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Lumpectomy vs Mastectomy - Help!

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Tarabeth View Drop Down
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    Posted: Feb 14 2017 at 10:44pm

I have a unique situation and I'm looking for other similar cases to help me in my surgery/radiation decisions. I'm Stage II, IDC, 1 tumor Left Side 1.9 cm + 2 lymph next to tumor. I'm 46 years old and have 10 year old implants that are intact and surgeons saying I could keep them up to 20 years (they are currently intact and fine).

  • Current Chemo: Carboplatin/Taxol - just finished 7/12 weekly +  4 AC (bi-weekly) to follow). 
  • Surgery June 2017 - type of surgery TBD
  • 6 weeks radiation has been strongly recommended.

I'm desperately looking for someone that has been in this situation or someone with some STATISTICS. My primary focus is to lower my risk for recurrance.  I have many options but the radiation is a large factor in my decisions too because of existing implants or option of new impants. 4 options:

1. Breast conservation: remove implants, have radiation. No reconstruction.

2. Lumpectomy: keep existing implants, do radiation and wait to see how implant responds. Fix right side to match left.

3. Nipple Sparing Double Mastectomy: replace implants, do radiation and deal with radiation impact on impants later.  Dr. said it's not IF they will be affected, but to what degree.

4. Nipple Sparing Double Mastectomy: replace implants, no radiation if clear margins and no positive lymph. Radiation if recurrence.

I really do not want to do #1 but I'm struggling on probably #2 or #3. Very concerned about recurrence rates in these 2 options. I don't want to be worried all the time about getting it again. Anyone have advice for me or links to studies/statistics that would help me choose.  NO DOCTOR WILL TELL ME what to do.  They said it's up to me and I'm a special case.  Also say that either surgury WITH radiation have very similar recurrance rates.  HELP!

Tara

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Tarabeth View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Tarabeth Quote  Post ReplyReply Direct Link To This Post Posted: Feb 14 2017 at 10:46pm
Also:  I am BRCA 1 & 2 Negative
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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Feb 15 2017 at 8:38pm
Hi Tara,

This link covers some discussion on radiation and the benefits with TNBC.  Read through it, the various studies.  I hope you find it helpful and possibly see why they are strongly recommending radiation.

http://forum.tnbcfoundation.org/radiation-and-possible-benefits-of-rni_topic10437.html

I can share my experience.  Initially stage 1 and chose double mastectomy with implants.  Radiation wasn't recommended because stage 1 and all sentinel nodes were clear.  13 months after finishing chemo, I had a recurrence to an internal mammary node(s), now stage 3.  I completed more chemo, then 40 rounds of radiation.  Since I had already completed my reconstruction with the implants, they had to work around the implants to get the correct angles for treatment (they kind of were in the way).  Before radiation, the reconstruction was very symmetrical and looked normal.  After the radiation on the right side, the implant is hard, smaller and positioned higher than the other side.  When I've asked what happens if I need to replace the implants, I get vague responses.  I talked to my onc's NP and said I realize the radiated skin will make reconstruction more difficult with possible healing problems, she just shook her head in agreement.  I'm older and for me, if I have to have them removed, I think I'd choose no reconstruction.  You're younger so I totally understand wanting the best reconstruction choices. 

Donna 

DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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