Lumpectomy with oncoplasty (bilateral reduction mammaplasty)
Comments
-
Hi Dawn - thanks for your post. I am glad to hear you are feeling better -- hope the improvement continues.... One foot in front of the other, right? Chemo has been no treat, that's for sure, though I have been able to continue to work so far! and that's a blessing. Fatigue is the worst of it -- not just tired, like sleepy, but more the muscle weakness that has me stopping at the landing when climbing stairs to give my legs a chance to recover before I take the next ten steps. And I don't like wearing wigs and hats, but don't feel brave enough to go bald either, so that is a pain. All in all, however, I am so fortunate compared to many of our brave sisters. It is all temporary, and we can do it!0 -
TeamKim,
I am truly sorry that the chemo is taking so much out of you. Yes, you are going to get through this!! One day all the treatment will be over and you will be able to move on I can see that you are a stong and positive person. I am thinking of you.
Dawn0 -
Dawn, thank you again for the pm!! How are you feeling? I'm gonna take a look at that link for breast reduction and rads now.
Kim, sorry chemo is making you so tired. But 1 more, so exciting its almost over!!! Enjoy the 3 week break before rads.
Shout out to ketofan and Jess. How are you?0 -
How reassuring to find this thread. I'd have the oncoplastic reduction done again in a heartbeat even though it turns out I'm a very slow healer. A word of caution if you end up with one of those spots that won't heal at the T junction, watch for infection and trust in your intuition. I was put on a wet-to-dry dressing and not not to sorry as it steadily got bigger instead of smaller. It eventually destroyed already healed tissue and grew to a 4x7 cm open wound before it was finally diagnosed with an infection. By then I was really sick and had to regrow a lot of skin. It took three different antibiotics to kill it and I've had my chemo delayed 2+ months because of it. It's been awful and I've been sleeping in a recliner since August so as not to stress the healing/new skin in that area. Trust your gut and don't be afraid to be pushy to get answers and results if you know something just isn't right.0 -
Hi QuirkyGirl I hope the wound is healed now! That t junction does take longer to heal. I asked my ps and she said that's where the most pressure is. I wonder why they don't use extra stitches or some other magical plastic surgery trick since it seems to happen often with this kind of surgery. Mine took long to heal on the right and healed quick on the left(bc side). I kept asking if it was infected cause it looked bad. My ps said globs of Neosporin and finally after 6 weeks it closed. You are right tho, always trust yourself when you feel something is wrong. Hope the rest of your healing and treatment is going well!0 -
thank you for starting this thread and all the info! I met with a plastic surgeon this week to talk about a reduction the same time as my lumpectomy. But I didn't prepare well and realized I have a lot of questions I didn't ask. Overall I liked the doctor and he did provide some good information. I am a 34H, so a reduction is something I have always wanted to do, but was afraid of surgery.
Seems like the main risk is the longer surgery, and the risks associated with that. He also explained the risk of not having symmetry after radiation, and the possibility of needing another surgery to correct that in the future.
Tomorrow is my last chemo, so I have about a month before surgery.
Any tips on questions to ask, or thoughts on recovery would be helpful, thanks!
0 -
Hi Yogagal,
This thread was so helpful to me when I had my reduction! The OP's info was great and Fephna and Teamkim were so supportive to me!
I had the reduction surgery on 10/29/13. If I had known what the surgery was like, I would have done it years ago. I did not find it to be too bad at all. The worst part was not being able to fully shower or wash my own hair for 10 days. It was not very painful but the first couple of days were kind of yucky( just blah)from pain meds and effects of anesthesia.
I completed my radiation on January 21st. So far, if there is any breast shrinkage, it is not obvious. My PS said that it is possible to see changes for up to a year. This is something I worry about too but am pleased that I have not shrunk at this point.
It is good that you liked your surgeon. The things I think are important: Did he show you photos of his previous work? It is important that you know what results you might expect. How much smaller will you be after the surgery? Will you have to have nipple grafting? I did not have to have nipple grafting but did lose sensation in the lumpectomy breast as the BS removed area right up behind the nipple. That is the one thing I wish had a different outcome for me.
Please feel free to PM me if you need to. I will be so happy to answer any questions!
