Experience w/Mammosite?

mbsoxr

Hello, BC sisters!

1st time w/BC (2003) I did 37 rads;  I am an extremely fair skinned, blue eyed, (former) strawberry blonde (all faded!).  Skin really suffered.  Doc suggesting Mammosite may be an option this go 'round...  I like the idea!  Any one done that type of rads?  Pros, cons?

 Thanks for any thoughts!

 Take care all of you!

Hugs, Mary 

ginger2345

I did mammosite radiation in 2004. The obvious pro is the shorter treatment time. Generally, you can only do rads once, but with mammosite there's a chance for a second go round and you seem to be able to do it in reverse: whole breast rads first, then mammosite.

There's a 10 year trial underway comparing whole breast, mammosite and another rad technique. It's in about year 3 or 4 years and if mammosite proves equal to whole breast rads for recurrence and survival, it'll give more women that option. My insurance company refused to pay for mammosite as it considered mammosite investigational and this study could end that. So do make sure your insurer is on-board to cover.

The biggest downside to mammosite for me was the second outpatient OR procedure to place the balloon. It was actually more trouble than the original partial mast. I'd waited about a month and there is a time limit on mammosite balloon placement because the tumor cavity will begin to close.

Keeping the area sterile is a must and you'll need to avoid water to the breast for the whole time the balloon is in. I took sponge baths in the bathtub and couldn't swim (my daily form of exercise).

You do need a somwhat flexible work schedule to accommodate the 2xday treatments.

There is the risk of damage to the skin, but those risks apply to other forms of radiation too. In fact because to the smaller area "hit" by the radiation and the skin not directly "hit", most of your breast skin will be normal with the possibility of some change in color and some telangiactasias in the small area where the balloon was closest to the skin. Some women have no skin changes, esp. if the cavity was somewhat deep in the breast, not close to the skin.

The balloon may feel awkward and will need to be in place for up to 2 weeks, depending on your treatment schedule.

I'm glad I did the mammosite even though I had to pay for it and feel I have a close to normal breast (as close as you can get with a scar and tissue taken out!).

mbsoxr

Thanks so much, Ginger!  You really gave me a great explanation of Mammosite!  I will be sure and check with my insurance Monday morning - that was a great tip!

 Have a great day!

Hugs, Mary 

samedaynurseJan

I had mammosite in December.....about 5 months ago.

Im a surgical nurse and I did a lot of research before I made my decision. I had absolutely no problem with my insurance covering it, my radiation oncologist said they havent been having payment problems for about the last year and a half.....women have now had Mammosite for over 5 years there is good documentation and the initial studies are already finished.

I took one week off from work to do my twice a day treatments rather than try to fit going for radiation on a daily basis for 6 weeks into my schedule. You have to meet several criteria perfectly to have mammosite and my Dr told me that if you miss on even one count they will not let you do it, so if they allow you to proceed to it, it means you met all the things that have to be in place.

I had a very very good experience....my surgeon put the expander in during my surgery on friday and after we got the path report back I went to her office on Monday and she exchanged the expander for the real balloon it took about 2 minutes and on a scale of 1-10 the discomfort was about a 3. I went to the radiation site and they tested the position and did a dry run of everything and the next morning I started my treatments.....each one took about 22 minutes because the source was starting to run low and that adds minutes to the time the source is in place in the balloon....I showered the entire time that I had the catheter in place...we used all kinds of ingenuity to cover the site and never got it wet once....I was told the balloon coming out was traumatic and it was even less painful than putting it in.....there was a Mammosite representative present for each major procedure. I had some redness, heat and swelling in the breast and some fluid collection along with some fatigue for a couple of weeks after, but now, 4 months later most of the heat and redness and fluid are gone, just a little darker than normal skin. I am seen every 3 months by the rad oncologist and checked very carefully on each visit .

If you qualify....tumor size, location, depth, right size breast, etc etc Mammosite is a wonderful option....thats just my opinion. I used the mammosite website and actually talked to a couple of women who had one to make sure I completely understood everything.....now that all is said and done I am very happy with my choice and very confident that it was the right thing for me. Feel free to send me a PM if I can help you further....it would be my pleasure.

jan

mbsoxr

Thanks, Jan - you have made my day with the details of your experience!  I was on the Mammosite website last night, and will go back right now and download the brochure!  Thanks so much, and I trust you are doing well!

Mary 

ginger2345

Mary,

I'm glad you've checked the Mammosite website and the info there. I continue to monitor mammosite coverage; as the office manager for my physician husband and a lawyer, I'm most interested in coverage issues. One doc in town will not even mention mammosite to the patients with BCBS because they still do not cover mammosite. Each state's BCBS is an independent franchise and has different "rules." That said, I checked your bio and you may be on Medicare and I know of no Medicare carrier that doesn't cover it. But I'd still check. Many insurers require preauthorization for the procedure that you should make sure your docs get if necessary.

