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May 23, 2017 05:59PM
Hi violamama Sorry was away from the boards for a few days. I was diagnosed with low grade ER positive DCIS, as well as dense breasts and fibrocystic disease, and had enhancement globally on MRI. I also have a strong Family History. I opted for a bilateral MX. Lumpectomy was off the cards due to the extent of microcalc on mammo.
From a prognostic point of view the higher grade is more aggressive and has a likelier chance of turning invasive. Also if its ER -ve, then using drugs like Tamoxifen is out. I would be taking this in mind when discussing with my BS. Choices of treatment are usually MX vs lumpectomy and rads and Tamoxifen. However you would not be able to take the Tamoxifen.
If you want my take on the surgery, yes it's doable. True I am well aware that I still have a recurrence risk. But I am very happy to have decreased my cancer risk from around 35% to 1%, and I can live with the 1% doubt. As my BS and oncoplastic surgeon have told me, my overall risk is now less than the general population. I have also avoided the need for rads, since rads are not needed after MX for DCIS. And do keep in mind that rads do not come without side effects. Also should you have a recurrence after having had rads, and then need to go on to MX and recon, you're doing recon with radiated skin, which has its own problems. Another thing I kept in mind when taking my decisions was that when a biopsy is taken it's actually a very small piece of tisse compared to the whole tumour, as well as the fact that other tumours not visible on mammogram may also coexist. Should you do opt for a lumpectomy instead of mastectomy I would try to at least get an MRI.
On the other hand if you do opt for the bilateral mastectomy, you should discuss the possibility of sentinel node biopsy. My BS had explained that should they have found any invasive element on the breast removed, and we hadn't done the sentinel, then he would have had to go in again and do a full axillary clearance, something I wanted to avoid unless absolutely necessary.
Take care and pm me if you think I can be of any help. I had looked up the NCCN guidelines on management of DCIS when taking my decisions.
The phoenix hope, can wing her way through the desert skies, and still defying fortune's spite; revive from ashes and rise.
1/23/2017, DCIS, Right, Stage 0, 0/4 nodes, ER+
2/21/2017 Lymph node removal: Right, Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement