Left+ and Right-???

howdidigethere

Previous HX of ovary
removal (1981), melanoma (1988) no rads or chemo, IVF for 3^rd DD
(1997), 2007 & 2008 atypia (left).  Took
Evista for 3 years. On Feb 3, mammo showed
2 areas of calcs followed by 2 stereos (left). 
DX of ADH and differential DCIS.  Original GS planned excisional biopsy April
3. 

Chose different
GS and scheduled for March 13 (left).  The
IDC is small at 1.5mm and DCIS listed at 1.8cm. 
ER+ >95%/PR + 40-45%, HER2-.  Need larger margins, rads because against chest
wall and SNB.  Easy Peasy.

MRI on April 1. Left
corresponds to surgery with seroma. 
Right showed nothing on T1, T2 but enhancement shows 5.6cm x 4.8cm asymmetric
area.  Area covers nearly the whole chest
wall but does not appear to invade.  Small breasts. Lymph
nodes appear to be clear.  Over and over
I’ve said right has symptoms, inverted last 6 mo. and occasional
bloody discharge since Feb 15.  GS says
not related?

Ultrasound biopsy (right) on April 7 with small sampling due
to size and hard to visualize. Large hematoma after biopsy. DX of intermediate/ high grade DCIS with minute
foci of central necrosis and lobular involvement.  ER- /PR-, HER2 not tested.  GS
wants to be aggressive with the surgery on right, MX, and go ahead as planned
on the left.  Or BMX.  If BMX, I would prefer immediate
reconstruction.   Surgeon
suggested SNB as a separate surgery as malignancy may inhibit immediate
reconstruction.  Can’t get that done
until April 25! 

Concerned about the ER/PR differences, difference in
aggressiveness, and the size of the enhancement that GS feels needs to be removed
therefore MX preferred.  Should I give up
on the idea of immediate reconstruction given everything going on?  Should labs or further testing before we move
forward?  Only creatinine run so far for
MRI.  Seek a second opinion prior to
moving forward?  NCI facility close but
will be out of pocket but can afford that. 
HMO does not have breast center and had to request the referrals to the
plastic surgeon (saw last week) and oncologist (April 23). Normally those don’t come until all pathology
is in.  This seems to be taking way too
long with many things having a 1-2 week time delay built in with the HMO.  Anyone out there with similar experiences?  Posting 2 places. 

Thank you.