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Time lapse between Chemo finish and D-Mastectomy

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Natalie View Drop Down
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    Posted: Nov 11 2011 at 10:24pm
New member here.
Diagnosed May 2011 Lumpectomy May 2011, stage 1 lymphnodes neg. Tumor under 2 cm. O.K really have to get all my numbers and acronyms straight.

Planned having double Mastectomy from the beginning.

I finished dd ACx4 -TaxolX4 every 2 weeks on October 17,2011. WooHoo :)

My question is this:
How long is recommended between finish of Chemo and double mastectomy with reconstruction (Inplants)?

I Just got the surgery date of December.27,2011. (BTW- the day before my birthday) Oh well, there's always next year.
Expressed that I didn't think it would be that delayed, and I wanted it sooner. Triple Neg and I have to live in my head with this. I need to feel like I went after this like a bull. Asked her to please speak to docs.

 The receptionist called back after speaking to both surgeons and was told the doctors felt that would be fine.

Called Oncologist and he said it will be fine. Recovery from Chemo was important before surgery.

I would like to know how you ladies feel about this. I have to live in my head. I felt as though...o.k. we kill the cancer with chemo then we swoop in and do surgery maybe a moth or 6 weeks out. 

Any info greatly appreciated
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Wade View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Wade Quote  Post ReplyReply Direct Link To This Post Posted: Nov 11 2011 at 10:42pm
Hi Natalie,

First let me say that I have no medical training, but I can tell you what my wife's dr.s recommended. She, too, was diagnosed in May 2011. She did chemo first, then had the lumpectomy just about 4 weeks after finishing chemo. Like you, she had dose dense A/C 4x , then Abraxane 4x. Her docs recommended surgery 4-6 weeks after finishing chemo.

It strikes me after re-reading your post that you had the lumpectomy first, so your original tumor has already been removed. It was my understanding that this "origin site removal" was the primary goal of the speedy surgery. So I don't know how relevant my information is...

I wish you the best of luck with your treatment. I'm assuming no radiation since you're having a double mastectomy?

Wade
Wife DX 5/2011@52 2.5x3.1cm;6/2011 DD A/C 4x,Abraxane 4x; Lumpectomy, SN biopsy 10/2011; 10/27/2011 NED; Rads start 11-22-2011, Rads fin 1-11-2012; 10-2013 NED; 07-18-2014 NED; 08/07/2015 NED!

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Natalie View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Natalie Quote  Post ReplyReply Direct Link To This Post Posted: Nov 11 2011 at 10:58pm
Hi Wade,
Yes I did have the Lumpectomy first, don't know why that varies with people. Some times I suppose to see if chemo works on the type of cancer? Sounds good anyway. I wanted the thing out and my docs agreed.

I think I would feel more comfortable with six weeks rather then what they are suggesting. 

Maybe since I had Lumpectomy first, they feel I can wait a bit and gain my strength back. Hmmm

Thanks Wade for the info.

Hope your wife is well.

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Barbi View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Barbi Quote  Post ReplyReply Direct Link To This Post Posted: Nov 12 2011 at 9:51am
Natalia, I agree with Wade, although none of us are docs.  If they did the lumptectomy pre-chemo and got clean margins and no nodes, they believe they got the cancer. The chemo was done to kill anything that had escaped systemically.  Even if you hadn't had surgery before chemo, they usually wait 4 to 6 weeks to do the lumpectomy/mastectomy. (Even if there is residual tumor showing up after the chemo).
10/10,age49,St3,gr3,5+cm,1 node,BRCA-,T+Cisplatin+Rad0001(or placebo),Lump 1+cm,AND 0/15,AC,rads finished 7/6/11.Mets bone, liver,mamm node 8/11,abrax/tigatuzamab failed.Started bicalutamide 11/16/11.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Barbi Quote  Post ReplyReply Direct Link To This Post Posted: Nov 12 2011 at 9:52am
OK, I hate typos - lumpectomy and systemically, please.
10/10,age49,St3,gr3,5+cm,1 node,BRCA-,T+Cisplatin+Rad0001(or placebo),Lump 1+cm,AND 0/15,AC,rads finished 7/6/11.Mets bone, liver,mamm node 8/11,abrax/tigatuzamab failed.Started bicalutamide 11/16/11.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Nov 12 2011 at 10:47am
Natalie,

I know you just want to get the surgery over with, but I agree that your body needs to heal after the chemo. The good part for you is that you had a lumpectomy with no nodal involvement. Mentally, these 6 weeks may be tough until you get the surgery. Don't be afraid to ask for some anxiety meds like Ativan if you need it. I sometimes think the mental/emotional part of this disease is worse than some of the treatment.

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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Natalie View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Natalie Quote  Post ReplyReply Direct Link To This Post Posted: Nov 16 2011 at 9:58pm
Thank you Donna ans Barbi for your input.
I am still having a hard time with it in my head, I will be speaking to my breast surgeon next week.
 
No one can really say that nothing will grow back in that time.
I realize I have to recover more from Chem, I have such fatigue and other symptoms. The fatigue is the worst part though.
Once again thank you for your supportive words.
 
Be well,
Natalie
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Grateful for today Quote  Post ReplyReply Direct Link To This Post Posted: Nov 16 2011 at 11:37pm
Hi Natalie,

Had some thoughts.....disregard if not helpful.

Initially, thought it is important to listen to one's gut reactions.
It SEEMED you really wanted the surgery as soon as possible/medically reasonable.
(although as others stated the tumor with clear margins is GONE).
If your body was ready, would encourage you to talk again with your MD about an
earlier surgery date as that seemed to be your gut feeing.

