LCIS- feeling defeated already.

taraleec

Hello,  about 10 days ago I was 99% sure I wanted PBM with reconstruction and implants.  I'm quite small breasted and have already had a lumpectomy with both breasts.  So trying to make myself feel better about the decision, the thought of being able to get implants and be larger breasted sounded good.  Then after meeting with a plastic surgeon he told me since I had radiation to my left breast that I wouldn't be able to do expanders, I'm at 15 -20% risk of infection and would have to do a back flap, (not sure of the technical term).  I don't think I can do that, I'm terrified.  But I'm also terrified of letting this LCIS go. (None of my Dr's had told me if I have radiation that I probably couldn't do expanders later). Has anyone who had radiation to one breast, had expanders, and had infection and healed and been succesful with reconstruction without having to use skin from other areas of body?

leaf

Taralee, you may want to ask this on the breast reconstruction board.

It would be impossible to give you statistics on this for YOUR particular situation. Even if there was a study that was just of people who are in your condition, it will also depend on your particular surgeon.  

When I had a prophylactic surgery (not breast, but on my neck spine) one of the first questions I asked was how many of these had he done, and what was his infection rate. I think that's an important question to ask.  In my case, in this neck vertebrae surgery, his group had done some 800 of them and had a Zero % infection rate of the central nervous system, though did have some local (incision site) infections.  I went for the prophylactic surgery and there was no infection.

I do know that the susceptibilities of different bacteria to different antibiotics differs from hospital to hospital. So in hospital X, most of their MRSA will be sensitive to vancomycin, whereas in another hospital Y, that can be just across town, they may have much more MRSA that is resistant to vancomycin.

With the increase in hospital acquired infections, due to the over-use and poor husbandry of antibiotics, we now have many more drug-resistant infections.  We now have MRSA in the community, in people who have had NO contact with anyone who is in the hospital, or in an institution.

I would imagine there are women who have had radiation for DCIS, and now want mastectomies and reconstruction. So you may want to ask on the reconstruction/surgery board, where you can get more women who have had more experience.  As you know, its very unusual for LCIS women to have radiation, so few of us would know from personal experience.

taraleec

Hi leaf,  just wondered what is MRSA?      And do you know if someone was found to have LCIS, atypical lobular hyperplasia and atypical ductal hyperplasia in one breast, what are the odds/chances that it's also in the other breast?

Anonymous

(MRSA===methylcillin resistant staphloccocus aureus (excuse my spelling)---"a superbug"; has to be treated with antibiotics.)

LCIS is most often found to be in both breasts; I'm not sure about ADH and ALH.

Anne

leaf

Sorry about the delay in getting back to your questions.

MRSA started out only being connected with people in institutions.  Now its found also in people who have had no contact with anyone in an institution.  Most/all hospitals have a sizable number of patients with MRSA.  Ordinarily, they start people on vancomycin in the hospital, an expensive antibiotic.  Unless the infection is inside of the gut, they have to give the vancomycin intravenously.  (Vancomycin is not absorbed orally unless the person is so sick they have holes in their gut - such as toxic megacolon.)

Now it is not unusual for people to have vancomycin resistant bacteria.  In that case, they may have to try antibiotics that are even more expensive, more toxic, and don't work as well.  These antibiotics can cost over $1000/day (I'm thinking of linezolid), and usually need at least a week of treatment.

In this study, atypical hyperplasia (ALH or ADH) had bilateral breast cancer risk. "Because only approximately 60% of cancers that develop in women with AH occur in the ipsilateral breast, for the purposes of clinical management, these lesions are viewed best as markers of a generalized (bilateral) increase in breast cancer risk."http://www.ncbi.nlm.nih.gov/pubmed/17154175