the reduction+lumpectomy thread

cookiegal

actually I think about that all the time...would a reduction 10 years ago have saved me from this...or at least spared my nodes

lopsidedlouey

Hello all !  I am scheduled in Dec of this year for a reduction and lift in both of my breasts.  I had a lumpectomy and radiation on my right/cancer side that left me lopsided.  I am about a DDD on my left side and a D on my right side now.  I have often contemplated reduction, but now that insurance will pay, I decided to do it.  It has been 15 months since my radiation ended and I went to see the PS about a month ago to discuss it.  He doesn't want to reduce the cancer side too much, but lift it and then make the other side match.  He cautioned me about the risks of surgery to the radiated side and as surgery gets closer, I am starting to have second thoughts... anyone have any advice about this?

mimi1964

lopsidedlouey - Hi, I had the same surgery last December, however i didn't quite wait 15 months.  I am well pleased with my surgery.  Much like you I was a DD on the left and the cancer (right side) I was left a C from the the partial mastectomy and radiation.  My plastic surgeon told me that minimal invasive surgery to the radiation side was best so he only did a lift to the right side and reduced the areola to make it match the left.  To be honest my right side healed much quicker than the left breast did.  Not really sure why... I was very careful and followed all the instructions and took all the antibiotics as ordered.  You will do fine.  If you have any questions you are welcome to inbox me.  I still have a small reduction to do on my left areola to make it completely even and we are going to complete it after the first of the year.  Good Luck.

cookiegal

there is a difference of opinion about whether before or after is better. My PS does revisions on lump/rads breasts all the time/

mimi1964

cookiegal I agree and wish mine would have been a little more willing as I would have like to have been a little smaller than the C that I am (LOL) but it is what it is and I am pleased. 

lopsidedlouey

Thanks Mimi and Cookie for responding... I shouldn't have scheduled my surgery for 2 months in the future because I keep going back and forth as to whether I want to or not... If I were retired, I'd have had it already.  My BS wanted me to have the reduction on the other side during my lumpectomy surgery, but when I went to the PS visit and mentioned it, he was strictly against it.  He said my good side would be 'beautiful', but the cancer side would change with radiation and in a year I would be uneven again.  I was always a little lopsided, but unfortunately I got cancer in the smaller one.  Mimi,,,you only had a lift on your radiated side, correct?  I am thinking that is what I am going to do.  My PS said that he wouldn't reduce that side at all or much due to the fact that radiated tissue has less blood supply and there is a risk for the nipple dying... I am just SO protective of that side now...!  LOL

momoschki

Lopsided,

Maybe it's time for a second opinion?  I can't speak to the implications of reducing on the side that has been radiated (I did not have radiation), but I can assure you, that for me, at least, the recovery from the reduction was not bad at all.  Had it done on a Thursday and that Saturday I went for a 4 mile walk-- by week 3 I was back in the gym and back on my bike, where I did a 30 mile ride.  Pot holes were a bit of a problem, but a very sturdy sports bra did the trick. 

PinkCarn

I was diagnosed last week. I have seen the Breast Surgeon and go to the Plastic Surgeon tomorrow. My husband and I are leaning towards the lumpectomy with breast reduction. What should I consider in making the decision?

Moderators

Hi PinkCarn, and welcome to Breastcancer.org. Until you hear from other members about their experiences, the main BCO site includes information from an older Ask The Expert conference that answers the question Reduction of other breast?

We hope this helps!

• The Mods

momoschki

hi Pink,

I had a lumpectomy & bilateral reduction after what turned out to be DCIS later downgraded to ADH.    In my case, the surgeries were done separately, but this is not the general procedure.  I would say that one if the most important factors to consider is your team of BS & PS:  you want to make sure that they have teamed up together in the past and have plenty of experience in oncoplastic procedures, since you will need the BS to do the lumpectomy in tandem with the PS, who will do the reduction.

Also, if chemo and/or radiation will be part of your tx plan, I would want to know how this surgery will affect your timetable of other possible treatments.  