THEN..... read your post today that you have such fatigue and other symptoms...........
Sounds like your body is speaking loudly to you that it is not quite ready for the double mastectomy.
Sounds like another month ( which would be just about when your surgery is scheduled)
would be better for your body.   If it's not emergency surgery, it is better to have your body
as healthy and rested as possible for the surgery and needed recovery afterwards.
Final decision is yours with your MD.

I prefer not to raise a question on the forum.
At the same time, feel a question is better addressed initially rather then after the fact.
Wondering if a radiation oncology consultation was recommended or already done with
recommendations and decision made. If not, maybe consider discussing with your MD.
( Just wondering. No need for you to reply. I respect your decisions and plans.)

With positive and caring thoughts for you and that your fatigue and other symptoms
lesson/resolve,

Grateful for today..................Judy
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Natalie View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Natalie Quote  Post ReplyReply Direct Link To This Post Posted: Nov 17 2011 at 12:02am
Judy,
 
I don't mind answering the radiation question.
 
When I began this jouney this past April my docs said radiation would not be needed if I had a mastectomy.
 
I too heard about the study  that said radiation after mastectomy even was helpful. Brought it to my Onc doc & breast surgeons attention and they told me, one study does not change the recommended treatment. That it would have to be many studies.
Now....I have read on here about this very thing. I at this time feel confused, and anxious to be done with this. If I bring this issue to a radiation doc....he will probably recommend it. Seems everyone wants a piece of me.
 
They also have not recommended any follow up testing? That seems really messed up too.
 
Did you have a mastectomy and radiation afterwards?
 
Trying to do protein shakes and extra supplements. Wanting to consult with a nutritional counselor in the near future. If I take everything everyone suggested I would be have 100 pills, liguids and gels a day. Fatigue is rough but slowly getting better. My bones and muscles ached b4 all of this. Just seems like more aches and pains then my norm.
 
Be well,
Natalie
 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Grateful for today Quote  Post ReplyReply Direct Link To This Post Posted: Nov 17 2011 at 12:56am
Hi Natalie,

I will post again later Thursday.....probably in the late evening.

Oh, am sorry, that I have brought up an issue that you already discussed with your Onc MD
and surgeon. My intent was to be sure that the question of the need for radiation had been
evaluated. I respect your decisions and plans.
I need to re-read some posts and re-read some articles and then will post again.

What I do know: different patients and their MD's looking at the same info/studies can come to
different decisions with EACH decision being the BEST for that particular situation. There are so many
things to consider.

Yes, I did neoadjuvant chemo (dose dense AC-T) then had a unilateral mastectomy with ALND (axillary lymph node dissection) and radiation.    BUT and a BIG BUT, my clinical situation was different.
I was Stage II and had 1 positive node out of 11 nodes.

There does not seem to be a universal agreement on f/u testing.
Some MDs/centers do physical exam with interval history plus or minus some blood work.
Some MDs/centers do MRI/CT/imaging tests etc. in addition to exam and blood work.
Everyone does mammograms unless bilateral mastectomies were done.
There have been a few other forums that dealt with this f/u testing topic (will try to find them and
    post for you)

You are right on to plan to see a nutritionist. If you can find an oncology nutritionist, it would be
great. I found the oncology nutritionist most helpful. Again, we all have different needs.
Think everyone agrees that vegetable and fruit food sources and protein are important.........
as well as having a good Vitamin D level and having sufficient calcium.

Will post again.   

With positive and caring thoughts,

Grateful for today................Judy
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Barbi Quote  Post ReplyReply Direct Link To This Post Posted: Nov 17 2011 at 9:20am
Natalia,
We all understand.  One study shows one thing and another refutes it.  Our docs want 10 studies to "prove" what works best, but we only get one shot at it.
 
Read what you have the energy for, ask lots of questions and if you don't get an answer that satisfies you, get another opinion.  I'm not suggesting you doctor shop until you get the doc that does what you want, but I do recommend you get an explanation that you accept and are comfortable with.  It's hard to basically give someone else control and we need to feel they are listening and paying attention and open to new ideas and helping us decide what's best.
 
 
10/10,age49,St3,gr3,5+cm,1 node,BRCA-,T+Cisplatin+Rad0001(or placebo),Lump 1+cm,AND 0/15,AC,rads finished 7/6/11.Mets bone, liver,mamm node 8/11,abrax/tigatuzamab failed.Started bicalutamide 11/16/11.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Grateful for today Quote  Post ReplyReply Direct Link To This Post Posted: Nov 18 2011 at 1:17am
Hi Natalie,

Barbi's above post has a lot of good info and gives a good perspective.

Sounds like you may have already seen Donna's post of Oct 20, 2011 8:26am on Benefit in radiation after
breast cancer surgery.

Just remembered the SABC (San Antonio Breast Conference) will be held Dec 6-10, 2011 in Texas.
There is usually updated clinically respected information from this yearly conference. MAYBE there
might be some updated info on Stage I with no nodes TNBC and radiation coming out of this year's
conference. The general news and cancer websites are very quick to publicize information from the
conference.

Regarding follow-up care.
There is a TNBC Talk: Topic: Help. What is standard follow care after chemo.
It was started by April-NJ on 9/14/2011 12:38pm. It has a number of postings.
If you are on information overload at the present, you may want to wait before reading
all the posts.
(A simple summary of follow-up care:
    There does not seem to be a universal agreement on f/u testing.    
    Some MDs/centers do physical exam with interval history plus or minus some blood work.
    Some MDs/centers do MRI/CT/imaging tests etc. in addition to exam and blood work.
    Everyone does mammograms unless bilateral mastectomies were done. )

Think Barbi's words are something to keep in mind.
You will get thru this.
You will continue to make good decisions.

With positive and caring thoughts ,

Grateful for today.............Judy
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