Lumpectomy with oncoplasty (bilateral reduction mammaplasty)
I'm starting this thread because I thought it might be useful for those of us undergoing this procedure. (I surely can't be the only one that did it!) I did find a thread that was a couple of years old, but it really didn't address what I hope to here, which is a description of the process, experiences of the procedure, and what to expect afterwards. While I've gotten some good information from the lumpectomy threads and some from the reconstruction threads, hopefully this is a way to put it all together. What follows is a combination of what I've experienced and what I've read about oncoplasty as I researched it pre-op. Hope it helps.
What is it?
Essentially, it's a lumpectomy combined with a bilateral reduction mammaplasty (bilateral lift and reduction)
Why do it?
Margins: This technique allows the surgeon to get large margins without fear of leaving the breast deformed or having the two breasts be lopsided after surgery. Good margins, as many of us know, are critical. My tumor was fairly shallow, so that is my closest margin, the one to the skin, and that one is 6mm. The rest are 14mm +. My
lumpectomy specimen, as delivered to pathology, was 7 cm x 7 cm x 4 cm for a 1.7 cm tumor, so pretty large. In addition to that even more tissue was removed from my breast(s) by the plastic surgeon. If future breastfeeding isn't a concern, they try to remove a lot of the parenchymal tissue from both breasts (the ducts and lobules) so theoretically that might also reduce some recurrences (studies still underway).
Radiation: From what my Dr. said and from what I've read, oncoplasty actually makes it easier for the follow-up radiation, which is an essential part of the treatment plan for oncoplastic lumpectomy, just like with regular lumpectomy. Easier positioning, easier to accurately dose, fewer complications.
Edited to add follow-up 6 months after radiation: Radiation was very easy for me with no skin breakdown or major problems. I have no idea if the reduction surgery helped in that regard or if it would have been that way anyway, but just weighing in on my experience.
Tumor location: Sometimes a tumor is located in a position that will make it more difficult for a breast surgeon to remove it all with good margins and still leave the breast looking fairly normal. In my case, my tumor was situated at about the 11:30 position, but much of it was actually under the areola-nipple complex. My surgical breast oncologist immediately offered this procedure to me as the way to get the best oncological and cosmetic results from the surgery. It can also be used to allow the lumpectomy option for some women who might have tumors larger than what is usually considered optimal for breast conserving surgery.
Physical/cosmetic: First, I should say that cosmetic results were almost the last thing on my mind when I started to go through this a couple of months ago. Having said that, I'm very satisfied with what my breasts look like/feel like now compared to my "BC" (Before Cancer) days. Not something I could have predicted as an outcome. While only a size D "BC," my breasts were uncomfortable -- saggy (ptosis), heavy (bra-strap indentations), cumbersome. I never would have sought out any surgery like a lift and reduction, but now having had it I just feel much better, aside from the post-surgical pain. The main reason for doing it, for me, was not the cosmetics but for the oncological benefits...however, if I have to go through having cancer, it's a nice, unexpected consolation prize. Some plastic surgeons will only do one breast initially and then do the other after radiation is completed and they can match it up better to the treated breast. The other option, which mine did, was to do them both at once and leave the cancerous breast slightly larger, anticipating it'll shrink down a little bit after radiation, with the plan of evening them out later only if necessary.
Edited to add follow-up 6 months after radiation: My PS's calculations were pretty correct and the radiated breast has shrunk down a little bit so they're pretty close to equal. It's still a tiny bit bigger, but I still feel occasional tightening going on so wouldn't be surprised if it shrinks down a tiny bit more. I'm pretty happy with the result. The scars have also faded considerably and I suspect that eventually they'll barely be noticeable.
Contraindications: Multi-focal cancers, certain kinds of aggressive cancers, any condition that would make a MX the best treatment of choice, not having access to an experienced team to perform the surgery (SO/BS + PS), small breasts. And probably more that I haven't run across yet.
Complications/negatives: Like with any surgery, they happen. Sometimes margins are still compromised. Sometimes there are issues with healing. Sometimes there is a loss of sensation in parts of the breast (more on that in next post). Sometimes there is a loss of the ability to breastfeed. There is a longer recovery time as compared to regular lumpectomy.
The next post will just focus on what I've learned in terms of preparation for surgery and recovering from the surgery, in case it might help someone else.
