Mastecomy Before or After Chemo?

ninel

I was recently diagnosed and am getting an MRI tomorrow. I guess they'll get a better idea of what we're dealing with. I have so many questions.

I've decided on the mastectomy. How do I know whether I should get the chemo first or the mastectomy? If I get chemo first, at least I'll know if the chemo is working. If I get the mastectomy I won't know, I'll just have to hope it is????
How did you decide?   Ninel

Raye99

Hi Ninel,

I am sorry about your recent diagnosis, but you can make it through this. Now, your question: I wasn't really given a choice - the bs scheduled my surgery (after the MRI as you mention to see if any nodes or the other breast was involved) to get the big tumor out of there, as it was growing quickly and the plan was to do chemo next and then radiation. Perhaps you can speak to your bs and onc and ask she/he feels would be most effective for you?

Good luck. Raye

Tarrazu

My oncologist and surgeon decided to do the chemo first. They told me the reason for the chemo first was that since I am triple negative and cannot take any of the AIs (tamoxifen, etc.), it would be beneficial to do the chemo first to shrink the tumor as much and possible to minimize the extent of any surgery (lumpectomy vs. mastectomy) and they would also know if the chemo works for me. They told me that if I had the surgery first (because of the tumor size, it would have definitely been a mastectomy), I would still have to have chemo afterwards.

Jyber

I had the surgery first (mastectomy). I had a large tumor (4.2 cm.) and was fine with the mastectomy - had little interest in saving the breast versus first shrinking the tumor and then possibly a lumpectomy. What I most wanted was as much info as possible re staging upfront. Had I had the chemo first, I would not have known if the cancer might have spread to my lymph nodes already, but been evicted by the chemo. (The chemo might have knocked it out.)

So I had the mastectomy with sentinel node biopsy and got the unexpected good news that I was node negative.

At least this is my understanding of what the tradeoff was for me. Your tumor is so much smaller than mine was so you are much less likely to have either a mastectomy or lymph node involvement.

sftfemme65

I had a mastectomy first then treatment.  We never even discussed another option honestly.  My tumor was not huge and I had node involvement so I'm glad it was taken out with the lymph nodes right up front.

Teresa

ekenny315

Had the mass removed & node dissection done prior to chemo, glad i made that decision because i'm trip neg with aggressive grade 3. However i do wonder how my treatment is working, how will my onc know if it is?

Raye99

Erika,

When I asked my onc the very same question - how do I know the tx is working and she said, "when it doesn't come back.". hmmm.  

dhettish

Hi Ninel,

I am the same as Raye. We must have the same oncologist. I was told mast, then chemo. I asked her about scans and Onco markers and she said she did not find the onco markers reliable and said she did not want to expose me to radiation from scans w/o a reason. She has told me just to take care of my body and listen to it.

So now, every little bone ache, stomach ache, cough, I worry. When it goes away, I breath a sigh of relief. Luckily, I rarely get headaches, but the first one will have me worrying.  I am told that in time, these fear will diminish. Right now, I "feel" cancer free. 

I do have one fear. I figured if one get bone mets, you would have bone pain. But I have heard of people falling and breaking a bone and then x-rays show mets. Did they have pain and ignore it? I am 50 and have minor arthritis and get some pains in my joints. How do I distinguish? I can listen if I get a signal, but what if there is no signal?

Debbie 

cheranthia

I had chemo before surgery and it allowed me to have a lupectomy instead of a mastectomy. That wasn't the main goal; it just happened to turn out that way. My onc thought it was more important to hit the cancer hard sytemically with chemo first in order to chase down any rogue cells. As it turns outs, the tumor disappeared completely. Before chemo, I had a sentinel node biopsy, so I do know my pre-chemo node status. It was negative. Personally, I find it very reassuring to know the chemo worked, but you have a very personal decision to make. I hope this helps. 

Cheranthia 

CaNatalie

Hi Ninel,

Just to chime in...I had chemo and then mastectomy. My Onc was with train of thought that because triple negative relies heavily on chemo treatment it was important to find an effective chemo.

To help with staging and possible lymph node involvement we did a sentinel node biopsy and had my port placed (in case you are considering one) and then started chemo. That way we knew more about the tumor involvement with the benefits of doing chemo first. However, I will say that chemo first can be stressful. I remember stressing out if it was working or not because here is this tumor sitting in my breast and we are hoping the chemo is effective. Then getting the final path report after the mastectomy was so rewarding it was easy to forget about those stressful months.

Either way I wish you the best in all those tough upcoming decisions.

Natalie

Kayree

Hi Ninel,

I had the chemo first because I was a triple negative and the tumors in my breast and my lymph node were large. My onc and breast surgeon both said that we needed to start chemo immediately to get this under control and hopefully shrink the tumors.  Then had bi-lateral mastectomies because I am also BRCA 1+.  Fortunately, I had a complete response to the chemo.  The only sign of the tumors at surgery was the one in my lymph node  The path report said tumors had been totally obliterated.  The best advice is to stay on top of things, get copies of your reports, and ask questions.  If you are uncomfortable with anything, ask MORE questions or get a referral for a 2nd opinion.   I wish you the very best! 

Yogi70

I had mast. then chemo.  We already knew that the cancer was in my lymph nodes because I discovered the lump under my arm.  It took three biopsies of my breast to actually find the primary tumor.  My onc. said that she did not like to do chemo before surgery and that in my case it really wasn't warranted.  Guess everyone is different.  I opted for mast. because once they found my primary which was 1.8 cm there were two smaller tumors next to it.  Good luck!!!

Beth

I also had my surgery first, so they could determine the size, type and stage of the cancer to better determine if chemo was warranted.

Beth

It is true that the worrying does get easier and occurs less often.  It's been three years for me, and I've finally stopped worrying with every ache and pain.