Mastectomy vs Chemo first

welcome
Sorry to hear of your diagnosis. I can't help with your questions. I have heard of chemo first with other cancers but don't know of anyone who did chemo first with breast cancer. Hugs!

Sorry to have to welcome you
Sorry to have to welcome you to this site, because it means you are also fighting the Beast. But, you will find a great group of women and men who are battling just like you. We will all give you our opinions and experiences and hopefully we will be able to answer all your questions. I had mastectomy first, chemo then reconstruction using my own tissue. I am very happy with my reconstruction. If you have more questions, write back. Hugs, Lili

Marcia527 said:

I had chemo first
I had to have chemo first. My tumors were too large and the surgeon said if we didn't try to shrink them first, he wouldn't have enough skin to close with and would have to do skin grafts. So I had 4 cycles of chemo first and it did shrink them. After surgery he said the chemo had changed me to stage 2. I was stage 3a before. He removed 15 lymph nodes and there was still cancer in 2 of them. He said he couldn't tell me how many was infected before chemo. He told me I couldn't have reconstruction at mastectomy surgery time because I also needed radiation. After my mastectomy he told me I'd need 4 more cycles of chemo. I was not happy but did it and then had the radiation.

My surgeon told me by having chemo first it would clean out any roaming cancer cells but it also meant he couldn't do a sentinel lymph node biopsy(where they check the first lymph node and a couple around it and if they are clean, they spare the rest). Ask your surgeon about this. I wanted this done but needed the chemo first.

Marcia527
I did immediate reconstruction and radiation. Can I ask why your surgeon or onc. told you that?

young_one said:

Marcia527
I did immediate reconstruction and radiation. Can I ask why your surgeon or onc. told you that?

surgeon told me
It was my surgeon that told me this. I was overwhelmed and didn't know any better. I didn't know about message boards at that time and we had just moved to a new state and I didn't have anyone to ask. I did do searchs for various info on surgeons. I ended up having to switch. This one was the second surgeon I had seen. The first one said she didn't know what to do with me. I won't go into the sad details. I trusted him and thought he knew what he was doing because I was referred by two different people and I looked at his background. So I didn't think to ask anyone else or check on it. At the time I didn't think I was going to survive anyway. My odds weren't too good. So I guess I thought it didn't matter.

Marcia527 said:

surgeon told me
It was my surgeon that told me this. I was overwhelmed and didn't know any better. I didn't know about message boards at that time and we had just moved to a new state and I didn't have anyone to ask. I did do searchs for various info on surgeons. I ended up having to switch. This one was the second surgeon I had seen. The first one said she didn't know what to do with me. I won't go into the sad details. I trusted him and thought he knew what he was doing because I was referred by two different people and I looked at his background. So I didn't think to ask anyone else or check on it. At the time I didn't think I was going to survive anyway. My odds weren't too good. So I guess I thought it didn't matter.

ah, yes..
My odds are not what the cancer world is holding up as "proof of progress" either. I am sorry that you and I have won that particular door prize at this party.

As to the reconstruction aspect of it... did you end up doing any?

And to swim1mom- i did the neo-adj chemo because they wanted to shrink the cancer as well. I did have a bilateral mastectomy following it. So, the neo-adjuvent chemo is not exclusive to breast conservation (lumpectomy). I had expanders placed during surgery and was fully expanded prior to radiation. I did the radiation (lots of it) and now I am waiting a couple more months to exchange my expanders for implants. I was not a good candidate for using my own tissue and I am definitely fine with that.

swim1mom said:

My original plan was to do
My original plan was to do chemo to shrink the tumor than lumpectomy (but found more cancer and is to large to do lumpectomy anymore)so now it is mastectomy. Actually it was one of my nurses that told me they could do chemo than surgery.....but knowing that I have more than what they originally thought....Decisions, decisions.....

Chemo...
I did the neo-adj chemo and many have told me that they wish they could have. Sounds strange, huh? Their logic was that if they had been able to do so, they would have at least known whether chemo worked for them. If you do the surgery, then chemo, you don't actually know if that chemo was effective or not. If you do chemo then surgery, you can gauge whether it was responsive to chemo. Your hormone status is also something to consider. If you are triple negative, you don't have hormonal treatment and chemo is important.