There's a lot of information about oncoplasty online, but here are a couple of sites that seem credible that I've run across.
Comments
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OK, so this is what I discovered in having this surgery. I didn't actually make all of the preparations I'm mentioning....but wish I had!!! Which is why I'm making the list for anyone else who might be interested.
As I said in the last post, the surgery requires a joint team of BS and PS. My PS has been the one responsible for most of my physical follow-up (post-op visits, etc.) except for one follow-up with the BS. For the actual surgery, the PS made the initial incisions, based on our planning visit when I got to "choose" my ultimate breast shape, and then the BS stepped in to remove the cancer and do the sentinel node dissection/biopsy. It was a
long surgery--about 3-4 hours. (Side-note: I just realized as I wrote this that that planning visit finally gave me a sense of control over a situation that, so far, had seemed so far OUT of my control. Never thought of it like that before, but it's definitely true. A plus.)Recovery from this surgery is a little different than from a regular lumpectomy. Some things are the same and some are different, so I'll just speak to my experiences even though some overlaps with that of a lumpectomy and some with some kinds of reconstruction and you'll find references to a lot of these things in one thread or another.
When I woke up after surgery, I had a large compression bandage over my chest -- looked like a big, gauze, bra--and two drains, one on each side. I've read that some doctors use either ace wraps over a dressing or a surgical bra with dressings, but this was what I had. I wasn't draining much, so had the drains out and got to leave the hospital the next day, and kept that initial bandage on for a week, after which it was removed at the PS's office. I then had to wear a bra night and day for the next 2 weeks. Try to buy a good, COMFORTABLE, supportive bra (no underwires). I've had a terrible time finding one that works for me, mostly because of the way it rubs my incisions under my breasts. I'd recommend one with a wide band. I know they're out there, but I just haven't been able to get one that works for me. Should've done it from the beginning or used the hospital breast center for that!
Plan on at least one week of doing almost nothing. Or, as my PS said, being a couch potato. That means no trips to the store, no going out to dinner, nothing. Technically, I was told not to drive for 3 weeks (!!!) since it pulls too much on the incisions, but I simply couldn't last that long and drove after a little over 2 weeks. Just a little (emergency trip to the store 1 mile away). I could see why I wasn't supposed to earlier, though. I basically set myself up a little nest with laptop and books in my bed and stayed there most of the time.
So be prepared with plenty of food, including pet food, pre-prepared meals, and friends and family willing to help and act as chauffeurs.
You will also be unable to raise your hands above your head for about 3 weeks, other than bending at the elbows to brush teeth, hair, etc., so prepare the house accordingly. I live alone, so took a supply of dishes & non- perishable food down from the higher cabinets and placed them on the countertops so I could reach them (who cares if the house looks like a mess, right?). The biggest unprepared-for problem for me was how to use the microwave, which is above my oven. I actually ended up using a step-stool so I could still reach the microwave without lifting my arms so I could zap my tea-water and some of the meals I'd prepared and frozen ahead of time.
Wash your hair the night before/morning of surgery, since no showers for a week post-op, until the big bandage/dressing is removed. It's still difficult for a couple of weeks after that since you basically have to keep the operated area dry as you can in the shower and only bend your arms at the elbow to reach your head. And baths. I--finally--got the OK to take my first bath this week (6 weeks post-op) as long as I don't soak the breast area yet, since I'm still healing. So a half-bath, really, but it felt SO good!
You won't be able to lift much for a while. Almost nothing the first week, and then up to around the weight of a milk container for the next couple of weeks. This presented a problem for me in a couple of unexpected ways. For instance, pouring the cat-food out of the ten lb. bag. (Solution - measuring cup inside the bag.) Also, things like opening/closing car doors or trying to open a lid from a jar or a child-proof medicine bottle cap presented unanticipated difficulties. The first week is especially rough.
Needless to say, no laundry, no housework, no vacuuming for about 3 weeks (good excuse, right? ) And front-closing bras and tops are a big help in the first weeks. The hardest part for me was not being able to babysit my two, rambunctous little grand-baby boys. Can't lift them plus they have too many elbows and knees. But I suppose if I had to it could be done, with some planning, and there are some moms out there for whom this might be an issue, too. Something to plan ahead for and figure out a way to make it work.
