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Topic: BMX too aggressive?

Forum: DCIS (Ductal Carcinoma In Situ) — Just diagnosed, in treatment, or finished treatment for DCIS.

Posted on: Sep 13, 2019 05:14PM

Miranda5579 wrote:

Newly diagnosed left breast DCIS (4mm, grade 3, necrosis present) ER weakly positive, 2%, after excisional biopsy. Core needle biopsy revealed ATypical Apocrine Adenosis (rare, high risk benign breast lesion), which is what prompted the excisional biopsy.

I’m healthy. Just turned 40 years old in May. Strong family history. (Maternal aunt, grandmother, first cousin). Meeting with genetic counseling on Monday. I anticipate a negative BRCA.

Treatment options A) re-excision to “clean up my margins”, radiation and possibly Tamoxifen. B) unilateral mastectomy

I am an Oncology RN. On strong recommendation from coworkers, my medical oncologist I work with, they recommend a BMX. (Based on family history, the DCIS, and the extensive atypia noted in my pathology report). Met with my breast surgeon today, she will support me, but is not 100% on board with removing the healthy breast.

I do realize the cancer is small, treatable. But I’m looking long term. I’m young. I don’t want radiation and I don’t want hormone therapy. Has anyone had a similar story and opted for the more aggressive approach despite backlash from surgery?

Dx 9/10/2019, DCIS, Left, <1cm, Stage 0, Grade 3, ER+ Surgery 10/1/2019 Mastectomy: Left; Reconstruction (left): Saline implant
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Sep 13, 2019 05:32PM VegGal wrote:

I had a BMX in 2016 for a 5 mm lesion of grade 2. Like you, it was weakly estrogen positive. Unlike your case, my surgeon was thrilled with my decision.

Do what feels right for YOU.

Dx 1/12/2016, DCIS, Left, <1cm, Stage 0, Grade 2, 0/3 nodes, ER+/PR-, HER2- Surgery 3/11/2016 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 6/10/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 9/8/2017 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Sep 13, 2019 06:36PM Miranda5579 wrote:

VegGal- thank-you so much for your post. It’s so nice to hear perspectives from people that have been through this. Everyone that I’ve told offers their suggestions, but, it’s a harder decision than people who haven’t gone through it to completely understand.

Dx 9/10/2019, DCIS, Left, <1cm, Stage 0, Grade 3, ER+ Surgery 10/1/2019 Mastectomy: Left; Reconstruction (left): Saline implant
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Sep 13, 2019 07:46PM VegGal wrote:

It is hard to comprehend it. I am very happy that I didn’t do radiation after reading about others. Same with the hormonal meds. Sure I was aggressive up front, but it was absolutely the right choice for me.

I would suggest, if you decide on the BMX, to consider all of your reconstruction choices (if that’s what you want). Here lately it seems that implants under the muscle are being phased out and prepectoral smooth implants or various tissue flap surgeries are becoming more popular. Take your time with your decision, and see at least two good surgeons for options. The ONE nice thing about having DCIS is that surgery isn’t usually an urgent matter.

Good luck

Dx 1/12/2016, DCIS, Left, <1cm, Stage 0, Grade 2, 0/3 nodes, ER+/PR-, HER2- Surgery 3/11/2016 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 6/10/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 9/8/2017 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Sep 13, 2019 08:51PM BgRose wrote:

Hi Miranda,

I was recently dx with dcis grade 2 ,ER+ PR+ 4mm lesion. 41 years with no family hx.

I am going with bmx and immediate reconstructive surgery, my surgeon fully supports my decision. Radiation and hormonal therapy are the reasons I chose BMX.

VegGal- how long was your recovery? I am stressing out about taking time off work- I am a new employee, not eligible for FMLA for another 4 months...

Dx 8/21/2019, DCIS, Right, <1cm, Stage 0, Grade 2, 0/1 nodes, ER+/PR+ Surgery 10/17/2019 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Sep 14, 2019 06:09AM Rah2464 wrote:

Miranda my original biopsy was a 13mm DCIS hormone receptive but close to the chest wall. I was hoping to avoid both radiation and potentially hormone therapy with a BMx and also to gain some peace of mind. Turned into IDC upon final pathology results. No regrets on my choice, however. It is such an individual decision, it isn't the easiest surgery and you can definitely have complications in recovery (iron bra anyone?). I would say 14 months out that I have recovered back to 90% but a large part of that i feel is the impact of the Tamoxifen I take making me tired. But everyone heals differently and you are quite a bit younger than me that can make a world of difference. All I can suggest is that you trust your inner voice and do what you feel is best. No judgment from anyone who knows what it is like to have to make these decisions, only support and best wishes for a speedy recovery.

