Choice, mastectomy or partial reconstructive surgery using local perforator flaps

Hi,  I was diagnosed with an invasion ductal carcinoma which was 36mm and also showing an abnormality in an another area which was 33mm and 35mm apart from the original lump.  Have you considered asking for a second opinion on this?  I am only suggesting you do,  because you haven't been given the option of chemo and the fact they are not quite sure if it is cancerous or not in that other area, well?  Hanging in the air question that you have to make the call on.

Keep asking the questions, only then can you decide x

Hi 1in7. Sorry to hear of your diagnosis. Whilst I didn’t have a mastectomy I had idc and although small at 22mm it was grade 3 so fast growing. You mentioned that you didn’t get a choice for chemo. Is this because you are grade 1? A tumour can be between 1 and 3 depending on the way the cells look under the microscope. I did have to have a second surgery as they found cancer in my sentinel  lymph node and had to have axillary clearance where they found 9 out of 12 nodes positive for cancer even though physical and ultrasound showed nothing. I then had chemo although this was part of the plan even before I had had my surgery as they were able to grade it At biopsy. I had a PET/CT scan to confirm if it had spread and luckily that can back clear, but I still had chemo to mop up and rogue cells floating around the body.  I agree with McQ14 it might be worth a second opinion or further discussion with your consultant to check on grade. 
Wishing you all the best with whatever decision you go with.

Hugs from cuffcake x x x x x

The small invasive one is grade 1 and slow growing, I suspect this is why they have said no chemo as yet,  but until they go in and check my lymph node, this may change.

Ah yes. Once surgery has been done they get the full picture and as you say things may change. There will be lots of others along soon who have had a mastectomy and can let you know what they did and how things worked for them.

Wishing you good luck for your surgery and results. 
Hugs from cuffcake x x x x x

This is a tricky one and the question I would ask myself in this situation is:

What is the highest priority for me? For some, it would be to avoid the extra inconveniences and pain that any reconstruction could bring with it, whether at the point of surgery/surgeries, recovery, treatment, and they are willing to end up with that side of the chest flat. For others, being able to look down and see two full breasts is important enough to be willing to put themselves through added stuff to achieve that goal.

Once you know that, you know if you are going for option 1 or one of the other options. If the highest priority is to achieve the appearance of two breasts, it's a question of which method to use. From what you are saying, option 2 is not a good option for you for the reasons you stated, leaving options 3-5.

By the way, on losing weight: I had to do that after nearly every pregnancy. For me, cutting out bread and sugary-type items took care of most if not all of it, so I am mentioning it here in case it might be useful. The question is, will the surgical team accept option 4 on the assumption you can reach the target BMI and will they accept 32 rather than 30? Worth asking the question so you know if option 4 is viable at this time.

If option 4 is viable, then if conserving the breast is the higher priority, this or option 5 are likely your best options. (I am not sure what “partial reconstruction” means – Option 5 – so worth asking what the difference is between that and option 4.)

In my opinion, based on what you were saying, option 5 sounds the best if available, but if the only option for reconstruction is to do it at a later date, tell the surgeon you want to have the option left open to you, go with the mastectomy for now, and decide about a reconstruction when you feel ready for making the decision.

Also they don’t use chemo for DCIS.  You have a big decision and I cannot advise as had lumpectomy on both breasts.  Regarding mastectomy have you checked out Goldilocks mastectomy?  They do a skin sparing procedure and then use the extra tissue to construct a breast mound.  I don’t know if you are larger breasted but this technique is meant for larger breasted women.  I have sent you a YouTube link from Mayo Climic so you can see the questions etc.  sometimes I imagine to get the breasts to look cosmetically good they may need to do a lift or reduction on other breast.  Certainly worth asking about.

 I wish you the best in your quest to find what will work the best for you.  
Here is the link https://m.youtube.com/watch?v=T74l50DG-4Y&autoplay=1

Hugs too. 
Barbara

There are others on this page who have the same experience that you are going through. They are more experienced on what you're going through than. I  hope everything works out for you. 

Hi 1 in 7, I was diagnosed with DCIS intermediate stage oestrogen/prog positive in 2016. I had a mastectomy with immediate LD flap reconstruction - where they take the latissimus dorsi muscle from your back-.I lost my nipple but the skin was saved and I later had nipple reconstruction and tattoo. It looks great (well, for a now 60 year old with saggy 38DD breasts!) . I didn’t need chemo so was lucky there. However, although it was a big surgery (7hrs I’m told), it was preferable to waiting for the reconstruction at a later date. I recovered well and am clear 7 yrs later. I was a bit overweight at BMI 28 but this was never mentioned to me as a concern. 
I had worried about having an implant as they said I might need one to create my larger breast, but luckily the muscle was big enough. 
it’s important to exercise regularly to regain strength in your shoulder and back and prevent lymphoedema in the long term. I now do Pilates every week. 
I had some issues with an infection post surgery and fluid build up which had to be drained a few times, but it was worth it for the longer term benefits. 

best of luck with your decision x

Hi, thanks that is really helpful.

Hi did you have any problems with back being very tight where they took mussel I’m 13 weeks since surgrey but very tight down donor site. Hope you have healed well.