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Jul 15, 2021 10:24AM
This was not my personal situation so my two cents are probably worth less than two cents, but in case it's helpful this is my thinking when I was making a decision...
Local recurrence doesn't kill you but the longer it takes to detect, the greater chance of it not being local anymore. I think anything that would make it harder to detect local recurrence would be less preferable.
Local recurrence can often be detected after no-reconstruction mastectomy with regular manual exams (by you and by docs) and after lumpectomy with manual exams/mammograms/MRIs (for high risk women). My impression, from my last reading about this but I am not an expert, is that certain types of reconstruction might make it harder to catch a recurrence early. I think this would be even more important if you turned out to have the genetic predisposition. In addition, I think screening would then again require imaging in addition to manual exams, and that undermines what many women find to be a huge benefit of mastectomy.
In your shoes, I'd definitely try to figure out what kind of same day reconstruction they are offering you and how it will impact screening.
To be honest for me this was an emotional decision. As soon as I learned that lumpectomy+radiation was not less protective for me long term, I had a very clear and strong wanting to keep my breasts.
If there is an evidence-based medical advantage to a certain path, your doctors should make that clear to you and of course that should be guiding. But when it comes to options... everyone has a different relationship with their breasts (whether natural, augmented, or reconstrcted), and I think the most important thing is to listen carefully to your inner voice and do what feels congruous and what you think you will feel good with. Despite what I wrote above, wanting reconstruction is a good enough reason to have reconstruction, even if it does introduce some extra potential complications. Quality of life and feeling good in your body - whatever that means to you personally - is super important.
Dx at 39. 1.8cm. Oncotype 9.
9/19/2018, IDC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (FISH)
10/17/2018 Lumpectomy; Lymph node removal: Sentinel
11/1/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
12/2/2018 Whole-breast: Breast
12/18/2019 Fareston (toremifene)