WLE (Wide Local Excision) v Therapeutic Mammoplasty..... Your thoughts or experience please

I wonder if anyone can let me have their thoughts WLE verses Therapeutic Mammoplasty.  I totally respect at the end of the day, it is my choice, I would be sincerely grateful to hear other ladies views (I'm 55 years of age).

I have been diagnosed with Grade 1 NST Ductal Breast Cancer 20mm diameter, ER positive.  It's on my left side above my breast (towards the shoulder). 

It was first suggested Wide Local Excision + Sentinel Lymph Node biopsy, followed by 3 and a half weeks of Radiotherapy.

I have been told I am a good candidate for the "Therapeutic Mammoplasty" in place of the WLE. I am a larger lady, 44DD or there about, by removing more breast tissue on both sides, there is less tissue available for a reoccurrence.

I wonder having a large breast, following a lumpectomy, would this hide the area where the 'lump' is taken from or would it exaggerate the area?

The thought of the operation scares the life out of me, I avoid the dentist, so you can imagine, I'm on the 'needs must' approach at the moment, I want it out, its the 'after effects' - any hiccups that can happen.... infection, pain, how soon are most mobile, etc.  

When I have weighted up all my options, the 'fore and against' my mind says to go for the "Therapeutic Mammaplasty". However, I then go into the that is such a big operation compared to the "lumpectomy" - but, I am fairly sure, I would not have the courage afterwards to if needed to go for corrective surgery, 'if required' - back to 'do larger breasts hide or exaggerate the operation area?'

Therapeutic Mammoplasty would enable more tissue to be taken - with the view of getting a clear margin, and the more tissue taken away, the less chance its has to come back, plus trying to look at any good points, less shoulder pain from my bra carrying this load around (I'm trying to make this light hearted, but, I'm not believe me).

My worry continues, my mum is over 80 years young, since loosing my dad, I am my mum's world (my poor mum) on the other hand mum is my world, I don't want to tell mum about this, well to be honest, I 'can't', I can't let her know about this, I could not do this to her, I could not be responsible for causing mum any heartache - she went through enough the way we lost dad; mum is of the generation that just don't understand just how much medicine has moved on for us.  For now, mum thinks I have a cyst - that would be better coming out; my just saying this caused tears and upset, so much upset. I think for now, I will either let her know after the operation that I've had my cyst removed or depending how I am - I'll cross that bridge when I get there.

If I go for the lumpectomy, I can be back home and behave like all is normal - but, mentally I will be going through the mill on a daily basis of should I have had the therapeutic mammoplasty (TM) with the chance of larger clearer margins.  

Or, if I go with the TM, I will tell mum I've had the operation and pray that I'm 'mobile after 4 or 5 days' so I can behave normal (normal, haha). My mind keeps imagining me in a hospital bed unable to move, covered in bandages, I am so, so scared. 

I would appreciate any thoughts and if any of you have gone through these thoughts or this situation and what you decided.

Of course, I know at the end of the day, I have to make this decision - Any advice would really be welcome ~ if you're still awake after reading this Thank You Sincerely xxxx

  • Hi WhatHappened:  Wow.  You do have some decisions to make.  I'm not really familiar with the therapeutic mammoplasty - I don't think it's widely used here in the States, Certainly not in the institutions I used/am using.  I just wanted to share a little about my lumpectomy experience and perhaps it will help you make decisions.  I had a WLE in early May.  Going in I was a 38DD.  I got a post operative hematoma and developed cellulitis and also didn't have clear margins.  So healing had to happen before a 2nd surgery.  I'm scared to death of even needles, but honestly the reality wasn't nearly as bad as the crazy thoughts and fears I had.  After the 2nd surgery the left side of my breast was flattened and the nipple was actually pointing to the left.  Kind of odd looking, but my surgeon assured me that the breast would fill back in eventually.  3 months later and nearly through my radiation I see that it has indeed filled in.  Yes I have a scar but no one in the world would even know I had anything done unless I told them.  I've worked hard to lose weight during this and am down almost 20 lbs (1.5 stones I think).  I'm not wearing traditional bras anymore, I've permanently switched to sports bras as they are so much more kind and comfortable to me.  I'm thinking though that I'm perhaps down to a 36C size.  Maybe a D, but no longer DD.  The nipple is slowly but surely moving back to the front and I couldn't be more pleased over all.  It's less weight, less bounce and no cancer!