If your radonc thinks you're a good candidate for mammosite, that probably means you meet the criteria. The one criteria that you won't know about until after placement of the balloon is skin spacing. Different docs/hospitals have different spacing standards and the mammosite people have their own recommendation. If your balloon doesn't show enough space between the balloon and skin surface on CT for your doc/hospital, the balloon would be explanted and you'd have to have whole breast radiation.

One of the issues with mammosite that caused problems for women was infection. I'm sure the docs are proactive in making sure that doesn't happen and the techniques for placement and delivery are quite sterile. My dressing was changed every day by the mammosite nurse and on the weekend by my husband. I couldn't get in water to protect against infection.

Mammosite is still not the "standard of care" but I think it will be an equal option once the 10 year study results are in. This is the only phase 3 study comparing different methods of rads for bc, and the mammosite "gurus" are hopeful that maybe mammosite or some other form of brachytherapy will become the standard of care for some women and diagnoses. Quite a few women on the board are participating. They would now be 3 or so years out from treatment and may come along and offer an opinion too.

Most comments from mammosite-treated women on the board that I've read thru the years have been very positive. Equally frim in their opinion are the women who decided against mammosite though they met the criteria. You sound like you'll be prepared to ask the pertinent questions of your radonc and will make the decision that's best for you.

mbsoxr

Thanks, Ginger!  Once again, you are so very helpful - obviously, you know your stuff!  I will check with my insurance, which is a BCBS Medicare alternative - it generally has offered pretty good coverage, but I definitely will check, given your info!  If it doesn't, we will be prepared to pay for it if I am deemed eligible, just because it seems like a much better alternative, not only time-wise (obviously, we are retired, but the summer home off of Savannah beckons, and that is an 8 hour trip - not one to take for traditional rads!), but most of all easier on the skin than whole breast - been there, done that (what a journey) with the other one!

Really appreciate your posting!

Mary 

ginger2345

Since you have a Medicare Advantage plan and one connected to a BCBS, I think you're wise in checking coverage out.

The cost of mammosite radiation isn't cheap. In my case, this is how it came out:

Radiation: 15,500.

Radonc:  2,000.

Surgeon: Her first mammosite placement and done without charge, but this would be a very small bill anyway

Hospital OR outpt surgery: 10,000. (IF your surgeon implanted the balloon in the office, the charge could be much less than that.)

Hopefully, you'll have coverage, but if not, try to negotiate a "cash," even if paid in installments, price.

mbsoxr

Thanks for the cost breakdown estimate - very clear and precise!  I called BCBS this afternoon, and the senior services rep will get back to me tomorrow with answers...  keeping my fingers crossed!  You have been SO helpful!

Mary 

mbsoxr

Got the info from Anthem, and since Medicare covers it, they will too - at 80% as does Medicare, and since my annual co-pays max out at $4000.00, I am singing a happy tune!  

 MRI is Friday morning, so lumpectomy date should not be too far away! Let's get this over!

 Hope y'all are doing great today!

Hugs, Mary 

ginger2345

Thanks for reporting back. I'm hoping your treatment goes smoothly. Good luck.

mbsoxr

Hi all!  Was just perusing the MammoSite website, again,  and heard a comment about a "surgical bra" on one of the videos.  I recently got 2 wirefree bras - I wear a 38 DDD and have long worn underwire bras for better support.  I had decided to get the wirefree for a little easier comfort after my upcoming lumpectomy, but they do close in the back.  When I "googled" surgical bras, some of which are for ladies undergoing enhancement or reduction, and some for compression.  Many of them close in the front, and now I am wondering if that front closure is important.  I am hoping to be able to do the MammoSite rads this time - b s is telling me I am probably a candidate, but won't commit until the final path comes in.  Any comments welcome!

Thanks, and hugs!

Mary 

mbsoxr

Good morning!  Hope everyone is doing great!  

Had a lumpectomy on the 24th of June, and will have the MammoSite balloon put in Wed. July 15th.  I am very excited about the probability of having radiation in this manner!  (There is a slight chance it won't happen, as my tumor was very close to the surface, but my surgeon did some "fancy work" to build the tissue up in that area, and my rad onc is quite sure it is okay - the CT scan and computer will 'decide' after the balloon is in).  I will be on antibiotics during the MammoSite treatment, and the rad onc has explained it all so well that I am ready to get started! Keeping fingers crossed that the measurements are right!  

 Will keep you posted, and thanks for all your help in getting me to this point!

Hugs, Mary 

mbsoxr

One question about the Mammosite - will I experience the fatigue that I was plagued with when I had 37 days of the 'traditional' rads to the other breast in 2003?