Pain and healing. I actually haven't had too much pain, nothing unbearable anyway. I stopped the pain pills the day I left the hospital and just used tylenol for a week, and then ibuprofen. However, it's now 6 weeks post-op and I'm still sore and tender. Some parts of the surface area of my breasts are actually numb due to the cut nerves, which is a weird feeling. Others are hypersensitive. Sometimes I feel sharp, shooting pains or a feeling like chills as nerves regenerate (or that's what it feels like they're doing). Sometimes the incision lines under my breasts feel like they're pulling...all part of the healing process I guess. I still have a little bit of scabbiness on a couple of the incisions. And I still have scabs on my nipples, which is not typical but a result of my particular procedure.
As I mentioned in the last post, my tumor was right under the nipple, so the decision was made, because of the location and since I'm past my childbearing years (so no need to breastfeed) to actually remove my nipples during surgery as full-thickness skin grafts and then re-attach them after the tumor was out. (Ewwwww, right? I stopped reading the op report about the time it said they were "properly labeled and placed on a moist sponge...."). This is NOT the typical procedure, though, but specific to my case. However, it's not too bad, in case someone who is reading this will have to go through it. They will look nicer, eventually, as the PS made the areolar areas smaller. ( Mine were too big to start with and would've looked even worse on smaller breasts.) He was also able to place them higher on my reduced breast so they look nicer in that way, too. The first set of stitches around the nipples, holding on the pressure bandage, were removed after the first week. The second set, holding the nipple on (talk about Franken-boobs!) at about three weeks post-op. The drawback is that, as of now, they have no sensation and it's likely they never will, although I do notice some response to cold. Not that I can feel it, but I can see it. And it takes a while to heal.
So. Like I said, it's kind of a mix of procedure and recovery issues to have this done. Hopefully listing some of the particulars will help someone contemplating/preparing for this surgery, not that I'm any authority or anything but I just didn't see another place where it was all combined so as to pertain specifically to oncoplasty. Despite some of the added difficulties compared to a lumpectomy only, I'm happy with my decision. Everyone is different, though.
Feel free to ask any questions, or if anyone else has gone through this and has a diffierent or similar experience, please chime in and add your two-cents.
Whew, this is a long post!
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Hi Nyama! Thank you for this most informative post. (I also read your other post to me as well :0) ) As you can see, it's 2:48am here in CT and again I can't sleep all night. I do have sleeping pills but I only take them if I truly have to. My PS gave me a list of prescriptions and post surgical things to get which I thought was great. The prescriptoins he gave me were: Percocet for pain, Keflex for infection and Zofran for nausea. He also told me to take a stool softener (Colase) three days before my surgery as the anestesia and medications usually cause constipation. He also told me to get a front closure sports bra and to order Tegaderm patches for scar care (website:www.amazon.com, search 3M - Tagaderm Transparent Dressing with Label - 4 x 4 3/4) I will continue to post so I can share my experience(s) with anyone else thinking about this type of treatment. Thank you again. I'm sure we'll talk again soon :0)
Nancy
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Hi Nyama - Similar to you, I have a DD+ cup size so I have a lot of "extra" tissue to work with. Luckily for me because my DCIS is 9cm long by about 2 cm. My BS offered this option to me and I am comfortable trying it. My reasoning is that even if she doesn't or cannot get clear margins, or there is an invasive component then at least I know that I tried to excape a possible unnecessary mx when I could've had a lumpectomy. Reducing the other breast made sense to me too so that it would match my other breast. My surgery is in 4 days (not counting or anything LOL) and I have moments of peace along with moments of anxiety. I was happy to read your posts. They helped me so much. (Maybe I can go back to sleep now :0)
Nancy
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Hi Nancyinct - Sounds like your PS is giving you some of the same medications as I had. I had the keflex and percocet and WISH I'd known to take something like colace because, yeow! I've never needed a stool softener before but those pain meds are horribly constipating, which I didn't know. I only needed percocet the day I came home and stopped the next day (thank goodness because I still was constipated for days afterwards.) While I, personally, wasn't nauseated, I know some people get that way after surgery.
I'll also have to look into those tagaderm patches (thanks for the links) My incisions still bother me, especially the ones under the breast where my bra rubs me. They alternately itch and burn. The rest of the my breasts are just tender, overall, but support really helps.
