Topic: Unilateral vs. bilateral mastectomy?

Feb 28, 2008 10:37 AM mradf wrote:

Lorena,

I believe that my genetic counseling sessions(my test was negative, too) and the consult with the plastic surgeon before making my decision both had a great impact on my decsion.  I opted for the bi-lateral mastectomy, one side cancerous and one side prophylactic and, two weeks out, have no regrets.  I was also given the best possible pathology report this week, as they got it all, clean margins, no invasion to the lymph nodes, and I do not need chemo or radiation.  To my surprise, I was not the best candidate for the reconstruction using my own abdominal or back tissue.  Honestly, although I would have loved having my own tissue and the happy side effect of the tummy tuck, I am happy I do not have the additional challenge of healing from that on top of the bi-lateral mastectomies.  I had expanders placed during surgery and my PS and BS anticipate an excellent outcome.  My PS said that the bi-lateral gives him the best chance   to provide me with the most uniform result. Although neither doctor pressured me to have bi-lateral, both told me afterward that I had made the best decision based on all the factors including family history, peace of mind, size of cancer, etc.     

Ultimately, you need to make the best decision for you using all the information you can gather.  And you will.  Once I made my decision, I felt calm and never looked back.  Please let us know what you decide.

Maria

Feb 28, 2008 04:29 PM, edited Feb 28, 2008 06:09 PM by Sassa

I was also over endowed before my diagnosis.  I opted for a mastectomy (no reconstruction at the time). 

It was horrible being so uneven.  I thought I had back, shoulder and neck pain before the mastectomy.  Believe me, it was much worse after the surgery.

I thought about having a reduction of the other side.  My oncologist recommended that I have a simple mastectomy as it is much easier to recover from than a reduction.  She also pointed out that if I decided to have reconstruction, I would be starting out even.

When I had a funky mammogram on the other breast, I went ahead and had the simple mastectomy (turned out everything in the breast was benign).

At this point, I have not had reconstruction.  My prostheses are about an A cup size.  There are days that I go without them.

I love being flat chested.  My back, shoulders and neck don't hurt.  I can finally find tops that fit across my bust and on my shoulders.  I can exercise without discomfit.

I don't think I will ever have reconstruction.

Mar 3, 2008 06:24 AM 1965sally wrote:

Glad to read about all your experiences.  I would have liked to have a support group to discuss the challenges of being DDD (me too!) even before I had cancer.  I hope more people who've experienced lopsidedness will post here.  I'm weighing up everything now, trying to decide whether to have a prophylactic on the other breast.  But I know cancer can still recur after mastectomy, but it would be nice to get off the surgery merry-go-round, as you said!

One factor I'm keeping in mind is my 2 year old daughter.  I would like to have the least arduous recovery possible, for now.  Is recovering from bilateral much worse than from unilateral?  Or is it better than two separate unilateral recoveries - like a two-for-one special??

Mar 4, 2008 06:25 PM LorenaB wrote:

"My oncologist recommended that I have a simple mastectomy as it is much easier to recover from than a reduction. " 

Hmm, if this is always the case, then it will definitely influence my decision in favor of the mastectomy.

A few more questions: is DIEP the surgery where they take muscle from the abdomen?  or is that TRAM?  I'm still no good at keeping all procedures straight. 

For those of you who elected to have a double mastectomy, did your health insurance cover it completely (including reconstruction) even if only one side was cancerous?

Right now I am leaning toward the bilateral but I still haven't seen a plastic surgeon, so I have a ways to go before making a final decision.  Thanks so much for the input, it is really helpful!

Mar 4, 2008 10:15 PM Kathy_K wrote:

In the muscle sparing free tram, the doctor uses a postage stamp size piece of muscle.  In DIEP the doctor dissects the muscle to remove the blood vessels that run through it.

And, yes, the insurance companies will pay for the surgery to the other side for symmetry.  At Kaiser, I had a unilateral MS free tram.   The Stage 2 included the reduction on the other side was considered a follow-up and only cost me $15.00 !!  Insane!  Anyway, I understand that the insurance companies must pay until you are satisfied as long as you do it with one of their providers.  Go outside the network and you may have a fight on your hands.

