Last chemo and approaching surgery

Hiya first can i say well done on getting through the chemo, its no easy task but you've done it, you should be proud.

I had chemotherapy then a lumpectomy with 3 lymph nodes removed. the lymph nodes came back clear but i didn't have clear margins from the lumpectomy. I went on to have a second lumpectomy to be told they had found a 5mm tumor and so went on to have a mastectomy. The reason i had the lumpectomies was because my nurse asked how would i feel if i had a mastectomy and was told there was only a small piece of cancer left and i had lost my whole breast because of it. Unfortunately i ended up having a mastectomy anyway but it was worth trying the lumpectomies first on the hope of saving my boob. In my opinion lumpectomies are a doddle compared to a mastectomy and if had got clear margins it would have definitely have been worth it.

My cancer is triple negative and so supposedly harder to get rid of.I do think about the future but i have every faith in my consultant to do whatever he believes is best for me. 

Hi Welshmakem,

My wife had a bilateral (double) mastectomy despite 'only' needing a single. She also needed lymph node clearance on the affected side.

She'd suffered from breast cysts for some years which is how it was discovered - during a routine scan prior to draining a particularly painful one.  The consultant thought it was a normal cyst and the mammogram didn't pick it up either. The guy who did the ultrasound was suspicious of it and ordered the biopsy, which confirmed.

She opted for the double because:
- she was worried her quality of life would suffer, ie constantly worrying if it had come back in the healthy breast and thus undergoing almost monthly prods, pokes and scans;
- worried if it did come back it would be missed.
    
When we discussed it with the Oncologist, she (the Oncologist) suggested there might be push back from the surgical team as they don't like to remove healthy tissue. However, the Oncologist supported Jen's position and argued the case. It certainly made sense to me and, being the average bloke that I am, I prepared to do verbal battle with anyone who stood in the way, using testicular lumps as an analogy (the surgical team at our hospital are predominately male), but that's a story for another day, perhaps.

However, however, the surgeon in question was agreeable to the bilateral approach so Jen had to have a psychological assessment to ensure she was of sound mind - essentially making the choice for the right reasons.

I'm telling you all of this as it's possible you may be met with resistance or you may not. But hopefully forewarned is forearmed.

Also keep in mind that the surgery is longer and thus fractionally more risky. Jen's took 7 hours in total, but it entailed immediate reconstruction. Recovery time is also longer, of course. The mastectomy was skin sparing but the placement of the tumour meant removal of the nipples. Dressed, the reconstruction is brilliant and only apparent to people intimately familiar with Jen - basically me, some immediate family and the wonderful medical folk who saved her life. I mean, it's brilliant unclothed if you ask me, but there is prominent scarring.

So you need to balance the risk of the cancer returning against the risk of doing longer surgery, plus the increased surgical and recovery times, the greater risk of infection (more wounds, more bacterial entry points) and the potential change in physical appearance.  

Definitely open dialogue with your oncologist and breast care nurse, as well as the surgeon. Discuss your concerns with them about quality of life and ask if they can gauge the likelihood of recurrence. You'll not be pressured to make an on-the-spot decision. At least, Jen wasn't.

Jen was given a great deal of latitude in the surgical approaches available and, frankly, I think she made the right choice.

Suffice to say it was difficult but the right course of treatment (for Jen).

..but we both have a few (more) grey hairs as a result.

Wishing you the very best. I truly hope this helps.

Hi Congrats on getting through chemo. 

Let me say first that we all worry about cancer returning. However hard we try to put it out of our minds, it's lurking there ready to jump out at the slightest opportunity. 

I don't think your surgeon would recommend a lumpectomy unless he was confident that it would deal with the problem but I do understand the feeling that you're safer if you chop off your boobs. I'm not sure that's strictly true however. Firstly, a friend of mine had a full mastectomy and when she went back a year or so later for a reconstruction they found a very small cancer. She was told that they don't necessarily manage to get ALL the breast tissue. 

Secondly, recurrence of cancer in your breast is horrid but isn't nearly as bad as return elsewhere (lungs, liver, bones, brain mostly). A double mastectomy won't solve that. It's something you'll have to live with.  

I'd suggest talking it over with the surgeon. He can take you through the relative risks. From what people have said on here, surgeons seem to leave the decision up to you but subtly (or maybe not so) push you in the direction they think is best. Be guided by the expert. 

Wishing you all the best.

Thanks for your reply and advice, I will listen the surgeons and breast nurse advice they are the experts after all, i just hope i can get peace of mind whatever i decide 

Pauline

Thanks for reply I have alot to think about don't I?

My husband is very supportive of my ultimate decision citing it's my body, he can see pros and cons in both options and so can I but hasn't made the decision any easier, I'll just have to speak to my oncologist on the 15th may ask her advice and see what surgeon says on the 16th

Thanks again

Pauline