I bet you'll be so happy to have that surgery over with! I know I was. I just wanted the cancer o.u.t. and have it be behind me. And I also had issues sleeping (and eating). It seemed to get better over time, though, as by putting one foot in front of the other I've walked my way through this. I was afraid of how much this surgery would hurt and tried to imagine it but, honestly, it hasn't been too bad (at least compared to what I anticipated). It's no fun being sore and scabby but it's not intolerable by any means.
Hopefully they'll be able to successfully get all of your DCIS with good margins. That's the beauty of this technique in that the PS can basically work around whatever the BS needs to do. Thinking positive thoughts for you that they'll be able to get it all.
Will they be doing a wire guided lumpectomy? (I'm not sure if it is the same for DCIS as IDC. ) Another good thing is it sounds like your Drs are being really communicative with you about what to expect. So sounds like you're very lucky!
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Hy Nyama - Yes, they will be doing a wire-guided surgery. They will insert two wires prior to the surgery. I asked how painful that part would be and they said that I wouldn't feel a thing. It will be much like the biopsies that I had and they will inject lidocain into the area first. I did well with the biopsies so I am not worried about the wire guides. I still need to get a front closure bra, which are a bit hard to find. I looked over the weekend and couldn't find one. I'll try again after work today. I've read on this site that Walmart has some, so I'll try there. Thank you for your post and your wealth of information. It has helped me so much.
Nancy
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I want this procedure as opposed to the traditional lumpectomy. I'm having a hell of a time finding a surgical team willing to perform it here in Oklahoma. Where did you have your surgery done at and who was your surgeon? I had a mastopexy (lift) with augmentation back in 2007 and love love love the results from that surgery. I have consulted with a few PS in the OKC area and only a handfull do "breast reconstruction" work. Any suggestions for a team willing to do this procedure for me would be greatly appreciated.
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Hi Raven. Well, I'm in Oregon (near Portland) but I know they do the surgery in other parts of the country. I'd google "oncoplasty doctor," or something similar, to see who is closer to you. I'd imagine it would be larger cities with teaching hospitals, but probably not exclusively. There seem to be a few procedures performed on the east coast and upper midwest. Or maybe Texas would be an option, since it's much closer to you and I know they have some fine facilities down there. ETA: I just googled "oncoplasty doctor texas" and came up with a few, although of course I don't know anything about them so you'd need to research them. I'd try to go with a reputable cancer center.
I do know the procedure is not right for everyone, but it wouldn't hurt to be evaluated to see. I know I'm happy with my decision.
Nancyinct, if you're still reading this thread, how did your surgery go?
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Hi Ladies so glad i have found your posts as this is the surgery i am due to have.
I was diagonosed on 29/05/13 with DCIS and Invasive Ductal Breast Cancer. I was started the day after on Tamoxifen. The surgeons told me that they could do a lumpectomy however i could be left with quite a dent or gave me the option of Lumpectomy with Oncoplasty (think its also known as Theraputic Mammoplasty) which is what i have choose.
We are going to the Carribean on hols on the 29th July and they have told me that it wont effect the cancer if i leave the op till i return. I am having a wire guided lumpectomy and oncoplasty followed by radiotherpy. They will also remove some lymph notes for testing at the same time.
I have searched the internet and several sites to see if anyone has had this op and yours is the first i have come across.
I have found a very usefull site on breast reduction that might help you with some of the questions.
http://www.breasthealthonline.org/cgi-bin/mwf/board_show.pl?bid=3
Bernie x
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While I did not have a cancer dx, a biopsy showed ADH in my case, which was removed via excisional biopsy. My breast surgeon said no further treatment was required, but being the worried and paranoid type that I am, i did some research on my own on breast reduction, which some European and Canadian studies have shown to reduce the incidence of BC. Being large breasted, this seemed like a no brainer to me. I wish I had had better timing so that I could have had only one surgery-- I had the lumpectomy first, followed by the bilateral reduction 3 months later.
While the first week post-surgery was painful (sleeping comfortably was a challenge), by and large, the whole ordeal was a good deal easier than I expected. I did not have trouble raising my hands above my head, had no drains, and was able to shower 48 hours later. I was back doing 35 mile bike rides 3 weeks afterwards (with a sturdy sports bra!) and used the silicone gel strips for scarring. It is now a little over 2 years later and the scars are really almost invisible.
