Need advice on surgery plan

LillieRose

hi all,

I am newly diagnosed currently having chemo... I met with my surgeon and she is recommending a lumpectomy.. I want a double mastectomy..

I am in a trial so I have to have surgery in the middle of chemo.. After my 12 weekly Taxol. After my surgey I will start AC chemo. Since she wants me back to chemo fast this is what she thinks we should do....

Lumpectomy w/ Sential node biopsy

Back to chemo

Then double Mastectomy with expanders.

Radiation

Implants put in once I heal from rads

So it's like I'm pretty much having an extra surgery because she said less healing time and less complications with lumpectomy...

What do you think? Do you think I could get back to chemo faster with the lumpectomy or should I do a single mastectomy? I'm not sure what the difference in healing time is... My doc said a double could lead to more complavations and healing time...

I have no idea what to expect form either of the surgeries so any info would be great! Thank you!

muska

Hi LillieRose, a double mastectomy with immediate reconstruction with expanders would definitely require more healing time and pose more risk b/c expanders make you more prone to infection and you would be doing it in the middle of chemo when your risk of infections is already higher than normal. Good thing is, that would be after Taxol that does not I believe suppress your immune system as much as AC does.

That being said, I am not sure I understand why you are having chemo if you haven't yet had sentinel node biopsy. Nor do I fully understand the purpose of sentinel node biopsy in the middle of chemo. I am sure somebody more experienced will explain.

dltnhm

LillieRose -

Triple negative with a little baby and so much on your plate and this too. I saw that you are being treated at Dana Farber - so you are in a really excellent place when it comes to treatment and options.

I was not triple negative, nor as young as you (48 at diagnosis). I had surgery (UMX with immediate DIEP reconstruction) followed by chemo (AC dose dense and then 12 weekly Taxols) and then I had 28 radiation treatments.

Because you are having neoadjuvant chemo, it is possible that the wisest course for you would be the least invasive surgery between your chemotherapy treatments. I cannot really speak to this. And since you are having chemotherapy after your surgery, there are always risks associated with the chemotherapy.

I do want to encourage you that I had minimal side effects with my AC course of chemo - basically, I lost my hair - that was it. I was able to continue to run daily, no nausea, no extreme fatigue, etc. It will definitely be more demanding on you with a baby - as my youngest was a senior in high school.

There are many who have written about their experiences with expanders and implants followed by chemotherapy and radiation, etc. I hope that they will chime in - but you can also do a search with those parameters and I believe you might find some with similar circumstances.

Diana

LillieRose

I'm doing chemo first because I'm triple -. No matter what stage you always do chemo. They did a FNB on my axcillary node and it was negative. We are hoping no node involment but wouldn't know for sure without surgery.

LillieRose

thanks Diana. It is a lot and really scary

SpecialK

Lillie - I had a TN friend who inquired about a different trial at Moffitt Cancer Center for TN.  They followed a similar protocol doing Taxol first, then a lumpectomy, then AC.  The trial drug was in addition to the Taxol in pill form, it was not an armed Taxol/Cisplatin trial.  Just wanted to offer than they wanted lumpectomy between chemo drugs for the very reasons outlined - easier and faster healing prior to the more intense chemo drug to follow.  Wishing you the best!

LillieRose

thanks specialk. It does make sense.. Its just so much and I've never had surgery before and now I'll have 3... Plus my body will be weakened by the chemo. I just need to make sure I do everything right so I beat this. I have month old baby girl that needs me!

SpecialK

Lillie - eat 100g of protein daily - during chemo if you can manage it, some pineapple, take some zinc if they allow - these will all help you heal.  If food sounds unappealing try protein shakes.  I agree your little girl does need you - I can't imagine going through this with a baby, I am so hopeful that everything goes smoothly for you!

debiann

I was having a hard time deciding between lx and mx. I did the lumpectomy first and then started chemo shortly after. When chemo was finished I had a bmx with diep recon. Because of the bmx I didn't need rads. 

Yes the lx is a much easier recovery. By doing that first, I had time during chemo to  better research my options and find a PS I liked.