 Thanks for any responses!  Hope you are all doing really well~

Hugs, Mary 

kdeit

Hi Mary,

I've answered your fatigue question on the thread "Has anyone done MammoSite Radiation Therapy?", but saw that you had posted a question here about bras.

You will have a flexible catheter which extends out a good 3 or 4 inches.  Depending on where your cavity is, you may find it very uncomfortable to be trying to close your bra in the back.  I bought sports bras with front closures, two sizes larger than my normal bra size.  The catheter tucked down inside the bra, and being larger than my normal bra size, there was plenty of room for the bandaging.  You might want to get at least one front-closing bra, just in case.

Hugs,

Karen

mbsoxr

Thanks, Karen!  

I am going to get a couple pf sports bras with front closures this afternoon!  Thanks for the suggestion, and I also really appreciated your reply to my question about fatigue!  I am sooo ready for this treatment, and feel now like I know everything to expect!

Hugs, Mary 

Triciaski

Hi, Mary,

Good luck with your Mammosite treatment. Your story sounds very similar to mine -- my tumor was near the skin, but my surgeon successfully worked around it. I'm very fair-skinned, too. I did get some skin irritation, but more from the tape over the dressing than from the treatment. After 6 months, my skin looks completely normal -- no redness, browness, or discoloration.

Regarding bras -- You will come to hate the little gauze bra they make you wear. It opens in the front with velcro, and you're supposed to wear it all times during the week of treatment. I bought a non-underwire bra to wear over the gauze bra because I found I was more comfortable moving around with more support. I was able to tuck in the catheter so it didn't irritate me and having it held down firmly by my bra made it less likely to get jostled accidentally. A back-closing bra was not a problem for me. 

Regarding fatigue -- I don't think I got fatigue from the radiation. I was tired, but I think it was more from driving back and forth to the cancer center twice a day (round trip 100 miles). Treatments must be at least 6 hours apart, so you have to go early in the morning and then again in the afternoon. If at all possible, take the week off work, and take very good care of yourself. I asked my daughter to come stay with me the weekend after my treatment because I thought I would need to be taken care of. But I felt fine, and we had a really good time doing normal activities.  

I hope your treatment and entire experince go as well as mine did. I feel very, very fortunate to have had the Mammosite treatment available to me.

Tricia

mbsoxr

Thanks so much, Tricia, for your words of wisdom!  I am very anxious for Wednesday, and really psyched after reading that your tumor was also near the skin so your surgeon had to be creative!  I also am very very fair, and when I had the 'traditional' radiation in 2003, my rad onc was very attentive to my burning - I literally gave him a run for his money!  LOL  And, fortunately, I am retired, so no worries about taking time off!  A gauze bra sounds rather interesting, but cannot imagine it will do much good for my DDD's!  Good thing I found sports bras, but they do close in the back, so glad to know that worked for you...

 With everyone's help on this forum, I know this will work for me!  I will keep you posted!

Hugs, Mary 

Triciaski

Keep us posted, Mary. Good luck tomorrow!

Tricia

mbsoxr

Well, it is Friday morning, and I am just back from Tx #3!!  The balloon went in Wednesday, lots of prep work in the brachytherapy (radiation oncology) center Wed afternoon - first Tx set for Thursday, but delayed a couple of hours due to air bubble that had occurred around balloon - rad onc manipulated breast to "burp" the air out - it worked!  New CT scan was perfect, so Tx #1 and then #2 later in the day - both preceded by CT scans.  CT scan was perfect this morning prior to #3 - big relief!  Go back at 3PM today.  Nurse gave me packet of sponges she had cut to fit around catheter, padding, and gauze "bras" for the weekend...  The hand held shower in my newly remodeled master bathroom works perfectly where I need it, hubby shampooing my hair -- I am a HAPPY CAMPER!!!! No pain, just a little "awareness"... I would definitely do this again rather than the 37 days of burned mess I had in 2003!  I am now a MammoSite junkie!

Hope you are all doing well!  

Hugs, and thanks so much  for your support! 

Mary 

Triciaski

That's great news, Mary. I'm so glad to hear your treatment is going well. It will be over before you know it!

 Tricia

lgore

it is so useful to read about all of your experiences with Mammosite. I was diagnosed with DCIS on July 6 and am scheduled for a lumpectomy on August 28th. I met with a radiation oncologist last week who told me that I would do well either with or without radiation, but that radiation would offer a better chance of avoiding recurrence. He said that if everything went as he imagined it would from the data in ( biopsy report, MRI, etc.) I would be a good candidate for MammoSet and it appears that my insurance would cover it.

I am planning to wait until the path report is in following my surgery to make my final decision, but am feeling open to Mammosite. I wonder of any of you can tell me how to access information about trials evaluating the effectiveness of Mammosite vs. whole breast radiation therapy?