Dawn
0 -
Hi! New to this thread. I had my exchange surgery on the left on 2/17/14 and had a reduction on the right. I was very chesty and droopy before and my PS said that getting a big implant on the left would be hard. So I am not quite 2 weeks post op. That yellow drainage has almost stopped, i still have quite a hole on the lengthwise incision. What I wonder about is my first mammogram next year ( my PS said it has to be a year from now-I wonder what my Onc. will say about that!). I got a copy of my pathology and I had the kind of reduction where the nipple and structures underneath were left attached. I see articles that say having a breast reduction lowers your risk of breast cancer. How can that be? ONly if you have actual breast tissue (ducts, lobes, etc) right? My pathology only says fibro-fatty tissue without neoplasia. I am assuming I have all the ducts I had before, right?
0 -
This is a controversial topic. When I got an ADH dx, I decided to have a bilateral reduction because of some literature I had read (from Europe & Canada) that showed that women who had reductions had a lower incidence of BC than women in the group that had not. Luckily, I found a great oncoplastic team that believes in the validity of this procedure from a prophylactic prospective. Still, my BS (another hospital, same city) was very dismissive. I think the rationale is that as breast tissue is removed (the glandular tissue, not the fat), it thereby reduces the probability of that tissue becoming cancerous.
I had my first mammogram 6 months after the surgery to get a new baseline.
Anyway, I think that if you had a substantial reduction, it is fair to assume that some if the ducts were removed? Ask your PS for clarification. How much tissue was removed? I went from a 34D to a 34B. Both my PS and onc believe that this reduces my risk somewhere in the neighborhood of 50%-- sure hope they're right!
(Btw, I also developed a small hole about 3 weeks post op at the junction where the IMF met the vertical incision. I was told this is quite common. I kept it covered with gauze and Neosporin and it healed completely after a week or so.)
0 -
Hi KimberlyAnn -
My understanding is that less breast tissue = less probability of cancer. I had my nipple still attached as well. That is an interesting question that you pose regarding what type of tissue was removed. Please let us know what your PS says about that.
I have been told by my BS that I will have a mammogram at approximately 1 year from diagnosis. I am grateful for that as my breasts are still tender from surgery and radiation.
I did not have any drainage after surgery but it isdefinitely quite common!
Dawn
0 -
Thanks to both of you for your replies. I would have thought he would have removed ducts, etc, as well, but I don't think he did. The description on the pathology report talks about skin, and fatty tissue and fibrofatty tissue. I looked up what fibrofatty tissue was and it is basically fat. I would THINK the grossdescription part would have said something like normal ducts without neoplasia or something. Obviously I am too early post op to be able to do a breast exam and things are still swollen, but I don't feel ANYTHING like I used to. I had very lumpy breasts. I will let you know what he says the next appt I have.
0 -
I was curious about this question, so did some googling. There seems to be a lot of info about the ability to breast feed following a reduction and the consensus is that breast feeding is usually adversely affected because ducts are cut/removed. My plastic surgeon told me that she removed significant glandular tissue. I'll be interested to hear what your surgeon has to say -- let us know, please.
0 -
I will. I read a lot of articles on that, too. I guess I was just looking for the path report to look reassuring for once
. During my diagnostic period I had gotten so used to seeing things like BIRADS 5, and descriptions of the ducts, etc that had the intraductal carcinoma in them that I wanted to see something like "extensive glandular tissue free of neoplasia" or something. He MUST have taken some out. I am sure not all. I actually thought I had some nipple discharge in the shower yesterday and that got me thinking.0 -
I certainly understand wanting reassurance, but I'd like to think that if there was anything malignant (or even verging on malignant, such as some type of atypical hyperplasia), the pathology report would have stated it.
0 -
Oh I realize there is nothing wrong with the pathology
I just wanted to see it in black and white. It would be sort of a victory. NOT seeing just made me wonder why I didn't see it. 0 -
In my post-op pathology report, the ductal/lobular tissue they took out was referred to as "parenchymal" tissue, so maybe there's some reference to that in the report. I know they took out a LOT of mine, along with the fibrous and fatty stuff.
0 -
thanks nyama!
This is what my path report says: (stuff added by me in parenthesis )
Diagnosis:
A. Right breast tissue--skin and underlying fibrofatty tissue (The term fibrofatty can be defined as consisting of fat-corpuscles and fibrous tissue. The most common fribofatty tissue is the adipose tissue that is found in the breast which gives the size and shape of the female breast) without evidence of neoplasia (yay!)