My own experience was that I did not find this a terribly hard surgery to recover from-- some  discomfort in the first couple of weeks, but by 3 weeks out, I was feeling fairly normal.  I'm hugely pleased with the cosmetic results.  Feel free to PM me if you have more specific questions.

Best of luck!

cookiegal

hi pink cam...this surgery has it's advantages and disadvantages like all do.

Big advantage....wide margins. Very wide. I feel it is better than a traditional lumpectomy.

Smaller breasts make radiation easier. Very large women can have special issues during rads.

Cosmetic benefit, my breasts have a nice lifted shape. If you are going through chemo, it's something posive to focus on.

No boost. I had 5 less  rads, since there is no tumor bed.

The can take out everything that looks even a little suspicious, calcifications, anything else, so you get a fresh start.

Of those of us on the board, I don't recall a recurrence.

Disadvantages... I has a lot of pain, and significant loss of sexual sensation.

I had a slow recovery.

I had a tough time with bras and comfort.

Also, if you don't have clean margins, there is no re-excision, the next stop is mastectomy. This is very rare, since you will have large margins, but nobody ever mentioned this.

I have Lymphedema, one of reduced breasts swells, and the reduction may have played a factor.

Still I think it is a great option. Good luck.

PinkCarn

Cookie this is most helpful information. My tumor is small 2mm and I have DCIS and invasive. The plan is to have 6.5 weeks of rad Monday - Friday. The PS will keep the affected breast slightly larger to allow for some shrinkage via rads. The BS and PS have worked together before. They are both excited because the perfect storm must come together to do this surgery (i.e. the tumor is small enough and located in a viable area and the breasts are large enough). It will be a 3 hour surgery and I have found with much shorter surgeries the anathesia takes my energy away for 6 -8 weeks. I start rads 1 month after surgery. 

Another question; I have heard people speak of surgical bras; I assume they provide compression. Do you get one before your surgery? I don't know what size to get. I did see some on Amazon. Please advise. Thanks so much, PinkCarn

lilyrose53

Hi all!

Just found this thread.  This seems to be the topic no one ever talks about.  I was starting to think I was the only one who had this done. 

Pink Carn - When I woke up from surgery I was wearing a compression bra. It felt good the first few days...like it was keeping my breasts from falling off.    Once I was done wearing that bra, I was able to buy a few lightweight, front=closure bras from my PS.  I am so glad I had this surgery!  It's been about six weeks for me and I can't believe how good they look!

Hope all goes well for you!   lilyrose

PinkCarn

Lilyrose, thanks so much that reassures me on both the surgery bra and how you are doing 6 weeks out. 

momoschki

Pink, 

I woke up

I woke up in  a surgical bra as well, which I wore for about a week, after which I switched to a sports bra.  I would recommend getting a couple of good high compression sports bras, keeping in mind that for several weeks after the surgery, you will be swollen.  I slept in these as well.  After about 6-8 weeks, I was able to switch to a regular bra.

cookiegal

There is a hospital post surgical bra.

Then I went to a mastectomy shop and got a pair of softer, lighter post surgical bras that were covered by insurance.

I had a few months that not much was comfortable. 

Honestly the best thing was the (non-racer back) fruit of the loom bras that are something like  3 for 12$. I got them in 3 different sizes.

They are the most trimmed down, without much to irritate, and you can double them up.

More expensive sports bras just had too much here or there.

I also wore shelf camisoles for a while. Kohl's has good ones.

I tried just about every sports bra and sports cami at target, walmart, and kohl's.

So many have racer backs which are fine for a little while but ultimately pulled down on my neck.

I realize everyone is different, but I wish they had not made my cancer breast larger.

It swelled during rads and never went down. I don't say this to scare you, but I would have rather taken my chances on shrinkage.

cookiegal

Bra's part two.

It was about 6 months before I could really wear normal bras again.

It was a lot of trial and error, I eventually went back to underwires.

