Immediate recon vs delayed

jlstacey

I am planning to ask my current breast surgeon this question as well, but I thought I would put this out here too.

I am triple negative with no node involvement on scans. Chemo has really worked for me (4 infusions left) and my 4cm tumor hasn't been palpable for about 6 weeks. My current hospital's protocol is to do sentinel node biopsy at the time of my BMX then determine if I will need rads. Recon is thus delayed.

Today I went to a surgeon at another hospital to consult about a DIEP. Their protocol is to do a sentinel node biopsy in advance and determine if I need radiation. If I don't then I cam have immediate recon at the time of BMX. This really appeals to me for several reasons (hello, one major surgery vs two!!). I'm just trying to understand the reasoning behind my hospital's protocol. The protocol of the hospital I went to today seems way more logical.

The hospital I go to is the top hospital in the state and ranked #2 in the state for cancer. The second hospital is the number 2 hospital in the state and the top cancer hospital in the state. Both are very good facilities

jbdayton

I had neo-chemo and tumor shrank to almost nothing; only 5 mm with no activity left. My nodes were checked by frozen section and came back clear.

After the pathologist did the detailed tissue checks they found that one node may have had some active cells but they were dead. He also found active DCIS in the original tumor bed not clear margins which was up against my chest wall. I ended up needing radiation.

Luckily, I had already decided to do delayed reconstruction to allow my body time to fully recover from chemo before starting reconstruction. Having negative nodes did not result in no rads.

Just food for thought. Follow your gut and the PS you feel most comfortable with.

Good luck. I wish I could have done immediate recon the results are so much better usually.

Mardea15

Jlstacey, I just completed my last dose of neoadjuvant chemo, & I also want to have immediate recon with DIEP at time of BMX. My BS is doing both a breast MRI & a SNB in advance, 2 weeks ahead of time so path report will be completed before BMX. If I don't need radiation then he & PS will do the DIEP recon at the same time. If SNB shows need for radiation, they will put in TEs for the interim & the DIEP flap will need to be delayed. Having the SNB far enough ahead of time makes a difference as a frozen section at the time of surgery does not give a complete picture.

Hope all goes well for you.

Eliz1973

Wow! I am so overwhelmed! I am new to all this so please be patient.... I was diagnosed about a month ago with breast cancer. I know I do not have clear margins and because there was more than one tumor the BS is recommending a mastectomy of my left side. Due to my age and statistics for reoccurrence I am contimplating a BX. My genetic test was negative, therefore I get to keep my ovaries. I do not have a PS on my ins that works with my surgeon, however because of separate health issues I am partial to my BS. It has been very difficult to locate a BS and PS that work together to perform my surgery. This leads me to the decision of following through with my BS I am partial too and having recon later or persevering through the endless tribulation of finding two Drs that work together. I will not know if rad is required until lymph node testing is done w BX. I am disappointed that finding Drs is so difficult with a breast cancer diagnosis.... Suggestions ? Comments? Experiences welcome!

Thank u,

Elizabeth

Moderators

Hi Eliz-

We want to welcome you to our community here at BCO. We're sorry for the circumstances that have brought you here, but we're glad you've found us, and hope you find the support you need!

This is a bit of an older thread, so there's a chance you won't get much feedback from the members who contributed to it. We would suggest starting a new topic in this forum, asking your question and opening it up for discussion and input from the community. You're always welcome and encouraged to start new discussions!

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jlstacey

Hi Elizabeth,

I had a little frustration too. There are no plastic surgeons whatsoever who work with your breast surgeon? When you have your BX, you will need to have tissue expanders put in and this will be done by a PS. It does not have to be the PS you use for DIEP flap though. I would meet with PS who are within your insurance network and find out if they are comfortable with doing recon with another surgeon doing your TE. I met with some who weren't comfortable with that. I ended up going with a PS at the same facility as my BS. Is the reason you can't find a plastic surgeon to work with your breast surgeon because there are no surgeons at your hospital who do DIEP flap?

Jena