Decision paralysis
I was recently diagnosed with stage 2 invasive breast cancer. ER positive Her2 negative. I have been given the option of a lumpectomy followed by radiation or a mastectomy with immediate implant reconstruction on the left and an implant /enhancement on the right to even things out. I have very small breasts 36a/b which are only getting smaller as I loose weight through stress of the whole experience. I’ve never been particularly body confident and have always considered my breasts too small and the lumpectomy worried me as I the surgeon said it will make my left breast even smaller and that radiation will contract it further. I was all set to go down the mastectomy and implant route but then had my pre surgery consent meeting and all the possible risks and what could go wrong with implants has scared me so much I’m now totally unsure of what to do. My main fear is that if my body rejects the implants ( I have a history of autoimmune conditions) that I will be left with nothing on the left and no way to fix it. If I go down the lumpectomy route then I’m pretty sure I’m going to want to pay for implants later on after radiation as I can’t imagine being happy with the result. But at least if I did that then if the implants went wrong I’d still be left with some breast tissue. I need to give my surgeon a decision in the next two days and I feel totally paralysed with fear of making the wrong decision and regretting it. I’m a runner and run to help deal with anxiety and the thought of long recovery times and not being able to run also scares me. Can anyone give me some guidance.
Comments
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Hi @poppet247, and welcome to BC.org. We’re so sorry you’re facing such a difficult decision, but glad you find us and hope we can help a bit.
Because you’re weighing a lumpectomy against a mastectomy, you might find these resources especially helpful:
Since you’re a runner, make sure to ask your surgeon specifically about return-to-running timelines for each option, as recovery can be quite different between a lumpectomy and a mastectomy with implants.
Please keep us posted, and don’t hesitate to ask more questions. We’re glad you found us.
The Mods
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Hi @poppet247, It's really hard to make a surgery decision in a short period of time. There is no predicting exactly how things will work out but in addition to the information the mods provided here are a few other thoughts.
If you can find a breast surgeon trained in the procedure, an oncoplastic lumpectomy is an option. The surgeon uses some of your breast tissue to form an internal flap so that the breast turns out just a bit smaller than its original size. I had this done for a 3.2 cm tumor and the cosmetic result was excellent. There is no knowing whether or not radiation will shrink your breast after this. I ended up with breast lymphedema after rads so the surgical side was larger than the other. Five years on the LE has improved some so I am almost symmetric.
If you have previously had radiation the implant failure rate is about 30% greater than an implant in a breast which has not been radiated.
While radiation is not automatically contraindicated for those with autoimmune conditions, people who have them are more likely to develop late term side effects. Lupus and scleroderma are the most common culprits but it would be a good idea to check with your rheumatologist whatever you are dealing with. Most people do just fine but a small percentage (including me - ILD) end up with serious side effects; there are others besides breast shrinkage/fibrosis.
There is no way of foretelling the future so you just have to make the best decision you can at the time. Hopefully you will sail through treatment but even if problems crop up along the way your team will help you deal with them. I don't intend to scare you but more information leads to a better informed decision. Keep in touch. All the best.
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