Questions to help decide re PBM

cmb35

Hi all,

I'm trying to compile a list of questions/thoughts to help me decide on whether or not to do a PBM. I'm trying to think long-term, and to avoid the situation I'm in now, where I blindly listened ot my surgeon and "preserved my breast" with the lump w/rads. Even though I didn't know about the family history, I was only 41 years old, many years left (I hope!) for another primary. I wish I had been told of the negative impact of rads for reconstruction, and been allowed to decide if I wanted a lump or a mast. I can't say I would have done anything differently, but it would have been nice to have the choice, and more importantly to have been properly informed.

My situation is triple neg/node pos dx in 5/05, lump/chemo/rads, BRCA2+ result in 2/08.

So far I have:

Questions for Onc:

If I get a new primary, can I do dose dense AC/T again (if needed), or is that a one-shot deal?

If I can't do AC/T again, what can I do? Is it as effective as AC/T?

Can I get scans to rule out mets from primary dx before the surgery (so I don't go through all that only to find I have mets halfway through the process?)

Questions for PS:

What is the smallest size implant available? (I have to buy "Nearly A-cup" bras, and they are still too big - I told you I was scrawny!)

If I have implants (my only option, I'm scrawny), and they fail due to rads, what are my options?

Does Alloderm help with the healing/infection issues with radiated skin?

Thanks!

Emily2008

Those are good questions.  When I was dx with IDC in May, I also had a lumpectomy and would have followed it up with rads, but the margins were bad.  Rather than a re-excision, I opted for a mast with a TRAM flap recon. That was done in Aug.  Lo and behold, I found out last week that I'm BRCA 2 +, so I'm looking at a prophylactic mast with expander, as well as saying bye-bye to my ovaries.

I'll tell you this:  when I was deciding btwn another lump or mast, I asked my breast surgeon and ps if rads would make the recon much harder.  They both acknowledged that it could be trickier due to skin and tissue damage, but that a good ps could overcome that and still do a great recon.  I opted for the mast anyway, and forwent the rads (though I did have chemo), but I thought it was good to know that just bc you have rads doesn't rule out  a good recon

BTW, I *think* you can only have AC 4 times in your life.  Don't know where I heard/read that, or if my brain is too befuddled to think clearly, but I would certainly double check.  After my AC x4, I often wonder what they would give if, God forbid, I have a recurrence.  I think CMF is the other option.

Excellent question about the scans prior to surgery.  I'll have to find out about that one, as well, since the only scans Ihad were just before starting chemo.  My onc doesn't routinely order scans unless he's worried about something.  Just follows up with blood work and pysical exams every 3 months.

Let me know what you find out.

Deirdre1

Hi cmb35:  I had a friend of the family who was a doc, and he suggested a PET scan to rule out whether the breast cancer had spread, this was after my biospy but before my final surgery.. (Strong family history)  My insurance was livid, but they did pay for it (I paid for it first and then they reimbursed me) but I was so relieved to find out that it had not spread OR that there was no other cancer in my body..  Most doc's won't recommend this you have to bring it up yourself..Most will popoo this but it is a valid question especially for your situation..  and I believe they can also do a bone scan (I think though - can't fully remember) the PET scan tops the bone scan.  They both have their place, but again because a PET is so expensive the doc's don't usually do it unless you ask - funny thing is once it is on the table (the question of whether you may have a PET scan) everyone (doc's) seem relieved.  Can't answer the other questions sorry..

Good Luck!  And I must say a list is a great idea!!