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Topic: Surgery options TNBC

Forum: Triple-Negative Breast Cancer —

Share with others who have ER-/PR-/HER2- breast cancer.

Posted on: Oct 28, 2019 12:36PM

NarendraRana wrote:

Hi everyone,

My wife was diagnosed with TNBC Stage 2B a few months back( She is 41) Doctors suggested, Chemo->Surgery->Raditaion. We have completed the Chemo phase, and are now contemplating surgery options. Our surgeon suggested Lumpectomy but we want to find out whether going for a more invasive surgey is going to give her a better chance of beating this.

On the one hand we want to minimize the risk of breast cancer from coming back but since the cancer has already infected 3 lymph nodes, we are worried whether such invasive surgery of breasts makes sense since we also have to worry about cancer coming back through the lymph nodes...

We will appreciate responses from patients who went through the same and how did they decide.

Thanks


Dx 5/10/2019, IDC, Right, 2cm, Grade 1, ER-/PR-, HER2- Lymph nodes:3
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Oct 28, 2019 02:43PM - edited Oct 28, 2019 11:26PM by PawPatrolMom

Hi,

I am happy she has completed chemotherapy! There's still a long road ahead but that was one of the toughest. I had TNBC and opted for bilateral mastectomy because I was afraid of it coming back since triple negative is aggressive. I only had one node infected. A lot of the studies say lumpectomy and mastectomy should have similar risk of recurrence but I feel I needed that for more of a piece of mind. I know a lot of women who had lumpectomies (they weren't TN) and we're fine and I know many that had recurrence. As long as you guys make an informed decision and are comfortable with your decision, that's all you can do. Something that is important as well is if your wife is BRCA positive. If she is, most people would say that's a no brainer due to the risk of recurrence being even higher than BRCA negative even in the healthy breast. Good luck in the rest of her process

Dx 6/13/2018, IDC, Right, 5cm, Grade 3, ER-/PR-, HER2- Chemotherapy 7/1/2018 Adriamycin (doxorubicin), Carboplatin (Paraplatin), Cytoxan (cyclophosphamide), Taxol (paclitaxel) Surgery 12/13/2018 Mastectomy: Right; Prophylactic mastectomy: Left
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Oct 28, 2019 05:48PM VL22 wrote:

I opted for a lumpectomy. Everything PawPatrol says is on point. I’m BRCA negative and I just didn’t think it necessary to have a mastectomy. I am 100% at ease with my decision.

It really is very personal. Best of luck!


Dx 5/5/2017, IDC, Right, <1cm, Stage IA, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 6/15/2017 Lumpectomy: Right; Lymph node removal: Sentinel Dx 6/23/2017, IDC, Right, 1cm, Stage IB, Grade 3, 1/2 nodes, ER-/PR-, HER2- Chemotherapy 8/10/2017 AC + T (Taxol) Radiation Therapy 1/11/2018 Whole-breast: Breast Hormonal Therapy 3/11/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Oct 28, 2019 06:50PM MountainMia wrote:

Me, too. TNBC, BRCA and gene-negative. I had lumpectomy, chemo, and radiation. I'm happy with that decision.

The lumpectomy-rads and mastectomy are both intended to deal with the cancer confined to the breasts. (Radiation also can be directed to lymph nodes.) They can't do anything with escaped cells, and that is why we do chemo.

If I were unsure, I'd check again with the surgeon for the reasoning behind the recommendation. I'd also consider getting a second opinion. But ultimately your wife has to be happy with her decision, so that's what it really comes down to.

My best to both of you.

The rain comes and the rain goes, but the mountain remains. I am the mountain.
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Oct 28, 2019 06:53PM - edited Oct 28, 2019 06:54PM by NinjaMeow

I initially had a mastectomy on my cancer side only (unilateral) but went back and had the non cancer side done so in the end I had a bi-lateral. My biggest rationale was post treatment if I had a lumpectomy getting a mammogram every 3-4 months and if anything suspicious showed up a biopsy would be done putting me mentally backwards. My cancer was found at my very first mammogram at 40 after I found a lump.
I was told there is no difference in survival either way. I would ask if she had a lumpectomy how frequent mammograms would be required. It is a very personal decision. Hope this helps!

Diagnosed at 40 Dx 10/9/2013, DCIS, Right, 1cm, Stage IA, Grade 3, 0/4 nodes, ER-/PR-, HER2- Surgery 11/20/2013 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Chemotherapy 12/16/2013 AC + T (Taxol)
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Oct 28, 2019 11:39PM NarendraRana wrote:

Thank you PawPatrolmom, we are paw patrol fans too :)

She is negative for both BRACA1 and 2. But she keeps saying "i want peace of mind". But i saw how upset she was when she lost her hair, i dont want her to regret the big invasive surgery later.

our doctors (we got second opinion too) both said deal with it in steps i.e. lumpectomy first if needed then mastectomy. They also said " there is only a single digit benefit in recurrence (lumpectomy vs mastectomy)" .... ill ask her to read all this ... and support her .

Dx 5/10/2019, IDC, Right, 2cm, Grade 1, ER-/PR-, HER2- Lymph nodes:3
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Oct 28, 2019 11:43PM NarendraRana wrote:

Thank you for responding and good luck to you VL22. Lumpectomy is what we have been advised as well. Lets see.