Anyway, I ended up having an unfavorable pathology report after my reduction and ended up having another mastectomy.  This time I needed to go for an implant.  I got the one-step procedure and that recovery was a piece of cake.  Whatever you decide  I will tell you that having bilateral surgery will give you the opportunity to have matching reconstructions.  If you think that if you go unilateral, you will be second guessing yourself and waiting for the other shoe to drop, bilateral may be the right thing for you.  Some women can just do one side and then forget about it and worry about the other side when and if they need to.  Which woman you are will determine your choice.

Good luck with it.  No matter which you choose, there will be others that will tell you that you are wrong.  You have to do whatever feels right to you and for you. 

Mar 5, 2008 05:57 AM 1965sally wrote:

This is a really helpful thread - thank you all. 

I asked my breast surgeon yesterday about getting a reduction on the good breast at the same time as the mastectomy, and he thought it was a good idea due to my large breast size (plus, the tissue from the reduction can be sent to the lab for a pathology report, which could help my peace of mind).  But the one plastic surgeon I'd consulted before said he wouldn't do that - insisted that you have to do any reduction at the time of reconstruction.  But I'm not so concerned about having a matched pair.  I may have to have radiation after the mast., delaying reconstruction for months, and I don't want to be carrying around a watermelon on one side with nothing on the other!  It sounds like bad back city.  So I'm shopping for other PS opinions this week. 

Do any of you have advice on this?

Mar 6, 2008 05:39 AM 1965sally wrote:

Thank you for the advice moonie, glad to know it worked out so well.

Mar 8, 2008 05:19 PM mradf wrote:

nurse1brastcancer2

I can tell you that my sister who was diagnosed at age 46 and is now 51 opted for the lumpectomy , followed by chemo, radiation and a subsequent brain tumor (cured).    When I was diagnosed in November, I took a lot more time to decide than she did, and opted for the bi-lateral mastectomy.  Now granted, our cancers and lives are different.  She had a palpable lump that she found, I had microcalcifications found by mammogram.  She never had children, and I have two ages 11 & 14.  She does say now, however, that if she were to have another breast cancer, she will not hesitate to have a bi-lateral.  It's cool that your husband is cool.  That helps a lot.  My husband of 24 years was okay with whatever I decided, and, more importantly, he was able to look at me after surgery, help with the drains, showers, dressings, etc.  THAT is what in sickness and in health really means!  I am still healing from Feb 14th surgery and in the reconstruction process and have no regrets at all.

You will make a decision that is right for you. 

Good luck.

Maria 

Mar 8, 2008 05:53 PM otter wrote:

nurse1breastcancer2,

I don't like the looks of that score.  Hopefully, it's only the first inning of the game, and you have 8 more innings and a lot of at-bats to turn things around! 

If you are really considering a bilateral mast. as the solution to your newest tumor, I think these issues are the most important:

1) Is there a strong history of BC in your family?  Were you (or were others in your immediate family) tested for BCRA1 and/or BCRA2 and found to be positive?  That would increase your risk, for sure.

2) Have you had a breast MRI in association with this most recent dx?  That will tell you whether there is anything of concern in the "good" breast. If there is evidence of another malignancy there, that would strengthen the argument for a bilateral (for some women).

3) How hard is it (or how hard has it been) to check your breasts for recurrence or new tumors?  If you have very dense breast tissue or fibrocystic breasts (like mine), you've had a devil of a time sorting out the normal from the suspicious, and mammograms haven't helped very much.  How was your newest tumor discovered (mammography?  self-exam?  annual CBE?)?

4) You said this was a "new breast cancer" in the same breast.  Are you sure it's an entirely new tumor (new primary), or is it recurrence of the original one that was treated in 1999?  The rate of same-side recurrence after removal by lumpectomy/rads is around 10% over a 12-yr period.  The same-side recurrence rate after mastectomy is only 5%.  So, maybe your new tumor is actually due to cells left over from your old tumor.

I don't know how your previous chemo fits into the recurrence picture.  And, I can certainly understand how frustrating and saddening this must be. Hang on to that dh--he sounds like he will be your rock through all of this!

