Differences - surgery decisions?

glorianna

Hi,

If you have dense breasts and LCIS, maybe multiple foci, - and decide to to a mastectomy - do you choose to

go to a private plastic surgeon or a surgeon at a large hospital? It seems to be a difference in how much tissue they

remove, and skills can differ between surgeons. Do the reconstruction implants make it difficult to detect

new ev lesions etc on imaging? Should you demand e-Caderin (?) staining fr the pathologist to be sure he he has not

missed LCIS.    (I have rechecked all my different pathologies, and had different diagnosis)

Does Tamoxifen have fewer side effects than Raloxifen?  I tried the Tamoxifen, but found many of the side effects

shared here.         Take care.

Anonymous

I think that usually the general surgeon and the plastic surgeon work together as a team during the surgery; the general surgeon doing the mastectomy part of the surgery, then the plastic surgeon doing the reconstruction part.  While it certainly depends on the skill of the surgeon, I don't think that anyone can absolutely remove 100% of the breast tissue during a mastectomy. I would think that implants would make it somewhat more difficult to see things on mammo; that's why they recommend MRI follow-up if you have implants. (also to prevent any risk of rupture). I'm not sure if they checked E-cadherin with my LCIS, but that was 10 years ago, it may be more standard now, I'm not sure. Tamox actually has more SEs than evista, but then it is more effective overall in decreasing risk. (evista has less SEs than tamox, but it is slightly less effective).  I have taken both (tamox 5 years, now evista over 4 years) and tolerated both well overall.

Anne

dlb823

glorianna, I personally believe that no matter what type of bc you have or which surgery/recon you are considering that you are better off in the hands of surgeons (both breast & plastic) whose primary focus is breast cancer, as opposed to surgeons whose practices include a much wider range of procedures.  It just makes sense to me that their focus and experience can better guide your decision-making and ensure that nothing is missed.

As far as the pathology report(s), pathology can be surprisingly subjective.  Two pathologists can look at the exact same slides and come to rather different conclusions.  Therefore, and especially if you have nagging doubts, it's always wise to get a second opinion on your slides -- maybe at an NCI-designated cancer center, where, again, they will have much more experience with LCIS than a local hospital that doesn't see as much breast cancer, period.

For some reason, I can't seem to do a link to the NCI website, but you can Google it for the comprehensive cancer center closest to you.   (((Hugs)))  Deanna

Beesie

I'm so confused! 

glorianna, in a late December post in the  "Living Without Reconstruction After a Mastectomy" forum, you said "I was forced to have implants and want to remove them."  At the same time, in a post in the LCIS forum, you said "I had the PBN" referring it seemed to a PBMX that you had that discovered (or didn't discover?) LCIS.  And in referring to your pathology, you said "Multipel foci of LCIS in 1 breast, not been seen on any imaging at ell, even MRI may as I personally see it warrant for the PBM thing"

So have you already had a PBMX or not?  Was any LCIS found or not?  Why are you asking about Tamoxifen vs. Raloxifen if you've had a BMX?  Or are you here just to take advantage of the good nature of the many women who spend their time responding to your questions about your current situation, which seems to change every time you come back to this board after being away for a while?  As you are well aware, my good nature wore out a while ago.