(It's weird that in 2019 patients are left on their own to decide stuff like this... it should not be a personal decision, but i guess its the non deterministic side of cancer recurrence that is making it so)

Dx 5/10/2019, IDC, Right, 2cm, Grade 1, ER-/PR-, HER2- Lymph nodes:3
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Oct 28, 2019 11:47PM NarendraRana wrote:

Thanks MountainMia,

we just came back from meeting our surgeon once more and got a second opinion too. Same recommendation from both surgeons, take it in steps "lumpectomy first, mastectomy if needed" . Wife on the other hand does not want to deal with mammograms and biopsys (atleast in the breast)....

Just worried that she might regret this later but if it comes back then there will be regret too. looks like regret might not be avoidable.

Good luck to you!

Dx 5/10/2019, IDC, Right, 2cm, Grade 1, ER-/PR-, HER2- Lymph nodes:3
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Oct 28, 2019 11:50PM NarendraRana wrote:

Thank you NinjaMeow,

My wife has a very similar rationale as yours. Thanks for the tip about the frequency of mammograms, we will definitely ask about it.

Another question for you, how restricted is your range of motion(if at all) after bilateral mastectomy?

Thank you again.

Dx 5/10/2019, IDC, Right, 2cm, Grade 1, ER-/PR-, HER2- Lymph nodes:3
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Oct 29, 2019 06:50AM MountainMia wrote:

NarendraNana, you asked about range of motion after bilateral mastectomy. I don't know anything about that, of course. But after my lumpectomy with lymph node excision, my ROM was not substantially different immediately after surgery. By a couple of weeks after it was just as good as before. For me, the lumpectomy had a very fast recovery time and surprisingly little pain. I never took opioids at all, only Tylenol, and didn't use it after a few days. So if recovery issues are of concern to your wife, that is a little more info she might consider.

The rain comes and the rain goes, but the mountain remains. I am the mountain.
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Oct 29, 2019 12:22PM RebzAmy wrote:

Does your wife have any family history of breast cancer? I had a mastectomy due to my family history (my mum's sister had it and my dad's sister had it). Good luck with whatever you decide

Diagnosed June 2007, IDC, Grade 3, 4-5cm lump, several lymph nodes involved, HER2+++, 4 months of high strength chemo, mastectomy and lymph node removal, radiotherapy & a year of herceptin and recently had preventative surgery to other breast.
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Oct 29, 2019 01:17PM santabarbarian wrote:

My MO told me LX+ rads was equivalent survival wise. I opted for LX. Very happy w my decision. Not painful for me either. I have some residual numbness in my arm pit, but my breast feels normal.

pCR after neoadjuvant chemo w/ integrative practices; Proton rads. Dx 7/13/2018, IDC, Left, 3cm, Stage IIB, Grade 3, ER-/PR-, HER2- (FISH) Chemotherapy 8/13/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 12/27/2018 Lumpectomy: Left Radiation Therapy 2/11/2019 Whole-breast: Breast, Lymph nodes
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Oct 30, 2019 04:42PM NarendraRana wrote:

Thanks santabarbarian,RebsAmy for your responses,

She doesn't have a family history of breast cancer ..

we are still deciding ... looks like mastectomy will give us freedom from mammograms in the future but we still have to keep monitoring the cancer closely since it did get to the lymph nodes. so the question then is does mastectomy buy us enough piece of mind and can it counter balance the invasive-ness of the surgery and recovery.Still struggling with this... now that we have more information , whatever she decides and feels comfortable with , is what we will opt for. (ill post an update with her decision)

Dx 5/10/2019, IDC, Right, 2cm, Grade 1, ER-/PR-, HER2- Lymph nodes:3
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Nov 26, 2019 05:27PM NarendraRana wrote:

Hi Everyone, Thanks for sharing your thoughts and recommendations. My wife chose to get a lumpectomy in the end. And though its too soon to say but she is happy with her decision, the pathology report showed a complete response to treatment which also makes us feel better about just going with lumpectomy. If someone else is in the same boat here are the two things that help us come to this decision

1. 2 surgeons suggested Lumpectomy as their recommendation.

2. Since the cancer had gone to the lymph nodes we realized that even after getting a mastectomy we were always going to have to monitor if it comes back anywhere else in the body. Which meant mastectomy was not offering us complete peace of mind, just increasing our peace of mind. Coupled with the long recovery time and possible complications this made mastectomy make very little sense to us.

Our best wishes and good luck to everyone who reads this.

Thank you.

Dx 5/10/2019, IDC, Right, 2cm, Grade 1, ER-/PR-, HER2- Lymph nodes:3
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Nov 26, 2019 07:23PM santabarbarian wrote:

great to hear about the pCR! Yay!

pCR after neoadjuvant chemo w/ integrative practices; Proton rads. Dx 7/13/2018, IDC, Left, 3cm, Stage IIB, Grade 3, ER-/PR-, HER2- (FISH) Chemotherapy 8/13/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 12/27/2018 Lumpectomy: Left Radiation Therapy 2/11/2019 Whole-breast: Breast, Lymph nodes

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