If I didn't explain this well, I apologize. Please ask questions if I need to clarify.

So many decisions
If you do chemo first, then you can see how effective chemo is with your particular cancer. That can be helpful and a lot of doctors these days give it a try. Then they operate and usually do a bit more chemo afterward. There are lots of different choices when it comes to reconstruction. Most large towns have doctors that can manage implants or perhaps tram flaps. If you go to a breast clinic in a large hospital, DIEP or SIEP flaps (where the surgeon removes body fat from your abdomen without removing hardly any muscles) can be used. The advantage of implants is that they are faster going in and don't need a blood supply to work. The disadvantage is that they may only last 5 years and then need replacing. The advantages of body tissue transplants are that they grow and shrink with the body, they feel more natural, and they don't have to be replaced once they are in place. However the recovery time is longer with tissue transplants, sometimes the blood supply isn't sufficient and they fail, and they are more costly if you are footing the bill. The DIEP and SIEP flaps are only done by specialists of the highest order and you can't find those guys just anywhere. Insurance will often pick up the tab for all of costs, but you have to check to make sure before you sign the dotted line. You also have to talk frankly with all the doctors involved. A friend of mine was all lined up for the DIEP flap operation. The plastic surgeon and the regular surgeon got in a fight while she was being prepped. It seemed that her cancer was too close to her armpit and the surgeon was insisting that she would need radiation afterward which would doom the tissue transplant operation. She ended up not getting them, but the worst thing was dealing with a conflict just before the operation. The Susan Love Website has actual photos of women who made various reconstruction decisions along with their stories. You might read their stories to decide what is right for you. No decision is wrong as long as you and your doctor think it will work for you. Good luck!

C. Abbott

Things can change...
This is a decision that you could delay.

Frankly, bi-lateral cancer is not so good.

That means that the priority of your team has to be first on saving your life and second on managing your cosmetic condition.

Sorry, honey. It's brutal, but that's what it is.

What is the pathology of these cancers?

I can't help it...it's an issue. ER+ cancers can be "blocked"...follow on hormone blockers can reduce your risk of recurrance. Us ER neg gals have to rely on chemo, surgery and rads.

The bi-lateral thing really means that you have an increased risk of getting breast cancer again. To my knowledge it doesn't mean that you MUST have mastectomy.

But, you certainly need to seriously consider having the bi-lateral. Seriously.

It is possible...my best understanding...for you to take a portion of the chemo...let's say 4 rounds of AC. Then, have surgery with placement of expanders. Then, do more chemo...let's say Taxotere and rads.

After everything heals, you could exchange the expanders. (6 months after rads.)

The advantage to doing some chemo first is that it may shrink the tumors and possibly reduce the amount of axillary dissection. (Usually, this "translates" to reduced risk of lymphadema.)

IF your efforts with implants don't work out...and there's a possibility that they won't, then you could go back (after all treatment is completed) and do flaps.

I know that things can change.

In January 2005...at initial diagnosis, I had cancer wrapped around my chest wall. It was inoperable. So, neo-adjuvant chemo wasn't OPTIONAL. It was mandated.

The cancer shrunk significantly. After the chemo, I was a candidate for breast conservation, but I elected to do bi-lateral mastectomies. After rads, I had reconstruction (flaps.)

Please keep us posted.

Tammy Lou

Mastectomy VS Chemo First
Wow, I am so sorry about your diagnosis. My personal opinion is a mastectomy asap, then have chemo. Your oncologist should be able to tell you how long your chemo will be held until you are healed. I think you will probably be advised to have radiation too, so then I wonder if you will need to hold off on reconstruction until you have finished with that. Only your oncologist can tell you that, but I would also speak with a good plastic surgeon.
It is so hard to think and make decisions at this time. Talk to the professionals and then chose.
I had the same type scenario as you have. I am 2.5 years out now and I am finally going for breast reconstruction in a month (had to wait due to some unfortunate cardiac side effects). But, things are looking good. It's very scary but somehow you get through it. Lot's of help out there.
Best to you,
Joan