    I know you don't want to upset your mother and I do respect that.  However, you need to think about the fact that you're likely to become very emotional over this whole journey and your reactions may be out of proportion for "having a cyst removed".  Your mother is likely to pick up on that and over worry herself about you even more than if you were to calmly tell her what your options are and ask for her support.  You're still her baby and I just know in my heart that she'd love to be able to take care of her little one.  It sounds like you two have a fabulous and loving relationship.  Of course it's your decision and I'm sure you'll decide the best thing for both of you.  I simply wanted to point out another aspect that you might like to ponder before deciding.

    I know I didn't answer your question about the differences between WLE and Therapeutic mammoplasty, but hope I gave you some food for thought on the WLE and your mother.  You're in my thoughts dear.  Mira

    Update nearly 3 years later I'm still cancer free!  Letrozole has issues, but they're cop-able if you stay on top of the symptoms.  It's a new life, but it's a wonderful one too!  Keep doing those breast checks!  I did find another lump, but this one was no more than the edge of scar tissue.  That was a bit of a fright, but all is well.  Love to you all!

    I know you are conflicted.  I'm going to tell you that the WLE is the one for you.  How does that make you feel?  Are you now tending towards the mammoplasty?  

    OK, so I tell you to have the mammoplasty.  Wish you were having the WLE?  I think sometimes you need to be given no option to realise which option you really want.  

    If you are fearing recurrence, you need to know that it doesn't matter how much breast tissue you have, it only takes one rogue cell to develop into breast cancer, so that's kinda irrelevant.  Also, secondaries can develop in the lungs, brain, bones, all over the place, so that is even more irrelevant.  

    If your surgeon goes for the WLE, he may find more cancer and decide to take more and you would be quite lopsided.  Then your mum would notice, most likely.  Or it may be less than expected, and you'd be up and about in no time.  

    I say go with your gut. Ask your surgeon for your statistics for both.  I'm pretty sure they'd be the same. You can use the Predict tool as well, if you want to try your own statistics.  

    Personally, I think your mum would want to know.  Mums always do, anyway, don't they?


    I am not medically qualified, please consult your doctor or undertake your own research.

  • I had a therapeutic mammoplasty at the end of July with other side done to match. I was a 32gg before and no idea what I am now but I love my new boobs!! 

    I'm actually still healing on one side as got delayed healing but It's not stopping me getting on with anything, was uncomfy for quite a bit after but I do feel it's worth it. Like you I'm glad I got a large margin around where the cancer was (got 100% response to chemo so no lump left!) 

    As you say it is a big operation and a big decision to make but I just wanted to let you know  my experience to help aid that decision. 



  • Hi

    I had a Therapeutic Mammaplasty in September 2015 and haven't looked back.  As a bit of background, I was diagnosed firstly with a troublesome cyst that was eventually diagnosed as breast cancer.  My surgeon was brilliant and recommended the mammaplasty as a course of action so he could ensure on getting extremely clear margins.  I too was terrified of the thought of the operation, half my boob going plus a nipple reconstruction but, apart from a very slight stitch infection, it all went to plan.  The operation took about 3 hours but only stayed in overnight.  The only downside was wearing a corset type bandage for about 2 weeks 24 hours a day.  Also not being able to have a bath but think was more about getting the sitches wet.  Yes it was uncomfortable and had to avoid any heavy lifting but was mobile and up and about within a day or so.  In fact the surgeon told me to carry on as much as normal.  Try not to worry.  Take the advice, have a think and go with your instinct to do what's best for you.  However, it really isn't as bad (or wasn't for me) as you may anticipate.

