So confused - can't decide on treatment options

jules72

Hello ladies,

I really could use some help. I know decided on treatment is a personal choice but I've never been so torn in my life and I just can't decide between a mastectomy and lumpectomy with brachytherapy,

Info: 2.8 cm apocrine DCIS cribiform, grade low & intermediate, no necrosis, ER-/PR-. I am 43 and already have above the muscle breast implants. Had lumpectomy on 7/2 - confirmed DCIS and size but not enough margin in the area right next to my implant.

Option 1: additional surgery to break the capsule around implant and get the clean margin - that is the only area left to get at is the capsule around existing implant. Then doc would replace implant with newer one (mine is 17 years old), then do brachytherapy. Then likely replace implant on left breast eventually for assymetry.

Option 2: Mastectomy with TE and later reconstruction under the muscle on right breast and later replace above the muscle in left breast for assymetry.

When first diagnosted I really wanted a mastectomy. Then docs said there is NO difference in survival between the two options. Frankly it's very hard to believe that and wrap my head around it. I mean with lumpectomy I'd be leaving a larger environment for this to come back and granted while we'd likely catch it early there's no guarantee right? I have dense tissue, rare form of dcis, er/pr- which I'd assume is more difficult to treat, etc. But the lumpectomy/brachy sounds great but it seems very complex to take more margin, replace implant, brachy, etc. brachy is not studied long term especially for women under 50 and then I'd have higher recurrence risk.

I feel like if I choose lumpectomy/brachy I'm playing with fire. How do I look at my young kids and tell them later if it comes back that I chose a less aggressive option? Also then after rads mx with implants isn't an option. Not to mention the anxiety with constant checkups.

If I choose mastectomy I'm most concerned with whether I'll ever feel normal. I don't really care about sensation as much but I don't want to feel uncomfortable or foriegn and I can't really imagine how different a mastectomy and implant will feel versus the tissue and implant I have now. Does it ever get to a comfortable normal versus a numb, balloon feeling?

I guess I'm back to leaning toward a mastectomy but only if I have more confidence that eventually it feels good/normal such that I can live my life and put this behind me. I want to continue to be active and fit without physical limitations or constant annoying symptoms for the rest of my life.

It is such a hard decision. I'd love any input from all of your experiences.

Thank you so much in advance!

Julie

mblinnc

Hello jules72 - I am not far enough along on this path to tell you how things will feel once the tissue expanders I have post BMX are exchanged for the saline implants. My surgery was 6/24. I just wanted to express that my decision to go with the bilateral after I was told the DCIS in the right breast would require mastectomy was for just the reason you expressed - to prevent having to always feel like I was looking over my shoulder for recurrence. The TE's are uncomfortable but my PS whom I trust assures me that this is the tough part and that the implants will be nothing like them. I spoke with someone who is fourteen months out from surgery last Aprilwith a similar diagnosis and surgery before I made my choices and she said that they felt normal to her and that she was even wearing two piece suits to an upcoming beach vacation.

I hope that your heart will lead you to what is the very best decision for you.

Hugs,

Michele

jules72

Michele thanks so much for sharing your experience. I hope all continues to go well for you! I really appreciate you taking the time to respond

Cmo65

Jules I was also torn so I asked my breast surgeon what she would do if she was me and she said based on my stats she would do XL and rads, so that's what I did. I also have implants and had no issue. Best to you