As for the cosmetic results, I couldn't have been more pleased. I went from a 34D to a 34B. As I am pretty active and athletic, it's liberating not having to drag the big boobs around, and I love that I can wear things now that weren't possible before. I am much more proportional.
I wish more people knew about this as an option. For anyone in the NYC area, NY Presbyterian Weill Cornell has a great team. I would highly recommend them. But what's disheartening is that my BS, who is at NYU and did the excisional biopsy was highly dismissive of this procedure-- one done at another top notch hospital less than 2 miles away.
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I'm so happy to read all of this. I was dx'd in Jan. 13 and chose to do chemo first. I've now finished with that and am starting the surgery portion of my treatment. I met with the BS and left feeling pretty confident about a double mx with recon. Well....I met with the PS today and he's turned me all topsy turvy! He's given me 4 options with lumpectomy with oncoplasty being his suggestion (the BS also suggested this, but was ok with my descision too). He said that if I was his wife or daughter he would suggest this same plan. So now I'm not sure what to do..... My surgery is scheduled for July 15 so I need to decide soon.
One of the reasons I didn't want to go the lumectomy route was that I would have to have 6 wks of daily rads - so I would love to hear about anyone's experience with that.
thanks for everyone's input!
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I had a partial MX w oncoplasty 2 years ago on my over sized DDD breast followed by bilat reduction a year later. My MX breast looks like a normal boob. The surgeon removed 10cm of tissue and thanx to the oncoplasty it has a very natural shape, but the 5 inch scar runs accross the top. Maybe a vine tatoo to hide it if my MO approves. The tumor was large but so was my breast. My reduced side is so cute. Never thought I'd feel that way about them, I wish they were smaller though. They are a large C. The PS had to match them.
I guess this is an under used procedure but maybe for good reason? I wonder sometimes if ca tissue was moved around to another part of my breast during the oncoplasty the surgeon didn't know yet if the margins were clear.... They were.
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My own opinion is that the medical establishment is very slow to embrace change. I think that new procedures can tend to be discounted simply on the basis of unfamiliarity or, in the case of this surgery, the fact that a particular surgeon is just not well versed in it.
I know I had some piece of mind when I was told that the 800 grams of tissue removed had been sent to pathology and that all was clear.0 -
I had an oncoplastic partial mastectomy for DCIS in 2009. My surgeon took a 10 X 4 cm chunk plus six additional margins from my 34 small D breast (average, not full figure, as I am petite). He filled in the cavity and reshaped and lifted the remaining tissue, leaving a well-shaped but smaller breast. After shrinkage from radiation, that breast was at least a cup size smaller. I waited until a year after radiation to have symmetry surgery; a small reduction and lift on the opposite breast and some fat grafting to augment the radiated breast. My breast surgeon told me that with oncoplasty, while the cosmetic result is much better than standard lumpectomy, the drawback is that if my margins were not clean, I would have had to go straight to mastectomy. After the tissue rearrangement, a re-excision would not be feasible.
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momoschki --- I felt the same way after my surgery (I had about 400 grams removed). My PS said they routinely get some really wide margins with this operation, which is one of the plusses. (But, yes, if for some reason there were poor margins, it would be hard/impossible to re-excise) And yes, I think a lot of surgeons really aren't familiar with it, although more and more breast centers seem to be offering it, especially overseas. It does take coordination with the PS. All I know is that I'm very happy I went with this choice for my particular cancer.
Mermaidia --- re: radiation....I'm actually in my third week right now. My experience has been so far so good. I have a very minimal rash starting now, but no biggie. I'm sure it'll get a bit more intense (and some women do have more severe issues) but the biggest problem I've had with rads so far is getting there every day, which is kind of a pain. I decided to save gas and wear and tear on my car, so I take the tri-met into downtown every day for my 10 minute appointment, about a minute of which is the actual radiation, and then turn around and head home.
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Mermaidia,
You did the neo chemo so I assume that your lump shrunk to make a lx easier and more feasable? That was the plan my first BS suggested but I was not comfortable with her plan. She wouldn't attempt a Lx unless I did the neo ACT. It was that or a Mx. I searched and found a BC sugeon in NY who uses CO2 laser for all his BC surgeries with oncoplasty, and the plan was to do LX or MX. He was able to do a Lx where NO other BS was willing to do for me.