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 6/27/2018 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 7/27/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Sep 14, 2019 08:08AM VegGal wrote:

BgRose, my recovery wasn’t typical. While I was 53 years old, I was quite ill with an autoimmune disease (myasthenia gravis) at the time, so was extremely weak. The first 3 weeks were tough and then I rapidly improved. Driving was a bear for a couple of months unless the drives were short. Doing the driving was no problem, but afterward I would be so sore.

I will say that prepectoral recon would be the easiest recon recovery as it is less traumatizing. Even with fat grafting that was an easy surgery.

Good luck

Dx 1/12/2016, DCIS, Left, <1cm, Stage 0, Grade 2, 0/3 nodes, ER+/PR-, HER2- Surgery 3/11/2016 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 6/10/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 9/8/2017 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Sep 14, 2019 08:49AM HopeWins wrote:

Miranda - very similar situation to yours. I'm a little older, 47, but ironically the exact same family history and I'm BRCA negative. Same tumor but mine ended up being a little larger, maybe 1.5cm and it was grade 2. I'm 3w out from bmx and DIEP flap. It's a tough recovery for sure but no regrets.

My first BS also said she would support my decision but was clearly disappointed when I told her I wanted bmx. I ended up switching hospitals for the PS and the new BS was not advocating for either but just supportive.

You're head nd heart need to be aligned and then you're good.

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Sep 14, 2019 12:24PM Belinda977 wrote:

I had a BMX (nipple sparing) with direct implants 16 days ago. I am 52 and it gets easier every day. The is my second time with breast cancer and I ended up having a second area of DCIS that was found in the pathology. For me, 100% right choice. Follow your instincts.

Belinda Dx 4/23/2012, IDC, 1cm, Stage IA, Grade 1, 0/7 nodes, ER+/PR+, HER2- Surgery 5/17/2012 Lumpectomy: Left; Lymph node removal: Left, Sentinel Radiation Therapy 7/30/2012 Breast Hormonal Therapy 9/18/2012 Dx 7/25/2019, DCIS, Right, Stage 0, Grade 2, ER+ Dx 8/29/2019, DCIS, Right, <1cm, Stage 0, Grade 1, 0/1 nodes, ER+/PR+, HER2- Surgery 8/29/2019 Mastectomy: Left, Right; Reconstruction (left); Reconstruction (right)
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Sep 14, 2019 02:38PM Legomaster225 wrote:

I am another that chose a BMX. My doctor was fine with it. I absolutely made the right decision as cancer was found in my "clean'' breast as well. I knew from day one that I just wanted them both gone. Fear? Fate? I don't know. I had prepec, skin, nipple sparing and am happy that they match and look pretty normal. I still had radiation on one side due to a positive lymph node pre chemo though. As others have said you need to just learn as much as you can and make the decision you can go forward with. It is not easy and sometimes I just wish someone would have just told me "This is what we are doing" instead of "here are a couple options". Although we are blessed to have options as well.

Diagnosed at 50. Currently 53. Oncotype score 39. One node positive at diagnosis negative after preadjuvent chemo. Bilateral cancer discovered at BMX. Left breast was supposed to be prophylactic. :-( Dx 12/3/2016, IDC, Right, 3cm, Stage IIB, Grade 2, 0/4 nodes, ER+/PR+, HER2- Chemotherapy 1/19/2017 AC + T (Taxol) Dx 6/22/2017, IDC, Left, <1cm, Stage IB, Grade 1, 0/0 nodes, ER+/PR+, HER2- Dx 6/22/2017, DCIS, Left, <1cm, Stage 0, Grade 1 Surgery 6/22/2017 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Radiation Therapy 8/22/2017 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 10/17/2017 Hormonal Therapy 9/9/2018 Aromasin (exemestane)
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Sep 14, 2019 04:36PM MBPooch wrote:

I immediately knew I wanted a BMX and my oncologist and surgeon were all in agreement that it was the best decision for me. I had implants previously and had little breast tissue. They suggested it in order to have a good cosmetic outcome which I selfishly wanted but also wanted to avoid radiation and hormone therapy so it was kind of a no brainer for me. I was diagnosed at 45 and didn't want to second guess every little thing and stress before future mammograms. I had immediate reconstruction and was happy to avoid a second surgery and to wake up with breasts that were similar to what I had. My recovery was surprisingly easy. I hosted Christmas Eve dinner for my husbands family and went on a NYE vacation. I found that the stretching exercises and light yoga helped a great deal in my recovery. Definitely make the decision that you're going to feel most comfortable with!

