Topic: Deciding on the next step - Lumpectomy? BMAST?

Forum: Just Diagnosed — Discuss next steps, options, and resources.

Posted on: Feb 4, 2023 01:07PM - edited Feb 4, 2023 01:08PM by distef

Posted on: Feb 4, 2023 01:07PM - edited Feb 4, 2023 01:08PM by distef

distef wrote:

I'm pre-surgery, stage 1A, grade 1, imaging measurements show the tumor >5mm. Assuming the stage/grade does not change after surgery, the MO says that I would not have to do AI if I choose a bilateral mastectomy and the RO says that I would not have to have radiation. I'm the one that brought up the idea of a bilateral mastectomy. The surgeon felt it was overkill considering the risks of the surgery (i.e. higher than a lumpectomy).

If I choose lumpectomy, (and the stage and grade don't change) they will recommend AI and a short course of RADS.

AI scares me silly. I have hypercholesteremia, hypertension, strong family history of heart disease, arthritis, and my hair is thin enough to start with. When I spoke with the MO, I didn't know anything about AI and didn't know to ask what the alternatives are or the risks of going without and I haven't been scheduled for my 2nd opinion yet.

I'm a DD and I have never liked the size of my breasts and I would be very happy to get rid of them.

My husband is somewhat supportive of the BMAST but feels that I should listen to the experts and maybe I wouldn't have much in the way of side effects from the AI or RADS.

A friend was on anastrazole for 8.5 years and she says it sucked and is a nasty drug. She was a stage 3A and did not have a choice like I presumably do.

I'm trying to decide what to do.

Surgery Hormonal Therapy Arimidex (anastrozole)
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Feb 4, 2023 03:30PM maggie15 wrote:

distef, Given your other medical concerns tamoxifen is an alternative to AIs even though it has different side effects. Browse the informational articles and threads on mastectomy/reconstruction, lumpectomy, radiation and hormonal therapy. Nothing is risk/side effect free so it's a matter of making an informed decision that seems best for you. Good luck with your treatment plan whatever it turns out to be!

DX 2/15/2021, IDC, Right, 3 cm, stage 2A, ER+/PR+, HER2-
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Feb 4, 2023 04:06PM salamandra wrote:

On these boards, I know lots of women who have or have had issues with endocrine therapy (including me!), but in real life, most of the women I've spoken with on these drugs are doing absolutely fine. It makes sense - those having issues are much more likely to come here and/or stick around. So try not to be too swayed by anecdotal experiences.

That said, if you would be happy to get rid of your breasts, to me that totally changes the risk benefit analysis. I would say please just do your research ahead of time about the cosmetic and tactile outcomes you are likely to have (this will be personal, depend on the location(s) of your cancer, the recommendations of your oncologist, and the skill and resources of your plastic surgeon if applicable).

I'm a bit confused though because normally mastectomy vs lumpectomy impacts rads vs no rads, but does NOT impact hormonal therapy vs no hormonal therapy. Rads and mastectomy are both local treatments, and hormonal therapy is a whole body treatment and the only one that can have a direct impact to reduce metastatic recurrence. But maybe it's because your tumor is so small?

Hopefully you can get another appointment to discuss with your doctor and get recommendations. Maybe even a second opinion to fully understand hormonal options - most insurances have coverage for this because the cost of cancer treatment is so high. Some high risk menopausal women take evista, which is a SERM like tamoxifen, to prevent breast cancer. It is considered slightly less effective than tamoxifen as far as I understand, but also better side effects profile. Normally it wouldn't be used for women with a history of breast cancer but if your doctor put forgoing AI on the table, then maybe they'd explore it with you as an intermediate option between nothing and AI.

Dx at 39. 1.8cm. Oncotype 9. Dx 9/19/2018, IDC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- Surgery 10/17/2018 Lumpectomy; Lymph node removal Hormonal Therapy 11/1/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy 12/3/2018 Whole breast: Breast Hormonal Therapy 12/18/2019 Fareston (toremifene)
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Feb 4, 2023 05:16PM distef wrote:

Thank you. The oncologist I talked to did not make me feel like she was listening to me and my husband isn't sure that she was listening to my question when I asked if I would need AI if I decided to go with a BMAST. I've asked to get a second opinion at the same hospital but the first appt isn't until 3/3 and that is too far out so we're asking that they squeeze me in. I've also asked to have a second opinion at Seattle Cancer Care Alliance but that hasn't been scheduled yet.

I will keep that information in mind when I talk to them.

Surgery Hormonal Therapy Arimidex (anastrozole)
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Mar 4, 2023 04:26PM msphil wrote:

hello sweetie I want to encourage others so here is a portion of my story. I was 42yrs old met man of my prayers this washout 2nd marriages we were planning when i found lump in my L breast in had worked as in O R for 15 yrs as Instrument tech then had my own office in medical records in Pediatric. Got my biopsy and was diagnosed with idc had 2nd opinion also. Got 3mo chemo before and after L mast then we got married and then 7 wks rads and 5 yrs on tamoxifen. Wanted lumpectomy but Oncologist and now husband said do mastectomy. I am this ur a 29 yr breast cancer Survivor Praise God and Our 29 th Wedding Anniversary. Hope n Positivity Faith Family Friends and My Husband got me thru. Pray this helps. Idc stage 2 L mast .

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Mar 15, 2023 09:55PM pokemom1959 wrote:

My diagnosis was similar to yours but my tumors were a little larger (still <1cm). I elected to have a lumpectomy with a bilateral lift and reduction (which is amazing). I was on the borderline for chemo but chose to have it - it was not bad at all other than the hair loss (even with cold capping). I also had 6 weeks of rads, which was very easy for me. I'm post-menopausal so I'm taking Letrozole and having no side effects whatsoever (I had previously taken Tamoxifen and did have side effects such as achy joints and fatigue). A friend who lives down the street was stage III and she had a bilateral mastectomy with reconstruction, chemo and rads and it was a very long and difficult road for her. For me, unless my surgeon or oncologist recommended anything other than a lumpectomy, I'm going with the lumpectomy (the reduction and lift was a bonus and covered by my insurance)!

Dx 11/7/2013, DCIS, <1cm, Stage 0, Grade 3, ER+/PR+ Surgery 1/22/2014 Lumpectomy; Lumpectomy (Left) Radiation Therapy 1/22/2014 Breast Dx 1/23/2014, IDC, <1cm, Stage I, Grade 2, 0/2 nodes, ER+/PR+, HER2- Surgery 2/19/2014 Lymph node removal; Lymph node removal (Left): Sentinel Hormonal Therapy 4/7/2014 Dx 2/2021, IDC, Left, <1cm, Stage IA, Grade 3, ER+/PR+, HER2- Dx 4/16/2021, IDC, Left, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2- Surgery 4/16/2021 Lumpectomy Chemotherapy 1/24/2022 Other Chemotherapy 1/24/2022 Other Radiation Therapy 5/1/2022 Whole breast: Left breast Hormonal Therapy Radiation Therapy

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