Big hugs!!! 

otter 

Mar 25, 2008 05:18 PM, edited Mar 25, 2008 05:19 PM by kswdy

It's time for me to make the big decision. I had a bilateral lumpectomy 8 years ago, no cancer. I went from a near B to a near A. This past August I was diagnosied with HER+ bc in my right breast (2.8 cm). I've had 24 weeks of chemo(tumor now drastically reduced) I will have Herceptin and Avastin for the next year. I can have a lumpectomy but I would need recon after so a mastectomy sounds better. I'm leaning toward bilateral because I'm HER2+ and I want to do whatever I can to further reduce the chances of this happening again. I'm afraid of how it would feel to only have one side done. Do you feel an imbalance? I'm 43 and there is no bc history in my family. I will have immediate recon with expanders....I am on the thin side of things. Does anyone have any advice? I am so confused.

Apr 12, 2008 09:37 AM kimbly wrote:

I am going for the unilateral with immediate reconstruction/ left breast.  At this time it is all I can handle.  I have thought about it alot, it is a very personal decision.  I did consider having the gene test but then decided at this time not to. There is no history of breast  cancer on my moms side at all but I am unsure of my dads side.  MY surgeon said that considering that and that I am 46 she would not try to talk me into the genetic testing.  I may decided to do it later and then go from there. 

Apr 14, 2008 07:11 PM VBG wrote:

I have opted for bi lat as I was diagnosed with ILC in June '06 and again in Jan '08 in my left breast.  I did have genetic testing and was negative.  I had rads and tamox and neither worked to stop the recurrence of cancer.  I am now 48 and my only concern is being cancer free from this point forward.  All the docs agreed that I needed a mast on the left side and most thought that the bi lat was a good idea given my age and the likelyhood of another cancer over the course of my lifetime.  My cancer journey has been challenging since the recurrence was a major surprsie to all my docs given that I had such a low grade cancer.

I did decide that I wanted a more uniform look as well so that was a factor too.  I keep telling myself that I will have young/perky boobs when this is all over!

I am scheduled on April 29th and hoping that the outcome will be good.  No matter the outcome I will be on my way to cancer free!

Apr 14, 2008 08:07 PM ehkonline wrote:

I also went for the bilateral mastectomy when I was diagnosed with ILC last fall (skin-sparing with expanders). I am only 36, with a strong family history and mom to 2 kids, so I had no desire to repeat this process.  In addition, I really felt like my outcome would look better with both being the same, and I thought it would feel strange to have one real and one fake.  I am very happy with my reconstruction and would not change a thing about my surgeries! 

Apr 15, 2008 07:26 AM Dejaboo wrote:

Im wondering too how you get your Surgeon & I also have an Oncologist who Is agaisnt a Bilateral Mastectomy.  My Surgeon says he wont argue with me, But he doesnt think its necessary to treat this current cancer (Hello-thats not my Only goal!! & I have told him that)

I see a Different Onco next week.

 I had a Lumpectomy already...Mainly because I had to do something & No one was listing to me saying I wanted a PBM.

So what Problems may I also encounter with Insurance...Does anyone know?  Will my Surgeon Be able to word it right so I can go ahead with my Plans?

I will get my Genetic testing back in early May- Im sure that would help with the insurance end.  I am hoping it will be Negative for my Daughters Sakes. (Would be nicer for me too )

Apr 15, 2008 08:21 AM Noni wrote:

My story and thinking is the same as Dani.  I had DCIS in one breast and decided to go with a bilateral.  

Honestly, if you want a bilateral your surgeon has no say. I had a mild cancer in one breast and could have easily gotten away with a lumpectomy and radiation but I decided to be more aggressive and just get it over with at once.   My surgeon was supportive but even if he weren't he couldn't override my decision with the insurance company.

The insurance company will pay for a bilateral and full reconstruction no questions asked.  They would much rather pay for one surgery than several other down the line, if it came to that.   Not to mention they are legally required to pay for it.

For what it's worth, I got the genetic testing done and decided on the bilateral before I even got the results.   I knew that regardless of the outcome I was going to go thru with the bilateral.  When they finally called to say that the results were in I seriously considered not getting them until after surgery.  In the end I learned my results (negative) on Friday and had the surgery on Monday.   I have no regrets.