Lumpectomy with oncoplasty (bilateral reduction mammaplasty)
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I have been using tube top type bras that I purchased on Amazon. A three pack, black, white, beige was about $15
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Okay so its 2018 and don't now how this works when all the posts are from 5 years ago. But I'm making the decision to have three lumpectomies and reduction simultaneously Its not an easy decision and I'm weighing it against double mastectomy. There are pros and cons to either. My surgery is April 25th 2018, My fears are that they will not get negative margins and how does that work with the reconstruction?. My other issue is that I have the check2 genetic mutations and the odds for more cancers down the line are higher. I've watched my mother's life unravel from chronic pain and worry about the stats with Mastectomies. So its weighing living with the specter of re occurrence and continual vigilance vs. the probable chronic pain from the MX.
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I’m having bilateral reduction with lift on the 17th. My understanding is that you have to be extra certain about the size and location of the cancer, because things get scrambled around. I had an additional biopsy and breast MRI to be as sure (as possible...) there were no surprise areas of concern. My surgeons have made sure I understand that if there aren’t clear margins, MX is the next treatment, because of the way they have to manipulate the breast tissue. I’m so sorry you have to make these decisions
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Thank you wellheresanewadventure. At least I'll have new perky decent sized boobs (size G to C)....something I would have never gone under the knife for before this diagnosis...silver lining...lemonade. You too, sorry you have to make these decisions....still trying to figure out the lesson in this. I wish I was someone who blindly trusted doctors.
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Does your Dr think that there could be node involvement? That could have an affect on your decision. I am 3 1/2 weeks out of my breast reduction and lift surgery. My PS told me that if the margins weren't clear that the BCS would still be able to do another excision. My mom and sister both have had cancer. My mother had a lumpectomy wit auxiliary node biopsy. She is an 18+ year survivor. My sister had one breast removed 2 years ago. She had DCIS. I had the genetic testing done and do not have the BRCA gene.
I pray that you will come to a decision that you are at peace with. It took me awhile, and getting a second opinion before I was comfortable with my decision.
You will be in my thoughts. Feel free to PM me.
Colleen
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Hello Ladies,
I had a bilateral reduction and lift with a lumpectomy on the right side 2 days ago.
This surgery was my stage 1. Due to some "areas of concern" identified on my MRI my surgeon has recommended a UMX with reconstruction. This surgery was meant to reposition my nipples to prepare for my nipple sparing UMX.
My surgery was pretty uneventful. I have two drains and the prevena wound vacs. I haven't had any pain, just discomfort --- mostly in the drain incisions and the SNB incision. The painkillers make me sleepy, so I've only had Tylenol today.
One thing I was not expecting was to pee and poop blue. I think it's from the radioactive stuff they injected into my nipple to help the BS identify the sentinel lymph nodes (which were clear, thank goodness).
My surgeon said no bra and I'm happy to comply since I went from a DDD to a full C/small D. They are very high and tight, but I expect they'll soften a bit as they heal.
I hope this info helps anyone else who is having this surgery. Best of luck and lots of hopes for uneventful surgeries for the rest of you.
Much love,
Cev20
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I'm not sure where to post this. I joined here last month after I was diagnosed with Stage II. I was all set up to have the lumpectomy and I read about being able to have a reduction at the same time. I went for a 2nd opinion at a larger teaching hospital that has a regular Breast Center and there's Breast Oncologists and Plastic Surgeons within the same practice. I come from a small town with one hospital and few surgeons, let alone a Breast Surgeon. That's where I got my first opinion and I really loved the doctor and trust her. She told me to go for a 2nd opinion and that this was no emergency. So, that is what I did in the past 2 months that I was diagnosed.. I decided to do the Oncoplasty at the larger hospital that's and hour away from home. I waited a week until they coordinated the 2 doctors for the surgery.
I just got the call today, a week later after seen. They told me the soonest date is a month from now. They have me returning about twice before the surgery. What I'd like to know is, what is the pre-op that you had to go through to have this surgery done and what about post-op care? I'm 2nd thinking my decision because of the extra visits they will have me doing. If it wasn't an hour away and if they weren't making me wait another month to get this cancer out of me, I'd be fine with it! Sorry, for the longer post, but, I need somewhere to vent and to hear from people that had the same thing done.