For me the rads weren't bad at all. the worst part was going everyday. 25 zaps and 9 boosts to the tumor bed. The skin never burned but did turn reddish, fatigue, and my blood glucose was out of control which they never warned me about. I'm diabetic. Today my skin feels soft and normal. Maybe the scar a bit deeper and darker??? It was really easy but it is toxic. ALL BC TX's are.
Good Luck with your decision. It ain't so simple.
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Chef127 - I'm also diabetic and chemo/steroids with chemo were really bad on my glucose. I've had to start using inslulin because of it and am now weaning off. I didn't realize rads would also do that...yikes. another reason to avoid it.
The main reason my PS thinks I should have an lx is because of my diabetes. He says the least amount of surgery is the best in my case..
The neo chemo has been very successful - my tumor started out at 1.8 centimeters (it could be felt and measured) and now my MO can't even hardly feel it. So I'm pretty sure the lx would be successful...I'm just not sure that's the route I want to go yet....
Nyama - I about choked when the BS said rads would be daily for 6 wks....and then I can't have my beautiful new breasts finished for up to a year....Where do you go for rads? I assumed I would go to St. Vinny's, but not really sure.
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Mermaidia, I'm going to Compass Oncology's Rose Quarter facility for the radiation. (And I live in Canby! .....which is why I decided to let tri-met do the driving, lol). I kind of like that most of my treatment (except PS) is going through the same group--more communication.
The good news is that during those 6 weeks of radiation you get weekends off! But, yeah, it's really a pain getting there everyday. On the other hand I'm almost half done already! Yay! Anyway, radiation is definitely a part of going this route. I would definitely ask your MO about the possible impact of radiation on your diabetes. And certainly the RO, if you go with the lumpectomy/rads.
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Bump
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Thank you so much for posting this. I had a lumpectomy with dirty margins on september 3rd. I have a re-excision scheduled but am meeting with a plastic surgeon beforehand to investigate having the surgery you had.
In my hospital, the ps and bs do work together to perform this procedure which would be covered by insurance.
How are you doing now and are you happy with your "new" breasts?
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DawnCT --
I had this surgery on July 30 but on one breast only. They took out a wedge of tissue (like a piece of cake) and scooted the remaining breast tissue together. The nipple was preserved and repositioned. I am left with an anchor-shaped scar all the way around my areola, vertical below the nipple and in the lower curve of my breast. The scars are very fine, and disappearing more and more as time passes. The BC (left) breast was originally larger than my right breast and now that the surgery has been done, they at about the same size, but the nipple his higher on the left breast, so it appears more perky (lol). Since rads can shrink the breast, I am waiting until about 6 months after all treatments have ended to see if I want a little breast lift on the right breast to even them out. The oncoplasty (BS and PS working together) and any reconstruction I have done after are covered by insurance. I was very pleased with the procedure -- a lot of artistry involved, and I was glad my Bs and PS collaborate often on this surgery...they do great work together.0 -
Hi TeamKim thanks again for the bump. My bc breast(left) was also slightly larger then my right. The bs explained I could also have the right done after rads but it would be another surgery under anesthesia. Her and the ps have been doing this surgery together for years. She said they have had very good success in doing both at 1 time leaving the bc breast slightly larger for the shrinking during rads. I will have a 6 month post rads visit with ps incase either need any adjustments.
My incisions are the same. Around the areola, from the nipple down to the crease and along the curve underneath. My ps calls it that part the T junction. Overall I am a slow healer and I am 7 weeks post surgery. I still have a few small areas that are not completely healed. On the right the T junction just closed. I thought it was infected cause it was still draining but ps kept saying it wasn't and to keep it constantly moist with Neosporin and just last week it finally closed. Very red but closed. I still can't sleep on my sides. Both breasts are sooo tender but finally soft. First few weeks they were hard as rocks from the swelling. I was so scared they were gonna stay that way lol
Hi DawnCT I'm sry to hear the margins weren't clear. Which ever procedure you have next I'm sure the margins will be clear!
I am happy so far with the results and honestly still getting used to my new look. My weight has been up and down thru the years plus breast fed both my boys, gravity was setting in. Now I can take my bra off and nipples are still facing out and not down lol.
I would make sure your bs and ps have experience with this surgery. The reduction to the non cancer side is covered by most insurance. It is still considered breast cancer surgery but you get the plus of perky breasts. It's just a longer recovery time then a lumpectomy. I have my dry run Monday for rads and treatment starts tues. My bs wanted to make sure incisions on the left were healed enough.