Sears also has a good soft bra, that is not racerback. It is part of the Apostrophe line, I think they have them near the PJ's.

My PS recommended another post surgical company with high end stuff. For me it was a waste of a few hundred dollars. They were very high quality, but not comfortable or a good fit.

I will be honest it took a lot of trial and error, and for a while I had to change every few hours to get comfortable.

Still I do not regret the choice.

OH...post surgical, I hated the button downs, I got some very stretchy black jersey nightgowns and robes with deep open necks. I had something to wear when people visited that looked normal.

Drains are a drag, but not the end of the world. Mine came out after a week.

This is a crazy tip, but I got my hair blown out the day before surgery, you are not going to wash it for a week, so it kind of gives you a head start. My PS thought this was pretty smart and funny.

Good Luck!

PinkCarn

This is all so helpful thank you. I am now waiting to get a surgery date. I found out I had cancer April 16th. My patience and nerves are wearing thin. 

PinkCarn

I actually have some of those fruit of the loom's from Walmart, 3 for $10. 

lilyrose53

PinkCam - Waiting for your surgery is nerve wracking.  Been there.  My BS was the one who suggested two PS that he had worked with many times.  I made appointments with both and made  my choice.  The PS I chose is a woman who made me feel very comfortable as she specializes in reconstruction after BC.  She also spent quite a bit of time with me explaining the procedure and answering all my questions.  She also showed me lots of photos - before and afters - of women she had done surgery on.  She also gave me very detailed instructions about my after care.  I literally have several pages of instructions!  I did not have drains after surgery, so I think my recovery went quicker than some.  I was allowed to shower two days after my surgery, but had to wear the compression bra 24/7 for a week.  Then I switched to the lighter weight bra.  At my two week mark, I was allowed to sleep w/o a bra.    After the six week mark, I am now allowed to wear an underwire bra - but I DON'T need one!  I am 60 years old.  Haven't had breasts this perky since before I had my kids.  Also was told not to lift anything heavier than ten lbs for the first six weeks.  And my favorite was - no vacuuming!

Bottom line is - ASK QUESTIONS.  Everyone's situation is different and no two people heal the same.  Make sure you are comfortable with your choice of doctors.  Mine had worked together many times before and I feel did a great job.

As far as bras go - My PS carries  bras that are front closure and cheap.  She charged me $10 apiece.  She also suggested the soft bralets that you can purchase cheap at places like Kohl's and Walmart.  I wear them around the house all the time.  I got rid of all my underwires, they are too big anyway. 

I hope all goes well for you!  I will be thinking of you.  lilyrose

PinkCarn

I just got a long email from a co worker I do not know well telling me all about his wife's cancer (not breast) and how she died. WTF this is not helpful. I am finding the way people respond speaks all about them and rarely about you. The best response so far: the friend who just took me in her arms and hugged me and said I love you. She gets it.

lilyrose53

PinkCam - I am sorry that happened to you.  Sadly, stuff like that will continue to happen.  I actually had someone ask me WHY I wasn't just 'cutting them off' because I'm old anyway,  Nice, huh?  I am learning to ignore stupid remarks and move on.  Those people will not be a part of my life moving forward.  It sounds like you DO have a good friend who gets it.

Hugs,  lilyrose

PinkCarn

Lilyrose, Thanks. That is good advice. I am going to need to accept people will say stupid stuff move on. 

PinkCarn

I just got a call from Dr. office. They are going to do two surgeries. One to remove Lymph nodes (45 minute, day surgery) a few days prior to the lumpectomy and reduction. I was surprised; I had no idea there would be two surgeries. Has anyone else had this done?

cookiegal

I have heard of it, but honestly I thought they did not do that anymore. 

Typically they remove one, look at it quickly and if it is pos, remove more.

Perhaps that sort of "instant" pathology is not available at your medical center, so they want do take out a node first???

I'll be honest, I don't want you to panic, but ask if this is just a sentinel or a level one dissection.

Lymphedema is a big fat nightmare, and I don't want you losing nodes you do not need to.