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Karinada my situation was similar to yours, except I did have a small breast center local and the BS did work occasionally with a local PS so I could go the Oncoplastic route, but I decided to take an hour and 20 minute drive to the larger teaching hospital and have a team. My BS there suggested that I meet with the PS about going the Oncoplastic route. She also had me meet with an RO who recommended that I have IORT followed by 15 whole breast radiation appointments. The reason for the IORT was to give a boost of radiation to the tumor bed before the PS did her thing. Once I decided on the direction it took a month before the surgery to line up all 3 doctors. What I tried to focus on was what my BS said "This is an emotional emergency not a medical emergency".
As for the appointments I've had a variety after meeting with my BS: genetic testing, an MRI, PS, RO. I had one day of pre-op the day before: bloodwork, EKG, chest xrays, BS and PS. I had postop appointments with the BS and PS 2 weeks after.
Ultimately you have to make the best decision for you. I choose to drive over and hour to a place that is considered #1 in my state for cancer treatment and am very happy with the decision I made. I will say driving back and forth for 15 days got a little old, they did have a place I could stay but I preferred to be home. Good luck with your decision, the anxiety about everything does subside. If you have questions please ask here or you can PM me.
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Did any of you regret the reduction? I'm having some serious second thoughts about the oncoplasty. My breasts aren't huge to begin with, and after the reduction I'll probably be 2 cup sizes smaller. I'm a small D/ large C right now and I don't know if I want to be a B cup. I want to be proportional to the rest of my body. I'm so confused and worried that I'll make a decision I'm unhappy with after it's all said and done. I feel like I'm having to make these decisions under duress and I don't know which is the right one. How do you make a decision when you have no idea what the final result will look like?
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Deweygirl, I'm happy I went the oncoplastic route but I was not really worried about size. My thought was more if I can do this with one surgery and have my breasts be somewhat normal when it was all over. I was a small D and I would say right now I'm probably Cish, have to admit that I haven't measured yet and I'm still wearing some stretchy bras that come in L/XL etc.
One caution is radiation will shrink your breast. My PS kept my cancer side a little bigger and it definitely shrunk. It is a little smaller now than the other side, I'm waiting to see how things settle before deciding if I want things touched up or of I'm good with what I have.
If you are worried you could opt to just get the cancer side worked on and then have the other one worked on later. Does your PS do this on a regular basis? Have they said what size they think you will end up with? I know my PS asked me about size and I said whatever works with the situation, and she thought I would be a C, worst case a B. I'm at 9 months post op and am just really getting comfortable in my updated breasts. Good Luck to you.
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I'm just starting to look into this. I had lumpectomy in April and am about to finish radiation. For whatever reason, I never knew this was an option until the last few days. Yesterday I talked to my BS's nurse and she said they'd refer me for a consult with PS. Honestly I'd be glad if both of my breasts were smaller. I'm not huge, but I'm petite and the right weight, so I still feel chesty. But if all that happened was making me symmetrical to the smaller breast, that would be great.
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Mountainmia there is no reason we need to go through life lopsided or disfigured because we had cancer. I know some don't worry about it, my mom had a UMX with no reconstruction which is fine, but seeing that almost 20 years ago, I just couldn't see that in the mirror everyday for the rest of my life. One word of advice, radiation can work for a year so you might want to wait a little bit before doing reconstruction. I would definitely consult with a PS it can't hurt.
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mymomsgirl thanks so much for your input! I had a consult with the PS and he wouldn't tell me a size and when I said I didn't want to be a lot smaller he replied “you can just have the lumpectomy then" he was very flippant. When I asked if I would get feeling back in my nipples he said there is no guarantee. The affected side is already smaller than the other side and my cancer is medial, so right in my cleavage. If I just have a lumpectomy I feel like it will be very obvious. Is my only option to reduce the other breast in order to have symmetrical breasts? Besides a full bmx , which I really don't want.
Also, what do you mean by having them “touched up”? This was never discussed in my consult.
