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Small breasts and surgery decisions

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purnamadah View Drop Down
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    Posted: Jan 15 2021 at 11:21pm
I am seeking the stories of other small chested women who’ve been through this process.

I get away with a 34A, but I don’t fill the cup and have to worry about bra gaps when I lean forward. Still got breast cancer. I joke it’s added insult to injury. However, in all seriousness, when I consider my options for surgery, I have to weigh the fact that I am small chested. Not because I want bigger breasts, but because I am afraid if I have a lumpectomy that radiation will leave me disfigured and unhappy, and, at that point, the only reconstruction option (latissimus muscle flap) is a hard no for my lifestyle and quality of life. I am active and such a surgery would likely mean I would never be able regain my current strength and mobility. I’ve worked hard for it. I can accept a surgery that would require me to heal and work slowly to regain it, but losing muscles entirely is out of the question. 

I see a lot of women with TNBC elect lumpectomy with radiation. I don’t see much discussion about mastectomy with reconstruction for TNBC. I have not found any discussion about breast size and the results of lumpectomy with radiation. I think it is amusing that, among my risk factors for breast cancer is dense breast tissue and yet my surgeon told me this characteristic is also a reason that I would very likely have a good immediate outcome from a lumpectomy (pre-radiation). Still a risk factor...

I was diagnosed 10/2020 and began neoadjuvant chemo (8x AC dose-dense, 4x Taxol dose-dense) that same month. I’m 38. I have two rounds of Taxol remaining. Initial MRI and pathology showed a 13mm tumor, grade 3 with ki-67 of 80% and no lymph involvement. There’s nothing to suggest the tumor is attached to my chest wall. I have post-chemo imaging next month and that’s when I have to confirm which surgery to undergo. For now, they’ve booked me for a bi-lateral mastectomy with implant-based reconstruction in March — radiation is unlikely, but won’t be confirmed either way until pathology comes back. For me, I need to decide soon so that I can start mentally preparing myself for surgery and also, ya know, organize my life and work around it for either a few days or several weeks. Again, I guess my hope is that some other small chested women might see this and share their experience. 
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Plume View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Plume Quote  Post ReplyReply Direct Link To This Post Posted: Jan 16 2021 at 6:39am
Well, yes, I am small breasted though maybe not as small as you are. I get your joke about us littlies getting breast cancer!  It is deffo unfair because, while we might wish for bigger breasts, we don't want bigger to mean with cancer lumpsSmile

My cancer was treated with partial mastectomy (that's what my surgeon calls lumpectomy) followed by chemo and then radio.  The cancer was stuck to my pectoral muscle so I developed very deep and "stubborn" scars.  I had lots and lots of physio massages and those electric machines the beauty industry uses for removing lines and scars.

Nearly 3 months ago, I had a "lipomodelage" which includes removing fat from my abdomen, centrifuging it and then injecting the fat into my breast.  First of all, he had a fair bit of difficulty cutting away the worst of the scar tissues and adhesions.  I am back having physio treatment and the whole area feels a lot more comfortable.  I will be getting another lipomodelage and the other breast lifted so that both breasts will be at the same level on my chest and I will stop looking like one of Picasso's paintings of ladies with lop-sided breasts.

It's a long process but I am also active and fit and it didn't take many weeks before I was nordic walking again though several months before I could carry a heavy rucksack.  I still don't have as much strength in my left arm (cancer side) as my right but all movements are possible though maybe stretching movements are very SLIGHTLY affected.

Don't know if you think that is a good route to explore.  On the plus side, you are decades younger than me and will probably heal at a quicker rate.

 Good Luck with your decision and please feel free to ask me any further questions you might have about my experience (which incidentally has been all mostly positive!)



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purnamadah View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote purnamadah Quote  Post ReplyReply Direct Link To This Post Posted: Jan 18 2021 at 10:06am
Thanks for the reply, Plume. It helps. Interestingly, it seems partial mastectomy and lumpectomy are used interchangeably by folks in the two medical systems I’ve been working with (in the US), but that seems to be because the latter is the more familiar term for the patient. I was told by my first surgeon that insurance companies only like to call them lumpectomies when it is benign, but it is still common to use the term for cancer. As I’ve researched surgery, it seems that, in my case, a bilateral mastectomy would be considered prophylactic on the side that does not present with cancer. It seems there’s a more specific name for every bit of this process. Anyway, I think it’s interesting. It keeps me from drowning in how awful cancer is. 

