Chemo then Mastectomy - any had it this way round?

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Hi,

I am coming towards the end of my chemo (3 cycles of 3 weekly EC completed and having my 10th of 12 weekly Paclitaxel with 3 weekly Phesgo tomorrow) and am starting to think/worry/panic about my mastectomy. Most people seem to have surgery first, has anyone done it the other way and can share their experience? 

I was due to have an Oncology appointment on Wednesday but got a phone call from the BCN instead saying they were discharging me back to the Breast Clinic.  I got an appointment yesterday for 20th May to see the surgeon who will be doing my mastectomy.  I haven’t seen him since my diagnosis meeting, which is all bit of a blur now, but at the time he recommended mastectomy with immediate reconstruction using an implant and a ADM plus a sentinel node biopsy and to have chemo first so there would be no treatment delays if there were any post op complications.  I have HER2+ ER+ PR- grade 3 invasive ductal carcinoma and extensive DCIS so mastectomy was the only option.

Any advice on what to ask the surgeon would be appreciated? Also an idea of how long after finishing chemo did your surgery happen and an idea of what to expect after surgery if you had a similar procedure would be really helpful.  Any top tips for coping with this whole thing?  I have tried really hard not to worry about the surgery as just wanted to concentrate on getting through the chemo, but can’t stop now I know I have this appointment coming up.

Thanks,

Tis x 

  • Hi 

    I had my treatment this way round but decided to go flat, didn’t have reconstruction. I was HER2+, Grade 3, had 4 rounds of EC and meant to have 12 of paclitaxal but only managed 9. I finished chemo on 11th November and had my mastectomy on the 29th November. In hospital overnight and home the next day with one drain. Was doing exercises before discharge and felt pretty ok, no real pain. Found the drain to be annoying and also was surprised about how tired I was, I slept a lot! Back at work 2 weeks after mastectomy, drain removed 10 days after mastectomy and was driving after 10 days too. I then started radiotherapy first week of Jan for 25 days. Ongoing herceptin for 14 cycles post surgery, next one will be number 8.

    I found surgery ok, my surgeon is amazing and she had me look at my scar and before going home, taught me my exercises and also taught me how to look after my drain and wound.  On the day of the surgery it was a very positive day, the team were pleased to see me and said that when I wake up it will all be gone and that they were there to make sure I was well looked after. I was relieved to have the breast removed but I was clear from the start that I wanted mastectomy without reconstruction. I find that I have stiffness in my arm and shoulder and I do exercises to minimise this, I also have a massage once per month and this really helps with stiffness and movement. 
    I am living abroad so my timeline may not be exactly the same as yours, but likely will be similar. 
    Good luck with your surgery and well done for getting this far Cherry blossom Don’t feel worried about how you feel, it’s only natural - it’s a big thing. We are all here for you xx

  • I asked similar questions some months ago, here is the list of questions from that time and additional questions in the responses I received. 

    There is a more extensive list of questions in this thread some of which are the same as in the first link.

    A thread from just a few days ago is now prompting me to say that it may be a good idea to ask for exact details of what to expect on the day of surgery, especially as you are taken to theatre and up to the point of being given the anaesthesia, so that you know if you are going to be expected to walk or be taken in a bed, etc.

    Regarding the time gap from chemo to surgery, my own surgeon told me on two separate occasions that she would not touch a patient under 4 weeks from chemo, and would much prefer a gap of 6 weeks, as she felt these were the minimum time spans needed for a body to be sufficiently far from chemo and able to withstand surgery well.

    I had a lot of chemo before I had any surgery, and I had some chemo after surgery too. While it is true that a lot of women have surgery first and chemo after, our treatment plans are tailored individually, within the general guidelines, to fit each of us in the best way.

    There are threads here with a lot of advice for after surgery, different shaped pillows and types of garments to use. One thing I want to highlight -- the exercises are extremely important and very highly beneficial.

  • Hello Tissy

    I had chemotherapy then the operation. I had 6 cycles of 3weekly chemotherapy with 2 delays of an extra week for unforseen issues. I had surgery 4 weeks after my last chemotherapy. 

    I have to say when first diagnosed the plan was for a right side mastectomy but after chemotherapy the plan changed to a lumpectomy as the mass had reduced so much. 2 weeks on from surgery the drain is out, I'm healing and struggling with the exercises.

    The surgeon and the anesthetist both talked me through what would be happening. From the time the anesthetist gave me the first meds I didn't know anything till I woke in Resus nearly 4 hours later.

    I just  take one day at a time. I kept reminding myself that these doctors know their stuff. They, sadly, do this everyday. I had trust they would do their best and they have. Try not to worry, if possible. I know it's easier said than done.  Good Luck.

  • Thanks for you reply Rumple.  I was glad your op and recovery went well and you seemed to have had as good an experience as possible under these circumstances. 

    It appears to be a more straightforward op without the reconstruction and I am going to find out more about my options at the appointment. At the time of diagnosis I was still in shock and just went along with what ever was recommended. I remember the surgeon did say we could revisit after the chemo.

    I hope the rest of your treatment goes well.

    Tis x 

  • Hi GreyCats,

    Thank you for your reply and the links - lots of useful questions/information there!

    The surgeon did initially say 6 weeks after chemo for the op but the oncology Breast Nurse said it could be 2 to 4 weeks which sent me into a panic as I have a uk holiday provisionally booked 4 weeks after chemo ends.  He also mentioned further treatment after the op depending on the pathology and other tests but I know there will definitely be some sort of “phase 3” treatment required.

    I will be doing my exercises religiously - as one of my hobbies is dancing (more enthusiasm than expertise!) I am keen to get full movement back if possible. 

    Sine joining the forum, it has amazed me how many different types of breast cancer and treatments there are and how everyone’s experience is different. Thanks for sharing yours,

    Tis x 

  • Thanks for the reply Dilly, I hope you are continuing to recover well from your op and finding the exercises a bit easier.  You had a fantastic response to the chemo .

    I have never had a general anaesthetic, and the only op I have had was a c-section done under spinal block so I am a bit worried about this to be honest but as you say we have to take it one day at a time and trust the medics. 

    Good luck with you recovery too.

    Tis x

  • Yeah, there are a lot of different presentations and treatment options, and more treatments keep coming up. Regarding the gap from chemo to surgery, it is the surgeon's decision so I am not sure why the nurse said that. If you do indeed get a date that is too close to chemo you can ask to postpone, I don't think anyone would mind, unless they have a medical-based reason, which seems unlikely.

    Dancing is great! Are you talking about ballet? Ballroom dancing? Belly dancing? When you see your surgeon prior to surgery you may want to ask how soon after surgery you are allowed to enjoy it again to the full. This will also depend on how you feel after chemo, but it's one of the best activities anyone here has ever mentioned (I am completely objective, of course Wink ) so I hope you can get back to it soom after!

  • GreyCats, I do ballet classes now and have really missed it during chemo and can’t wait to get back to it both for the physical and mental benefits. I only started about 18 months ago (never done ballet before) and took part in my first show in October 21 as one of my turning 50 self-challenges! I have previously done ballroom and Latin, as well as tap and disco though.