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Deweygirl first of all I think I would get a second opinion from another PS due to his response to your question. I'm not sure of your location but I went to a BS at a breast center and she has a PS that she works closely with, I'm not sure if you have that option or not, but I think you need a second opinion from someone who has worked with a lot of BC patients.
Mine was also in my cleavage area and it was my BS who suggested meeting with a PS and RO before coming up with my plan. She said you might have a divot and I don't think you will be happy with that. One note, since I was doing reconstruction at the same time my RO wanted to do a dose of radiation during my surgery before the tissue was rearranged. I then had 15 treatments afterwards as well.
So I did get the feeling back in my nipples but can say that some of my breasts are still numb, but it can take some time for feeling to come back. I will warn you that when things start coming back to life your nipples might be hypersensitive. As for the touch up my PS said about 10% of the time she ends up doing something additional to touch things up so her patients are happy. It might be working on scars or adjusting size or nipple placement depending on how things settle in.
I know you mentioned a BMX but remember once they are removed they are gone, but if you go the oncoplastic route and aren't happy you can always have a BMX later. Remember you have to feel comfortable with your decision and the only one who is going to advocate for you is you.
If you have other questions just ask or PM me.
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I am having my lumpectomy and oncoplasty tomorrow, so I am rereading this thread for support and courage. It is just amazing to me how differently doctors deal with all of this. I understand that every patient's situation is different, but it's very frustrating to read about doctors (like the BS I saw initially!) who don't even make their patients aware of options like oncoplasty. I am so grateful that I found this forum on the same day I was diagnosed and learned right away to get second opinions!
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Karen, my understanding is that "oncoplasty" includes rearrangement of tissue within the breast having the lumpectomy, so that the post-surgery appearance is relatively normal. My BS did that, and the outcome is fantastic. One thing I DIDN'T know (among many!) was that there was any option to have surgery on the healthy breast. But yeah, why aren't we told these things?
Good luck with your surgery. Are you having both breasts done tomorrow? Let us know how it goes.
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Mia,
Yes, I am having both breasts done tomorrow. My PS is going to remove tissue in the healthy breast to make it better match the other after the lumpectomy, and in the process will be rearranging tissue in both.. I was shocked, and thrilled, when my second opinion BS told me insurance would cover all of it. Crossing my fingers that I am as happy with my outcome as you are with yours! I will definitely be posting about things as I go
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Karen, just to be clear, I've only had the lumpectomy part done so far. But she really did a good job. Now I just need to get the other one to match it!
When I talked to the BS's nurse the other day, she said the PS group will know how to get it coded so insurance will pay for it. I'm hoping that's true. I'm glad yours will be. Really wishing you great luck with this. It's exciting but of course a bit scary, too.
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Karen good luck tomorrow and yes your insurance should cover it, except for co-pays. I'm not going to lie it was nice for things to be a little perky again. One thing to keep in mind is that you PS might leave the cancer side a little larger, radiation shrinks tissue, so the goal is for them to be the same size in the end.
MountainMia yes you should be able to get the reduction on your other breast covered. I believe there are some laws out there that require them to cover reconstruction to get you to a more balanced/normal place.
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Hi, I thought I posted a few hours ago, but it appears that it didn't go through. Sorry if this is a repeat.
Deweygirl, I'd recommend a second opinion. It is important to have a PS you trust, who treats you with respect and who listens.
Karen2019, Sending good wishes for a successful and uneventful surgery tomorrow.
For many reasons, I've been very pleased that I had the bilateral reduction. I had the lumpectomy first, then the bilateral reduction, and then whole breast radiation. It takes longer to heal from the reduction than from a lumpectomy but it's worth it. (And it still wasn't bad. It was just a bit longer.) I believe that the reduction made the radiation a lot easier from a technical standpoint and in terms of my experience (of having to try to keep skin from touching skin). I was also relieved that because of the reduction, much more breast tissue was removed and was available for pathology.
When I was trying to find out about my options, I had a hard time identifying anyone who'd had lumpectomy with bilateral reduction mammaplasty, so I was pleased to find this forum. If I can be of help to anyone, please let me know.
Sending good wishes to all.