Have a good weekend and keep us posted
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I too had the slow healing to a tiny spot right at the "T" -- PS says this happens about 20% of the time. I had my surgery July 30 and it just finally healed all the way this week. Another difference from a regular lumpectomy was that I had a drain after surgery, which was removed at my first appointment one week after.
Fephna is right, the healing takes a little longer, but I traveled across the country 3 weeks after surgery to take my son to college and I had no problems with traveling at all. I slept in a recliner for the first two weeks, then propped a travel pillow under my side so that I wouldn't roll in bed. Since I only had one done, I could sleep on the other side, but only recently (after 6 weeks) have been comfortable sleeping on the surgery side. I have no pain in my breast at all at this point -- I would say the pain from surgery was only about two days of needing prescription meds, then about a week of Tylenol. The glue all came off after about 3 weeks, and at that point I had the little pea-sized spot that took a long time to heal. Used the Neosporin with a bit of gauze over it, held in place by my bra (my skin was sensitive to the bandaid adhesive), and that has gradually cleared it up.
So hope all that info helps you, DawnCT. So sorry about the bad margins -- keeps you marking time in the surgery phase when you just want to get on with life! Good luck, and ask away if you have questions!0 -
I know very well about no tape. I had all the gauze in place held there by the surgical bra. I did have steri strips,alot of them, and I seem to do ok with those. When they do
come off its red for several days. Was supposed to have drains but didn't. Ps said there wasn't that much drainage to need them. But I wonder now if I did would the right t junction closed faster.
I was able to sleep on my right side for a few hours before I was starting to ache. Woo hoo lol I am not a back sleeper and have since aug 1. Forget the left side. After 5 minutes my hand was falling asleep. The snb incision is still soar. I think that hurts more at times then the both breast getting worked on.0 -
Hi again TeamKim and Fephna -
Thank you so much for your responses and support! I am still tossing and turning at night considering whether I should do the reduction. One factor that may be different for me is I do not have to have a SNB done. Hopefully that would make the recovery a little easier?
I actually wish my surgeon had offered me this option from the very beginning(before first lumpectomy) but it was me who started asking questions about it. I started considering it because I know that after radiation , I would never be able to have it done. I have thought of having a reduction/lift for many years. I am just so nervous about getting good results. I have looked at a lot of before and after photos online and some results were not so great!
My BS did say, though, that she has never had a patient regret her decision to do a reduction.
I will be meeting with the PS on Weds afternoon and will find out whether he thinks I will get a good result. I will update you then.
I know there is a health benefit to the wider margins so that's important too. I also think I would feel lighter.
So much to think about! I am grateful for BC.org and this thread!!
Dawn
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Hi DawnCT
I don't think I would of considered having a lift/reduction if I didn't have bc. Of course I would think about it but wouldn't be able to afford it. My main goal was to get the cancer out with clear margins. The area I live in doesnt have a breast specialist/surgeon. Plenty of general surgeons which I did consult with first. I wasn't happy with his opinion of the lumpectomy leaving a dent. He said no one would really notice. Maybe he didn't realize I would notice. I don't have the best breasts or body but I am single. I live in Florida and I have a pool. I do wear tank tops and bathing suits often. I think a dent would be noticeable.
So I am very happy with my decision to travel to the bs. She is up to date with the latest treatments and surgery and is the head of the breast center at her hospital. She highly recommended the reduction. I liked the ps very much. She reassured me I would be happy with the results. I did have 2nd thoughts many times before surgery day! I had tons of questions for both surgeons.
And here I am now 7 weeks post surgery. I had my dry run for rads today. Officially start tomm. The hardness and swelling of the breast has gone down. Tenderness and pain are less. Both are falling into a more natural look. I'm seeing now as its healing what both surgeons were talking about. Having this beast of bc and the long road of surgery, treatment then meds, I have lil smaller but perker breasts. And after rads they hopefully will be the same size. The bc breast was left a lil larger incase of shrinkage with the rads. I'm just hoping rads doesn't ruin my skin. I'm so sensitive.
