Deciding whether chemo first or lumpectomy first for tnbc.

Hi vibraphone

im not sure I fully understand the chemo or surgery first options entirely but there definitely seemed to be a size consideration for myself(15mm) and no suggestion other than lumpectomy and sentinel lobe excision biopsy followed by chemo /radio or both depending upon results

I scored the hat trick and just finished radiotherapy after 6 cycles of docetaxol/carboplatin which was bloody tough

my friend refused to have surgery first as she was hoping chemo could shrink it and prevent a mastectomy-that was not the case so mastectomy followed chemo and finally radiotherapy -she’s now awaiting a reconstruction 

so I think you can have a say in the matter and there are some guideline sizes etc but I just wanted it out which I believe has to be within 30 days  of diagnosis and I’m glad he went wide and big so good margins and total axillary clearance so no having to go back for second op

if the option is to try to preserve breast by using chemo first and that’s important to you then go for it-like I say I just wanted it out whatever it took(think that might be my profession as a veterinary surgeon showing through!)

hope this helps 

Hi Wizz, Thankyou for your reply and very best wishes to you.

You point out usefully that the op may change what happens next. It’s just possible chemo won’t be needed .

There e is no prospect of anything being within 30 days of diagnosis here in Cornwall - delay of over a week between every consultation or procedure and maybe a month before an operation. Having changed my mind really because of the chance to avoid chemo I now await the surgeon contacting me again.

x vibraphone

Do you know how they make sure they operate on the correct breast? Do they mark it whilst you are awake? 

Hi there, Vibraphone. 
I think it’s the right call, especially under the circumstances. I was diagnosed in July 2016 and decided after a second opinion to start with chemo (Lymph node biopsies were positive) to mop up any cells that might have leaked through, so didn’t have mastectomy til end Dec 16. The chemo was stopped early and made little difference - 55mm diffuse HER2+ tumour. 
Bottom line seems to me now that chemo response is individual in a way that’s surgery isn’t (and I’m back on it btw). Surgery has a guaranteed outcome as far as the tumour is concerned! 

Thankyou Dosydo and best wishes to you. All the waiting is terrible- I went to my gp before lock down. My triple negative cancer is said to be fast growing and urgent but I suppose resources are lacking so it all takes ages with waiting for apt’s.

Yes, waiting is a pain and I very much hope you don’t get held up - hopefully some services are reorienting back to normal and you will be ready and waiting to go. 
You already have a bit of leeway - if the lump is larger than expected you can go for a mastectomy. This may seem a horrific prospect, but it is a matter of getting your head and heart used to the idea. Hope for the best outcome but consider the back-up options too. Try to discuss them with your family and med team, so they are not buried as fears in the back of your mind. You’re on a pathway and the prospects are good, getting better all the time!