Dx 10/16/2017, DCIS/Paget's, Left, 1cm, Grade 3, 0/3 nodes, ER+/PR+ Surgery 11/29/2017 Lymph node removal: Sentinel; Mastectomy: Left, Right; Prophylactic mastectomy: Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Sep 14, 2019 05:55PM OnTarget wrote:

I was originally diagnosed as having Mammary Carcinoma in just my left. When they found BIRADS 4 in my right I said immediately that I wanted the BMX. My surgeon was not against it but wanted to talk through it and counsel me just to be sure of the reasons behind my decision.

Before we could do that, the biopsy showed that I had ILC in the right, so she said "great call to go BMX" and we never discussed it further. I really liked that she was willing to give me that option before we knew for sure.

I hope you do what is right for you and don't worry about what other people think.

Diagnosed at 42, Oncotype score 16, ITC in one node- considered node negative Dx 4/8/2019, ILC, Left, 3cm, Stage IB, Grade 2, 0/3 nodes, ER+/PR+, HER2- Dx 4/23/2019, ILC, Right, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- Surgery 5/15/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 6/13/2019 Zoladex (goserelin) Chemotherapy 8/5/2019 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 11/5/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Sep 15, 2019 01:41PM - edited Sep 15, 2019 01:45PM by Miranda5579

This Post was deleted by Miranda5579.
Dx 9/10/2019, DCIS, Left, <1cm, Stage 0, Grade 3, ER+ Surgery 10/1/2019 Mastectomy: Left; Reconstruction (left): Saline implant
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Sep 15, 2019 01:49PM Miranda5579 wrote:

I’m so grateful I posted on this site. Thank-you all for the slew of knowledge, personal experience and advice. You’ve given me a lot to think about and consider. Thank-you all

Dx 9/10/2019, DCIS, Left, <1cm, Stage 0, Grade 3, ER+ Surgery 10/1/2019 Mastectomy: Left; Reconstruction (left): Saline implant
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Sep 19, 2019 04:06PM - edited Sep 19, 2019 04:07PM by JNN

I too chose a BMX. 1cm, Grade 3 right side, ER/PR + and family history. I was only 33 years old and it was the toughest decision I ever made. Everyone will gladly tell you what they would do, but until you are actually faced with it, it's easier said than done. Ultimately, for me, it came down to my future. The unknown, the constant worry, the checking and yearly mammos were just going to overwhelm my life. I couldn't live that way. Eliminating the need for radiation and hormone therapy was also a plus. Tissue expanders were immediately put in after surgery and my nipples were not spared. I had them reconstructed using my own skin which was one of my last surgeries. And I will say after the nipple/areola tattooing, they actually look really great. Overall, you need to do what feels right for you. All the opinions in the world should not make your decision. Make lists. Asks questions. Don't ever hesitate. Although this journey is not one anyone likes to take, I welcome you to a great family of warriors. Heart

Dx 9/29/2013, DCIS, Right, 1cm, Stage 0, Grade 3, 0/5 nodes, ER+/PR+ Surgery 11/4/2013 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Fat grafting, Nipple reconstruction, Nipple tattoo, Silicone implant, Tissue expander placement; Reconstruction (right): Fat grafting, Nipple reconstruction, Nipple tattoo, Silicone implant, Tissue expander placement
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Sep 20, 2019 08:30PM sierramtngirl wrote:

Bilateral mastectomy here, zero regrets. My best friends sister did a single and ended up needing the other side removed one year after her first diagnosis. That was enough for me to do both at the same time! I had immediate recon with TE placed and my exchange was 6 month so later.

Dx 10/13/2017, DCIS, Right, 2cm, Stage 0, Grade 3, 0/1 nodes, ER+/PR+ Surgery 12/12/2017 Lymph node removal: Sentinel; Mastectomy: Left, Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Sep 20, 2019 11:19PM SDWoman wrote:

No regrets for me at all. Bypassing dugs and radiation was worth it for me. Also, with my family history it made sense for me. BS was very supportive as well.

Diagnosed at 48. Extensive family history of breast cancer (3 aunts, 3 cousins, sister) Dx 11/21/2018, DCIS, Right, 1cm, Stage 0, 0/3 nodes, ER+/PR+ Surgery 12/14/2018 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant

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