I noticed on other discussion boards not to many other women had the reduction, just lumpectomy. I think it is a personal choice. Also sometimes medically necessary if you have very large breasts. I also think it depends on your bs and what they are comfortable surgery wise doing. Or it's just a procedure that could be newer or under used. If your bs does it with a good ps I would consult with them. Ask hundreds of questions till you feel comfortable with what ever procedure you choose.
Good luck wed!! Keep us posted0 -
Fephna -
It is really so nice to be able to have this discusssion! Thank you.
I don't actually think i would ever actually would have had it done. But now with the BC, it seems to more worthwhile.
I really like my breast surgeon and hopefully will like the PS as well. They do work together in the operating room. My BS is also head of the breast center at my hospital so I trust her recommendation on the PS.
I know what you mean about the dent because I already have one from the first surgery and of course it would be worse after the re-excision.
I am happy that you are pleased with your surgery and wish you good the best with the rads. I hope your skin comes through well. This is all such a long process, isn't it?
I will be back to post on Thurs. The PS office called earlier and moved my appt to Thurs morning.
Thanks again!
Dawn
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Hello. Just found this thread. Even tho I must have a left breast mastectomy some of my situation is similar. The PS is making and closing the incision and then doing a right breast reduction. I saw the PS today. He didn't tell me anything about the surgery really. I was wondering about the areoles area. I guess mine will be reduced too (I hope). My breasts are huge. My bra size now - 34 i that's a b c d e f g h - i !). Even the PS was impressed. He said "and you NEVER thought of having those reduced??!!" We'll, no. That would have meant surgery and money. Anyway, he didn't tell me anything about a bra, or meds, or anything else. I go back the day before surgery to get "marked". He says my breast are too large to do the reconstruction during the same surgery as the mastectomy. He say wound healing is often a problem with large breasts and he wants the mastectomy incision to heal properly first. Yuck. That means three surgeries. I didn't even want reconstruction but the breast surgeon convinced me that I would be miserable with one huge breast on the right and no breast on the left. Geez. I haven't had so many people comment on my large breasts since I was 15 and in high school! Thanks for the good info.
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Hi Fephna, Teamkim, and everyone,
Checking back in. I saw the Plastic Surgeon today and he was wonderful. He was very compassionate and patient. I loved how he explained to my husband how psychologically invasive it is to have strangers taking care of my body during the cancer treatment process. He expressed so well what I have been feeling!
What he told me is that I will be better off getting the breast reduction vs just the re-excision. I already have an indention from the first lumpectomy and now would have to remove more tissue when dong a re-excision so it would be more pronounced. He also said that radaition will make that area contract and the nipple will likely start to pull to the left.
I am not going to be reduced by much. I am a DD but I am a larger boned person and 5'9" so I do not feel disproportionate so I do not want to be a lot smaller.
We discussed doing one breast now and one a year from now but he said he almost never can talk anyone into doing that! He showed me pictures of breasts after radiation and really, it was not a huge change.
So, I am setting surgery up for after October 20. I'm sure I will be really nervous but I do think I am doing the right thing.
I appreciate your help!
Dawn
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Hi Nahelton12 I'm sorry to hear the ps won't do the reduction or reconstruction at the same time as the mastectomy. It sounds like he is cautious and wants that wound to heal before further surgery. My mom had bs twice. 2nd time she had partial mastectomy. She didn't get reconstruction for a year. I do remember her saying she felt off. Kinda like being off balance and it hurt her back. She has large breast. Could be why bs recommends reconstruction. These are just my guesses lol I stayed at the hospital overnight so was pumped with antibiotics thru the iv. When I was released I only had pain killers. For a bra I had the surgical bra they sent me home in that I had to wear 24/7. At my 3 week post op check she said I could get sports bras which I did. Only recently I started using vitamin e oil for the scars and that's cause they are all closed now. But reading thru breast reduction forums different ps recommend different things. I just followed my ps orders. Since you are having partial mastectomy there might be some other type of bra or wrap you should wear. At the planning appt I would def ask alot of questions.
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Hi Dawn, I'm so glad your appt with ps went so well and you are comfortable with him. That's important you like and trust you bc team. I wasn't reduced to much either. The great thing is its pushed up! Lol I had 2nd thoughts as well about my surgery and I think now it was more the distance I had to travel. If I did just a lumpectomy I could of done it close to home quick with a gs. But traveling I had the bs and ps but had to wait a month. Now I def don't regret it. Do you have to do chemo or going to rads once your healed?
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