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blooming, that's great information. Thanks for sharing. Do you know what cup size you went from and to?
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Hi,
I think my cup size went from a G to a D or DD. I believe that although a PS probably can't predict the exact cup size, I believe that the PS can discuss it. I believe that in my situation, there was a certain amount of breast tissue that was supposed to come out. (I don't know if that was related to justifying that I needed the surgery.)
Since the surgery, I've felt better physically. I'd had upper back pain, tenderness in my shoulders (from the weight of the breasts), as well as pain and skin problems under my breasts (from the very tight underwire bras). That's all gone away.
While I was healing from bilateral reduction, I needed different bras and bra sizes. At first, I think I needed bandages, then a surgical bra, and then a cotton bra without underwire. I was able to remove the underwire from my bras and still wear them (since the band size across my chest was the same). At first, there's swelling, but that diminishes as the breast heals. (With radiation, there was also swelling that has gone away with healing.)
Sending good wishes.
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Hi ladies, I am now one week post-lumpectomy and oncoplasty with bilateral reduction and so far, so good. I've had pretty easily controlled pain and came off of the meds as of Saturday. Drove myself to my PS postop today where the bandages were removed. My breasts definitely feel a lot different than before - a lot of the sensation I thought was tightness from the bandages is actually loss of sensation in general. And they feel artificially high and tight, but the PA says that should lessen as they heal and settle. But while they feel odd, the PS did a really good job with filling the hole from the tumor excision and they generally look really good. I think I'm going to be very happy with my decision to have the additional procedures.
Thanks to everyone for all of the continued support. It has been wonderful
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Karen I'm glad things went well for you and so far so good. Things will settle down over then next few months. I remember my nurse the next morning was like those are great, nice and perky...lol. The sensation will gradually come back as well. I remember be worried about sensation in my nipples and within a couple of weeks I was like wow don't even come close to those babies. I used nursing pads to avoid any additional friction. Keep us posted on your progress.
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as we speak, I’m sitting in the PS’ office for my post radiation check. I’ve been and continue to be delighted with the results so far. They look even to me and have healed beautifully. I did lose sensation in the nipple of the affected breast. But he warned me about that and I’m okay with it, c’est la vie. The healthy reduced breast is just fine.
Hoping to get the green light to go bra shopping for real again
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Congrats, mom. I do wonder about the nipple sensitivity. (Very personal, I know!) I've never been very sensitive, anyway, so am not sure that would bother me much.
Is it a matter of just being numb, or are we talking about sexual sensation? If you prefer not to weigh in, perhaps someone else will.
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Hey Mountain! No please, we share everything here are you kidding? Anything to help. I touch it but only know I’m touching it because my fingers know. But hey. A) I’m alive.
the left one feels evvvvvvverything. So, it’s all cool.PS agreed boobs are “balanced nicely!” See him againin a year.
He said the nipple sensation could come back in 6 months to a year, but whateves.
New bras here I come!
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Finally got my wretched drain removed today. As much as I hated it, I dreaded the removal because I couldn't imagine it not being incredibly painful, knowing there was a foot of tubing that had to be pulled out. But it turned out to be completely painless and over in literally two seconds! I was so relieved I did a spontaneous happy dance right there in front of the tech. And since then I have had the best sense of freedom, it's ridiculous! You'd think I'd had it in for years instead of a week and a half! I immediately came home, stripped down to my underwear, and took a nap with my cat, which I hadn't done since before my surgery because he always tried to mess with the tubing. It's funny what little things will bring joy on this crappy journey
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oh Karen, yippeee! Good for you. So glad it wasn't a painful process but I sure can understand why you were reluctant!
I finally got a phone call today to set up my consult with plastic surgery. It's another month from now. I'm afraid if I decide on surgery it won't be until next year, and then I have a new out-of-pocket to fulfill. Then there would be the decision of whether it's worth it to me, or not, in a dollar sense.
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Mia, I totally understand the "new out of pocket period" concern. I hope that if you decide you want the surgery that your PS can find a way to do it by the end of the year. Having to make medical decisions like these due to financial/insurance issues adds a whole new level to the crappiness of this disease.
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