Reconstruction after Lumpectomy???

NYCarol

I had a lumpectomy on the left side followed by radiation.  My left breast ended up about 30% smaller than my right.  My PS discouraged me from having implant in the left breast as he said it is very hard to get a good result after radiation.  He suggested making the right breast smaller to match the left.  I waited about 2 years after radiation and then followed his advice.  I am so happy with the result.  I wasn't large to begin with....about a 36 B, and now I'm a 36A, but I am even, and clothes fit well. 

dgrizwold

I have had implants since my radiation and two lumpectomies. The first two weeks they were both even and I was very happy...... since.. my left breast ( my bc breast) is smaller and different shaped..... my ps wants me to wait until March to see what we can do about getting it even.... my surgery was in September of 2007 one year and 3 mos after my diagnosis. I always wanted implants and heck..life is too short so I say do all the things you always wanted to do.. NOW... and I did.... I did see another p s actually I consulted with  5 before making my decision... the one that I should have went to said this: lets do an expander first to stretch and I declined... I wish I would of possibly researched this and possibly went this route first...let me know what you are being told etc.... and I will keep you updated on my progress... I have searched many breast websites to find anyone who has had implants after radiation and I have had Zero luck... so hopefully I can help you....:-) ........

Mamie2

Thanks to all of you for sharing your stories. I have just had my second surgery on my right breast to clear a wider margin of idc lump of 2cm. Had 2 nodes biopsied as well. Tomorrow I will go to my post op with a different point of view after reading all of this. I'm worried that I didn't "jump" to have a bilateral mastectomy that so many women are choosing to do after they learn they have bc. But in my reading, i've learned there bc can also re-occur even after mastectomy, implant or autologous tissue. Now, I'm wondering what treatment options I have. Do I have to have rad? Can I take a pill? Chemo? Can i preserve my breast tissue somehow in case I decide to do mastec and recon later? So many questions. Also, who manages your care if you have no primary care dr? The surgeon, the medical oncologist or the radiological oncologist? Sorry for all the questions!!

Anonymous

Mamie2 - my case is similar to yours - IDC, 1.6cm, no nodes, er/pr+ and her2- (I don't know your her2 status) .  I had a lumpectomy on 12/1 and need a re-excision - I have 1mm of clear dcis margin - and surgeon needs 2mm.  So, it was really close.  I have DDD breasts and have wanted a reduction for a couple of years.  The lumpectomy really didn't change the size too much, but since he is going back in I asked him about a bi--lateral reduction during the reexcision.  I want to do this now as my BIL is a plastic surgeon and he said do it before radiaition as most PS do not want to operate on radiated skin - at least for a few years due to poor healing.  So, I have started chemo (6 months) will do a bi-lateral reduction after chemo, and then do radiation.  I have already met with the PS that  works well with my breast surgeon.  Mastectomies are necessary in some cases, but my cancer docs and even Dr. Love say that they are often done without need due to our fear - and it is not justified in many cases.  It is a personal decision.  I do not think I have a high chance of a recurrence (assuming I take tamoxifen or an AI).  As you stated, you can still have a local recurrence after a mastectomy so there is no guarantee anyway.

Lumpectomy usually always means radiation.  Lumpectomy  was highly advised by both surgeons I met with - mastectomy does not equate to higher survival rates.  Dr. Susan Love reviews this well on her website - google her as I can't remember it.  I also had an  MRI and ultrasound to rule out additional tumors or issues.  I am also brac1/2 negative.

Did you have your tumor oncotyped?  That will help you with the decision to do chemo.  As far as managing your care, that has been a pain at my TOP RATED cancer center.  They do not have a care coordinator like the community hospital has here.  My surgeon has a nurse coordinator, as does my oncologist so at your point I was still working with the surgical nurse scheduler and also calling the oncologists nurse scheduler until my oncotype dx appt.  At that point, chemo was recommended and I have started chemo - so am totally in the system, have a set schedule and lots of follow up which makes me feel better.

Absolutely you can stick with the lumpectomy now and do reconstruction or mastectomy later.  I think there is a federal law about this that insurance has to pay for reconstruction after breast cancer surgery but I don't know what it is called - therapeutic masteplasty or something like that.

My surgical nurse is working with the plastic surgery nurse and they have me on the schedule in the beginning of July for my surgery.  Once I am cleared from chemo, waiting for surgery (3 weeks off) I get started with the Radiaition Oncologist to get appt set 3 weeks after the surgery.

I am assuming I will be having radiaition in August - I met with the Rad. Onc. briefly in November - part of the breast cancer team.

Cancer is a full time job - and who has the additional time??!!!!  Hang in there - make sure you get oncotyped.  

 Susan

Mamie2

Hi Aprilgirl 

What was your Oncotype? Mine was 22 - intermediate. Dr wanted me to chose what to do...she says I would receive an absolute benefit of 5% if I take chemo (TC) 1x every 3 wks for 4 cycles. I thought about it for a couple days but decided no chemo. I am going straight to rads and then Arimidex. My right breast looks ok. I can tell the difference in it though.... I'm worried that it will be really small after rads. My surgery was 12/10 and we are already three months past and no treatment which makes me anxious... Good luck w/your plan. I like that you have the whole year practically planned. That is great. 

bluewillowskys

I had a lumpectomy with rads in May 2011. I had a 2nd surgery a few days later as i developed a large hematoma. Both breasts have lacked perkiness since having breastfed 3 kids about 20 yrs ago so I was already not that happy with the sagging. Now as my right boob has settled in so to speak after the lumpectomy and rads, I see a good size dent along the upper left portion, about 3-4 fingers wide. The tissues there still are tender as well. I just read on an other site that its mandatory for insurance companies to cover reconstruction....I figure I would need a lift for sure. But im wondering how such a dent could be fixed with an implant or if thats even possible? or would fat grafting to fill the area be better? I would like to be a full B/C as i was when I was younger before nursing. Will insurance cover to make my breats match or just cover the one that had the lumpectomy??

Gatomal

I'm going in for a re excision in four weeks. My lumpectomy Breast is still more swollen than non lumpy Breast, could be swelling, could be just bigger. I think it's still swelling with post op of truncal LE setting in early. I had eight nodes removed from the Breast incision, without a new incision under my armpit. So far I have no numbness, just the opposite in fact. I have a painful neuroma around some of the nerves on the side of my Breast. Got some relief with a steroid shot,one and two weeks post op. Two weeks post op wa yesterday. And we did some suture removal around the nipple that didn't dissolve (ouch) ripped steri strips off my breast reduction incisions (ouch) and did and ultrasound on the lumpy Breast to find the clips they put in during surgery (really really ouch) back on the heavy pain meds today. I'm saving my two twin pregnancy belly skin for two years NED so if there is a recurrence, I can use it for the mx recon. And if there is not, plastic surgery here I come. I need to get some control top panties in the interim though

Erica3681

You would probably get more responses if you posted this in the Breast Reconstruction forum. This forum is for women who choose not to have reconstruction after a mastectomy, so they aren't as likely to be able to help with your issues.