I’ll ask my plastic surgeon about less invasive reconstruction options, but he seemed pretty firm about latissimus muscle flap being the only option — but maybe that’s because he thought I’d want to be bigger (because I did say that in the context of implant-based reconstruction). My breast surgeon does have special training and has told me she’d be able to give me a good, immediate outcome from a lumpectomy — it’s just that radiation is so unpredictable. It’s funny; I’ve spent over a decade learning to love and embrace the unexpected. But, there’s nothing like cancer to make you question all that work. 

I feel terrible about using the word “disfigured” in my original post. I get so caught up in all of this that falling victim can run a tornado through my perspective. I’m actually starting to come around to the idea of being asymmetrical. It’s just a different kind of scar. Scars tell stories about resilience. There’s nothing to be ashamed of.

I wonder if a lesser surgery that would get me “back to normal” sooner wouldn’t be more important to me long term than a bigger surgery that might leave me closer to someone else’s normal. I like not having to wear bras. Sure, I’d like to fill out a swimsuit, but is it more important to me to “appear normal” or to “feel good”? I think that spectrum is definitely different for everyone. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Plume Quote  Post ReplyReply Direct Link To This Post Posted: Jan 19 2021 at 4:26pm
How interestingly you talk about all this purnamadah.  You are right in that people seem to assume that, because you have small breasts, you'd naturally want them to be bigger.

I don't want bigger breasts because I think that they are more aging, especially as it seems that your breasts get bigger anyway as you age.  I have also wondered whether, because my breasts are small, I was able to have a smaller operation and maybe even less dose of radio.  I haven't looked up any scientific papers on this, I just think that, with small breasts, it is easier to isolate the cancer and deal with it.  But all that might be wishful thinking on my part and could be complete bunkum!

I am active and I like doing things at speed, I wouldn't like to bounce around and have to spend a fortune on bras with good support.  Since my surgery, I find myself buying pretty, lacy but comfortable bras.  Strange, because I used to like my bras plain and utilitarian.  I think because my hair is now thin and the joy of being alive is such that I like girly and pretty.....really weird.

Hey, "disfigured" is not such a bad word.  I told the surgeon I felt "mutilated" which is a far worse word but I was just so frightened and so numb and bereft of hope and expectation.  Plus, I HATED the tattoos I had for them to target the tumour with the xrays.  Now I don't notice the dots most of the time but I still remember the pain when they did the one over my sternum.

I still don't like the scars that show above my bras unless I wear a really high cut one.  OTOH, as I am mostly in work-out gear, my chest is never exposed to public scrutiny!!

Your surgeon is right about radiation being "unpredictable".  It really seems to have "cooked" my breast and the orange-peel skin lasted nearly 3 years.  Also took nearly that long for the colour of my skin to nearly match the other side.

However, I must emphasise that I do not regret any of my treatment.  So far, it's done what it's meant to do, got rid of the cancer for now and no remission to date.

I understand about how difficult you must find having to make these choices.  I didn't make any choices, too shocked and disbelieving to have chosen for myself.  Just glad that the medical team did for me what they in their collective wisdom thought was best.
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kirby View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote kirby Quote  Post ReplyReply Direct Link To This Post Posted: Jan 20 2021 at 10:46am
I am not in your category but will tell you about my run partner's experience. We have run together mornings since before I was dx 20 years ago. She was dx 2 years ago with Her2 in her nodes as well. She is fairly small breasted. Her originally dr pushed for mastectomy. He really didn't give her options. She felt he was pushing for that more for his ease and convenience than hers. She went for a 2nd opinion and found a dr more open to options. She chose a lumpectomy wanting to not give up time for recuperating and uncertainties that come come with surgery. Time and being able to get on with life and activities were more important to her than disfigurement. 

My surgeon had offered to redo my scar as there was some puckering. Even at the time, there was no way I was interested in another surgery. Other than initially, I haven't notice any puckering. I'd have to look now to see if it's even there! With age I have gained weight. My breast I had surgery on doesn't seem to put on the additional weight the other side has.  
kirby

dx Feb. 2001. Age 44
Lumpectomy

2cm. no nodes stage 1 grade 3

4 rnds AC, 35 rads
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