaries being removed I don't have any experience in that area but am sure someone else will be able to help answer that question. If you have any other questions about the tramflap please let me know.
Hugs, Linda

cabbott said:

Tere,

I'm going to try to answer pieces of your question bit by bit. I know the information curve when you first get diagnosed is overwhelming, so write back if you don't understand anything. First, anyone who HAS to have a mastectomy in this day and age SHOULD be offered reconstruction. There are many ways to do reconstruction if you want it but not all surgeons can do all kinds. Usually the general surgeon or a breast cancer surgical oncologist does the mastectomy and the plastic surgeon does the reconstruction. You are out for the entire surgery so it doesn't matter how long the surgery lasts on your part. Recovery takes longer with the more complicated transplants, but none of them put you in the hospital for over a week barring complications and some kinds of reconstruction (I'm thinking implants) don't require any extra days in the hospital at all. There are tram flap reconstruction procedures where tissue is taken from the abdomen but stays attached for good circulatory function, free tram flap where tissue is transplanted and the circulatory function is grafted into existing systems in your chest, DIEP or SIEP flap transplant where almost no abdominal muscles is removed and the surgeon reattaches the circulatory stuff via microscopic surgery(takes an experienced specialist in the field to do this even among plastic surgeons), implants of various sorts that make recovery faster but may require replacement 5 years down the road or so, tissue transplants taken from your butt and reattached like the DIEP flaps, just to name a few. You have to pick what is right for you. I recommend the Susan Love website for pictures and stories of folks that have done reconstruction or skipped it. Yes, you can have a mastectomy and use an external prosthesis. They sell them along with bras that fit them, but I've been told that this option is difficult for folks that are bigger. It is the option I went with just because I'm small and it seemed right for me. You pick what is right for you. Insurance usually picks up the tab if you have insurance. Some folks have to wait for reconstruction until after radiation treatment. Be sure to ask if this will be the case for you. A friend of mine had a mastectomy and wanted immediate reconstruction with a DIEP flap. The two surgeons duked it out as she was prepped for surgery. It was not a good time for her and she found out seconds before she went under that she would not get the option she wanted.

Please be aware that lumpectomy followed by radiation has an equal or slightly better (though not statistically significantly better) survival rate for folks who do not need a mastectomy. Lumpectomy followed by radiation is standard of care! More tissue out is not better UNLESS the tumor is too large, you can't get clean margins without a mastectomy, the cancer is spread out in more than one area and multiple lumpectomies are cosmetically unacceptable. I had two small tumors in a size "A" breast and fell in the last category. A mastectomy had to be done. But most leading breast specialists will do a lumpectomy if at all possible. If you have a family history of inherited breast cancer or the kind of cancer that tends to reappear in either breast, you might also choose to do a bilateral mastectomy to reduce your chance of reoccurance. If you have reconstruction, know that neither implants or abdominal tissue can get breast cancer as they are not breast tissue. The doctor has to give you the choice because there is no way he can guarentee anything. He can and should give you ideas on what seems to work best for most folks with your kind of cancer. Your path report is where you find out what kind of cancer you have. They are not all the same even though they are all breast cancers.

Getting your ovaries out is a totally different operation. If you have a certain form of inherited breast cancer (and I forget whether it is BRCA 1 or BRCA 2 here ladies), you have a really high chance of getting ovarian cancer. If that is the case and your child bearing days are over, then get them out. Otherwise, if you are pre-menapausal and have estrogen positive breast cancer (ER+ on the path report), oncologists will give you tamoxifen to stop the estrogen made by your ovaries from fueling your breast cancer cells' growth. If you are post-menapausal and ER+, then they can give you either tamoxifen or other estrogen reducers called aromatase inhibitors. You might have seen the pink boxing glove add for Arimidex in women's magazines. That's one of them. Are your eyes starting to glaze over? Your oncologist will understand all this drug stuff and deciding which to use won't happen until after chemo is over, should you need chemo. They have lots of drugs these days to make chemo less than the nightmare it was ten years ago. Fatigue and stomach upset are problems with chemo mainly, but I've known women that continued working while taking chemo and barely slowed down. Others needed a year off. Getting your ovaries out along with chemo used to be done in the 60's, but it is no longer needed since other drugs mentioned above and better research showed it was not needed for the majority of women, save for the inherited situations I mentioned above. You will still run into surgeon that are very "old school" that will do radical mastectomies and oopherectomies (ovaries out) because that is how they were taught 20 years ago. Please get a second opinion if that is the case just to be sure that is what you actually MUST have. And come back here with all questions. The folks here(I was going to say "ladies" but let's not forget Bill!)have great ideas on coping with everything: surgery, chemo, radiation, reconstruction, you name it. They are also just great people!

C. Abbott