B. Left mastectomy scar-- No evidence if malignancy (yay!) I won't include anymore about the scar
Microscopic description
A. Sections are of skin and underlying subcutaneous tissue (Definition:The subcutaneous tissue is the third of the three layers of skin. The subcutaneous layer contains fat and connective tissue that houses larger blood vessels and nerves) Neoplasia is not identified (yay!)
Gross description
A. ...the specimen consists of 4 portions of skin which range in size from 10x4x0.4 cm to 8x4x0.4 cm. These are grossly unremarkable...
I am a nurse so I am extra familiar with path reports which is why I am extra-interested in this. Like I said it's not that I think there is anything wrong, I really wanted to SEE normal and SEE how much of the ducts were removed. I realize that even with a mastectomy no one is assured 100% that they will not get breast cancer again, but I made the hard decision to not take Tamoxifen due to risks/benefits. Any of the structural breast that was removed just lowers my risk. I chose not to have a PMX and that was the right decision for me, this would just be an added benefit. I don 't mean to sound obsesssed over this or anything, it's just when you are looking forward to seeing something and you don't it's a little disappointing. I see my PS on Weds so I will ask him.
0 -
I got my answer already
Since being diagnosed I have requested and received copies of all pertinent mammograms, biopsies, and path reports--people were asking so many detailed questions that I really needed to have copies. I had also requested a copy of the surgery notes this time-that came to me today. In the notes he stated that because I had "close symmetry" with how large my expander was and the size I wanted to be on the mastectomy side "minimal breast tissue was removed." Basically he took out the extra droop by removing the skin/fat. So, mystery solved I wonder what my mammogram will look like now? I'll know in a short year's time! 0 -
Kimberly,
Glad you got a definitive answer to your questions. There has also got to be somewhere on the report where the surgeon states just how many grams of tissue were removed, to get even more exact.
As for the mammogram, I can tell you that after years and years of constant callbacks (big boob, lots of overlapping tissue problems, needing spot compressions, etc.) I was shocked that when I had my first mammo following the reduction, I had no call back for the very first time. Of course, everything gets totally rearranged, but it seems that the smaller size made the films easier to read. I've had 2 subsequent mammos since then and the same experience-- 4 shots, radiologist tells me everything looks good, and I am on my way. Fingers crossed that this continues (I am superstitious.)
0 -
I hope that continues for you, too! My first screening mammogram at age 40(last year) was the abnormal one so hopefully next year's screening for me does not follow suit!
0 -
thanks-- keep me posted!
0 -
I am having a DCIS lump on 3-25. I inquired about a bilateral reduction at the same time but my BS basically wouldn't do it. She said she wanted to be sure the margins are clear first. One minute I think a "get it" the next it still confuses me.
I have a tentative appointment on the 28th for the report. If margins are clear I will meet that day with the PS again. He said he would probably do the reduction within a week of that. RADS to start about 4-5 weeks after. Oh I'm a 36 H so yeah been looking forward to it.
But I have no issue with him taking more duct. Should I inquire about having more duct, lobe removal?
0 -
rettermich, there are surgeons who will do that operation. Most of us are happy with it.
0 -
yes, typically BS & PS work together and because the reduction takes so much additional tissue, margins are not an issue. Lumpectomy and reduction can be done in one surgery.
My understanding is that lobes/ducts cannot be removed separately. All are part of the breast tissue removed by the reduction.
0 -
my surgery is Tuesday, and I am pretty anxious about it. But re-reading this thread, now that I am out of the chemo fog, has really helped. Thanks to everyone for sharing your stories!
0 -
yogagal - good luck with your surgery on Tues. Please let us know how we can help!
In retrospect, it really was not a bad process! You are going to be fine!!!
0 -
yes, really not a bad surgery at all. Third week out is the toughest, when nerves start to regenerate and you feel weird zaps and shooting pains. Three weeks after surgery I did a 30 mile bike ridewith no problems (except for the occasional pothole!)
0 -
momo, that was so weird. I felt like a musical instrument or a drum circle.
0 -
cookie, what felt like musical instrument? The nerve pings? Not sure I understand you...
0 -
surgery was 3 days ago and I am home doing pretty well. My husband has taken the week off, and takes care of changing the dressing. I only have the bandages, no bra until the drain comes out. Not sure why this is the case but I am not moving around much, so it doesn't matter. Today I noticed that my underarm on the lumpectomy/node removal side is very numb. Looking around the surgery boards, this seems normal, but it is not a good feeling.
I am still trying to get used to how small my breasts are now. Not sure how I feel about it.
0