Ask questions!!!!  

PinkCarn

Thanks Cookie. I will call and ask. I live in Dallas and I can't imagine we don't have the latest technology. I do need to better understand the why. I was so surprized I did not ask too much.

lilyrose53

PinkCam - I didn't think they did that anymore either.  My BS wanted me to have everything done at once because he said the fewer times I had to have anesthesia, the better.  So he removed the tumor and did a sentinel node biopsy plus removed another 3 nodes.   Meanwhile my PS was doing her thing.  The surgery lasted a total of about five hours, but I'm glad I didn't need to go back!  I did have anesthesia again two weeks ago to have my port put in.  I would ask why he doesn't want to do it in one surgery. 

Also, my BS told me on my first visit with him, to go buy an expandable file to keep all my records in.  He gave me copies of all of my pathology reports and the CD of my ultrasound when I was diagnosed.  My MO gives me copies of all my bloodwork and meds given to me in my chemo.  I wouldn't have known to ask.

Hope you get it all figured out.  Wishing you well,  lilyrose

PinkCarn

My BS gave me a binder with all sorts of information. I quickly out grew the binder and went to Office Depot to upgrade to a larger one with a zipper close. The cool thing about my hospital system is I can log into it and down load all my reports. I have done that and keep an electronic copy as well as a hard copy. I also sent all of this to my Primary Care Provider (Internist) who operates out of another hospital. I really like that I can see my reports and don't have to bug the provider to get them. 

Per the extra surgery; I have a meeting the day before the lymph node surgery to ask all my questions. I know the PS was not available next week so I have the nodes on May 7th and the lumpectomy and reduction on May12th. It did surprise me to have two surgeries. It might have to do with the PS schedule. But I will find out soon. Thanks for all the help and support Lilyrose. 

PinkCarn

I would highly recommend the Mayo Clinic Breast book. It is detailed and high level enough to satisfy my scientific side (I work in healthcare) but understandable and thorough. 

PinkCarn

Remember when our Mother’s called them “Bosoms”?

There
were the pointy years in the 1950’s and early 1960’s. For those of you who are
younger; think early Madonna when she wore that pointy boob outfit. Then in the early 1970’s the women’s
liberation movement lead to burning bras. I remember flower child Wendy
Berlowitz, an associate professor of English at Okla. U, taking her bra and shirt
off and going topless while teaching a freshman English class. Her husband used
to hang out on Campus Corner playing his guitar. During this time I kept my bra
on and my shirt tucked in and played the cello.

Today it seems our breasts are part of a movement. We adorn
them with pink ribbons and take them on runs for the cure. Others find them in
need of reduction, or enhancement. Others put tattoos on them. Ouch.

Then there is the “club;” the breast cancer club. It seems
so common these days that millions of us have joined this club. As one of my
friends says, it is a heck of a sorority but a hell of an initiation. It starts with a mammogram. My mother,
Latane, always called that a “titty pullin”. This was said of course in her best Tennessee accent. Then
it leads to biopsy’s and in the interest of good taste I will not share the
details of that. And on it goes…

Breasts become the focus of your life. I have never talked
so much to so many about my tatas, girls, bosoms. They X ray them, measure them
and if you are not careful they and you may forget these bosoms are a part of
you. They are your bosoms, tatas and girls. They are part of who you are and
suddenly they have rebelled against the greater good of you.

So this leads us to the folks who want us to “beat this” or
“fight it”. This may seem weird; but I have a negative reaction to that
approach. In no way do I mean I don’t want to be free of cancer and in perfect
health. But it just doesn’t feel right to fight something your body created.
What does feel natural to me is to just allow yourself to let go of something
that you do not need. First you have to accept it and then look at your life
and reorder it without this unwanted aspect. Face it first then allow yourself
to let it go. I may have gone all Zen on this and I reserve the right to change
my perspective on the “fight”. I am yet a neophyte in this club and I know I
will change in the process.

For any of my friends who are in the club; I would be interested
in your perspective on this.