Thanks!

Lois

levisdocker

The biggest downside to mammosite for me was the second outpatient OR procedure to place the balloon. It was actually more trouble than the original partial mast. I'd waited about a month and there is a time limit on mammosite balloon placement because the tumor cavity will begin to close.

Keeping the area sterile is a must and you'll need to avoid water to the 646-223 breast for the whole time the balloon is in. I took sponge baths in the bathtub and couldn't swim (my daily form of exercise).

You do need a somwhat flexible work schedule to accommodate the 2xday treatments.

There is the risk of damage to the skin, but those risks apply to other forms of radiation too. In fact because to the smaller area 650-251 "hit" by the radiation and the skin not directly "hit", most of your breast skin will be normal with the possibility of some change in color and some telangiactasias in the small area where the balloon was closest to the skin. Some women have no skin changes, esp. if the cavity was 70-271 somewhat deep in the breast, not close to the skin.

alexanderccna

You will appear to abhorrence the little cast bra they accomplish you wear. It opens in the foreground with velcro, and you're declared to abrasion it all times during the anniversary of treatment. I bought a non-underwire bra to abrasion over the cast bra because I begin I was added adequate affective about with added support. I was able to constrict in the catheter so it didn't abrade me and accepting it captivated down durably by my bra fabricated it beneath acceptable to get jostled accidentally. A back-closing bra was not a botheration for me. || pass4sure EX0-101 || pass4sure PMI-001 || pass4sure 642-456

bjean

I am told I have a stage one pea-sized, slow-growing tumor in left breast. The surgeon is refusing to do the surgery unless I agree to have the mammosite installed during the surgery, to be switched out 2 days later. Is it not appropriate to wait for pathology results? Clear margins? I am willing to do the surgery, but the mammosite device is totally freaking me out. Will appreciate feedback.

sesohio

bjean, my surgeon inserted a placeholder device--not the real mammosite, during surgery.  The real mammosite is very expensive so they want to be sure you qualify from your pathology reports.  Once they get the pathology showing clear margins then they will exchange the placeholder with the real thing.  They have to insert the placeholder during surgery because they have to put it in just the right spot where they removed your tumor.

FYI, I just had this done but didn't get to do mammosite because I didn't have clear margins.

Hope this isn't too late to help!

joannad

I'm considering the MammoSite procedure and was wondering if you're still happy with the results?

voraciousreader

Breast Brachytherapy Linked with More Complications and Higher Mastectomy Rate

Among women with early-stage breast cancer, use of brachytherapy to administer radiation therapy may result in more post-operative complications than conventional external beam radiation therapy, and may also increase the likelihood that a woman will later require a mastectomy. These results were presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium.   

For women with early-stage breast cancer who are treated with breast-conserving surgery (lumpectomy), surgery is generally followed by radiation therapy in order to reduce the risk of cancer recurrence. Radiation therapy is often delivered to the whole breast from a machine outside the body (external beam radiation therapy). This treatment is commonly delivered on a daily basis for several weeks.   

Breast brachytherapy is an alternative to traditional external beam radiation therapy for women who choose breast-conserving surgery. A specialized catheter that contains radioactive material is placed directly into the area of the breast where the cancer was removed. This is often done twice daily over a period of a week or so. Because this approach requires many fewer weeks of treatment than conventional external beam radiation therapy, it may be a much more convenient option for the patient. Information about the safety and efficacy of breast brachytherapy is somewhat limited, however, and clinical trials to address these issues are underway.    

While awaiting the results of ongoing clinical trials, researchers at the MD Anderson Cancer Center conducted an analysis of Medicare claims data. The analysis included information about more than 130,000 female Medicare beneficiaries who were diagnosed with invasive breast cancer between 2000 and 2007. All of the women included in the analysis had been treated with breast-conserving surgery followed by either breast brachytherapy or whole-breast external beam radiation therapy.   

• Use of brachytherapy increased over time. In 2000, less than 1% of the women had been treated with brachytherapy. By 2007, 13% of women were being treated with brachytherapy.
• Postoperative complications were more common in the brachytherapy group. Infectious complications, for example, developed in 16% of women treated with brachytherapy and 10% of women treated with external beam radiation therapy. 
• By five years after treatment, 4% of women treated with brachytherapy had required additional treatment with a mastectomy, compared with 2.2% of women who had received external beam radiation therapy. The researchers note that the higher rate of mastectomy in the brachytherapy group could be due to breast cancer recurrence or breast complications.

These results raise the possibility that breast brachytherapy may be less effective and more apt to cause breast complications than whole-breast external beam radiation therapy....

http://ww5.komen.org/KomenNewsArticle.aspx?id=19327354022