Jun 10, 2020 07:00AM SpecialK wrote:
hray - of course you have questions, its a big decision! I think you are smart to consider the pros and cons of each type of surgery so that you are making an informed decision rather than one based on an emotional reaction. Firstly, I am brokenhearted that you even have to wrestle with this at such a young age, it is so very unfair. I am old enough to be your mom and I struggled with the very same question. My oncological breast surgeon initially offered lumpectomy and 5 day brachytherapy rads as an option. I had large B cup breasts and a tumor that was a minimum of 2.6cm and located at the outside edge of the breast kind of where an underwire in a bra would end. I had surgery prior to chemo and I was concerned that taking that much of my breast in that location would pull the nipple to the side and bug me due to the asymmetry. My secondary concern was that this very palpable tumor did not show up on my mammogram, only on ultrasound. I did not trust that imaging going forward would pick up a recurrence or a new primary. I had been closely monitored (imaging every six months) for quite a while, but I still had extremely dense breast tissue even nine years after surgical menopause, so I was difficult to image. How was your tumor found? Was it easy to see on mammogram, or did it require additional forms of imaging to detect? I realized that for me personally, bi-lateral mastectomy was the only surgery that would give me peace of mind knowing that my larger tumor in my smaller breast couldn't been seen on the first line of imaging. I ended up having a bunch of unseen DCIS with my triple positive IDC on the cancer side, so much so that it had also moved into the lobules, and also had copious amounts of atypical lobular hyperplasia and atypical ductal hyperplasia in the non-cancer breast, so potentially a ticking time bomb - surprise! Have you had MRI done? It is important to have a full picture of all that is going on in both breasts before a surgical recommendation can be made. I had always had numerous cysts in both breasts simultaneously, all the time, so self-exam was pretty useless, further complicating things. Several questions to ask yourself - if the lumpectomy creates a non-symmetrical breast, will you be ok with that? Not that this will be a foregone conclusion, but is a possibility depending on your anatomy and how much tissue needs to be taken. Your surgeon should be able to address this and should be discussed. One option, if you are a candidate, is talking to a plastic surgeon who does oncoplastic work so that they can rearrange some tissue during your lumpectomy and fill in the lumpectomy defect for better appearance. Something else to consider, if you did lumpectomy and radiation now it may complicate mastectomy with reconstruction later should you choose that later. Radiated skin doesn't stretch well and can eliminate some kinds of reconstruction down the road - usually implant - leaving autologous flap surgery as your only option. It is important to consider whether this is something you want to undertake if you would choose to reconstruct. Previously radiated skin is less of an issue if you choose to go flat but can cause some healing problems even in that scenario. How do you feel about the level of imaging surveillance you will need if you choose lumpectomy? Some really struggle with their worries and emotions when it is time for mammograms after lumpectomy, and particularly if something shows up and further imaging is needed. You would likely be on an accelerated schedule of imaging for some period of time following your active treatment, so it is important to give that some thought. There are people here who have had a lumpectomy and later opted for mastectomy, your surgeon should be able to tell you whether your insurance will cover the later surgery - usually they have to code it so that it is medically necessary - but I think for the most part it is covered. You would potentially have additional expense with a new deductible in a new insurance year for the additional surgery. I sure wish you didn't have to make this decision, it is hard, but particularly so for a 27 year old. Wishing you the best, hang in there.