    Good luck and hugs to whatever you do

  • Hi, I’ve had a therapeutic mammaplasty, and do not regret it! I don’t know if I was just lucky but I had no pain afterwards. I totally love my new boobie! 1 cup size smaller but that’s fine by me DD to a D. I will be having the other one done to match after all my treatment has finished. I have 1 boobie of a 21 year old and 1 of a 43 year old at present.

    I was glued together so no stitches, I had 1 dressing from my nipple to the bottom of my breast and one under my breast. My nipple was exposed and covered in glue. I had a drain which came out 2 days later, no problems there. Dressings were on for 2 weeks.

    Recovering was a pain in the bum though, not able to do much for a few weeks.

    I also had 25 lymph nodes removed so recovery was a bit longer for me. Chemo and radiotherapy next for me.

    Good luck with your decision xxx

  • "Thank You" for your experiences and thoughts - they all mean a lot and are truly helpful.  It all comes as such a shock and the treadmill is still moving, you can't take it all in and with me not wanting my Mom to know at this moment, I have very few people that I can share or discuss this with.  It is the fear of the un-known and I am someone that looks into things a lot, worries before it is time to worry.  

    Mirabo:  Thank You for sharing this, I am sorry you had to go through so much, your words have helped.  Heaven knows how you were mentally during this time. Reading what you have said, I can tell you are in a far better place now and massive 'Well Done' on loosing the weight, this is brilliant.  

    Mistymoley:Thank You for your words, it's so true what you say, when I was reading this, I was like owww have the WLE and I did think, no the other and then switched back.  It is true in a way we need less options - its not done like this now though - they leave it with us - which again good in one way but, bad in another.  Then when you get someone like me that is 'so' indecisive its of no help at all. I sincerely appreciate what you have said and, it does put some things into perspective xx

    Boobarama: Thank You for taking the time to reply.  Reading your reply made me smile 'I love my new boobs' - this makes me smile from such a situation you've turned it around.  I am sorry your healing is taking longer - the main thing is you have come so far and are still able to get on with things xx

    Bunny1971: Thank You for responding, your experience helps me a lot, I know we are all different and different things can happen. Reading how your operation and outcome helps.  So long as I can speak on the phone to my Mom 'sounding normal' for the first few days, will be good for me, the bath...  I can live without (I think). You sound so positive from all this, I am so pleased everyone went good for you xx 

    Pocket rocket: Thank You for replying.  Again, I have to chuckle 'I totally love my new boogie!' - How lucky was you to have no pain afterwards. Just reading what you have said again, '1 boogie of a 21 year old and 1 of a 43 year old'.  I wonder if the 'glue' is a newer way than the stitches - you would not thing glue would hold in such an area - sounds amazing, I wonder if you have less scaring with this method?  I have read many of the ladies say that the lymph nodes cause take longer to recover from - 25 wow.  Thank You again. I wish you so much love and strength during the coming times.

    "Thank You" for all sharing your experiences with me - it really has helped me.  After been in shock for a few weeks and saying 'just get it out of me' I am trying to look at it from all sides.  I know in my gut, for various reasons, including my own mental state of mind the "Therapeutic Mammoplasty" is the way forward for me, for a number of reasons;
    The main one, the possibility of a good chance of a clear margin.
    The more tissue removed the less there is for it to come back in.  
    The operation is all done at one time (when it involves myself, I have a horrible imagination and make my self worry for all sorts of reasons).
    I don't think I would have the courage to go back for corrective surgery.
    And well, 'trying to turn this around for some extra benefits; without a bra on my breasts/boobs are down by my waist :(  before all this, I would hardly ever wear a bra in the house, due to bring uncomfortable and the weight pulling on my shoulders.  
    This all points to the 'Therapeutic Mammoplasty' - just that from a denial point of view, it seems to be such a massive operation for a 'lump'.
    With regards to Mom, at the moment its still the 'cyst' that needs removing and I'm looking into having it remove. If I had a crystal ball and could see the outcome of the operation - I would be in a better place to know what to say.

    Sorry I've waffled on - I would of replied individually, but, I not sure how to, so I opted for this way.  Thank You and if I can help any of you, I'm here, I've got ears, shoulders and virtual arms for hugs.... Laughs well I'm good at this too xxxxxxx