Now I'm REALLY confused! Help please?!

etnasgrl

Ugh....I was confused and overwhelmed before, now I'm just....well.... I don't even know. Beyond confused!

I posted here last night about my upcoming lumpectomy and how my surgical oncologist explained the procedure to me and then referred me on to a plastic surgeon. The plastic surgeon wants to lift/contour and fill out the breast that is getting the lumpectomy as well as reduce some of the unaffected breast, so that both breasts are as even as possible.
I wrote that I had thought this was normal procedure until I began reading on here about how many/most women are NOT having plastic surgery during their lumpectomy, so I wanted to know if what I'm supposed to have done is normal or not.
Several ladies responded NO, this is NOT normal, they never heard of this and to run the other way because someone was only looking to make some money off me.

Okay.

Then, I come back here and find a thread titled, "The Reduction + Lumpectomy Thread", which talks about just what I'm supposed to have done.
So....I'm guessing that this IS normal!!?? My plastic surgeon is not some money hungry jerk??!!
UGH! Please....can someone out there help?
I'm overwhelmed, scared, and confused.
I want to make sure that I do the right thing.....but now, I'm totally clueless as to what the right thing even is!

SpecialK

etnas - I think those who posted were unfamiliar with oncoplasty and so might not have known that in some instances, particularly when a lumpectomy is of enough size that it may leave the breast with a significant deformity, it is an appropriate and desirable thing to have done during the lumpectomy surgery itself.  Generally speaking, oncoplasty is the movement of tissue within the breast after the lumpectomy is completed to fill in the missing area.  My concern is with reduction of the other breast prior to rads of the affected breast.  Without knowing whether rads will shrink your breast, and by how much, there is the possibility that there will still not be symmetry after a reduction is done.  YouI might consider having the oncoplasty done during lumpectomy, then wait until some time has passed after rads to address the reduction to the unaffected breast, if it is necessary - but you run the risk that it will not be covered by insurance.  One of the driving factors in doing this surgery at the time of the lumpectomy is that the WHCRA does not cover symmetry surgery after the fact for lumpectomy patients the majority of the time. The federal law was put in place to cover symmetry surgery for mastectomy patients, but offers no specific protection for lumpectomy patients. If your insurance company will cover the oncoplasty and reduction it may be your only opportunity to have this paid for.

BrooksideVT

I think the issue for most of those of us who responded on your other thread was that you indicated the ps would do only a very minor reduction on your other breast, in hopes of matching the post-rads size of your post-lumpectomy breast. You did not indicate any wish for reduction, or, for that matter, for any plastic improvement.

If what you would like is smaller, higher breasts, then go right ahead. This is indeed the time for that. If, however, your concern is simply to give your cancer the old heave-ho, then, unless your surgeon indicates a need for plastic repair of the procedure he or she is considers appropriate, your risk of complications and your normal recovery will both be affected.

What is your goal?

etnasgrl

My goal is to get the cancer OUT and move forward. I like both breasts the way that they are and are NOT looking for a reduction.
I do understand that having radiation MAY make the breast shrink....but I'm really not sure if I want to have a perfectly healthy breast made smaller IN CASE that happens to the breast that has the cancer. (Does this make sense?) I would rather wait to see what the lumpectomy and cancer do to my breast. Once everything is done, I can determine THEN if I want to make changes to the unaffected breast.

I'm just struggling to find a reason to do anything to the unaffected breast before I'm sure I will need it. If it helps I'm a 42D, so on the larger size.
(I really could care less about "higher", more lifted breasts.)


*I was told that a golf ball size would most likely be removed. Since my breasts are on the larger size, would that be really noticeable when wearing a bra and top or really only noticeable when naked?*

octogirl

I posted on the other thread, and as I mentioned on that thread, I did have some oncoplasty along with lx (and rads to come) but it was on the bad breast, not the 'good' breast, and was because they removed the nipple also...and while I didn't say 'run' I did say that I really didn't get, and still don't get, why you would do work on the 'good' breast in anticipation of radiation SEs, since the SE in question, shrinkage, doesn't always happen, and when it does happen, can be unpredictable. Do you really care enough that you would risk increasing the lack of symmetry in order to assure that insurance will cover it? What if your doc is wrong about shrinkage from rads (which was the main issue I read in your original post, for the good breast). I also would be hesitant about lifting and reduction on the bad breast in the same surgery as the lx, because, (as is also pointed out here and was pointed out in the other post), until you have the pathology post surgery, they can't be sure they won't need to do more surgery to get clean margins.

One question you haven't addressed that I saw, however, that I think might make a difference in your decision: where on the breast is the tumor? A golf ball size area is going to show up a lot more in some locations than in others. As I believe I said on the other post, I am large chested (40DD bra size), and my tumor was twice the size of yours, and they also had to remove the nipple. Obviously you can tell that the nipple is gone (the oncoplasty made it look better but it still isn't a nipple), but even without clothes I can't see much if any difference because most of what they took out is on the bottom below the saggy part (the scar is underneath the curve of the breast for the most part.) And no, I don't give a damn if my breasts sag. I'd rather have sag than any more surgery than necessary any day of the week. Now, if lx had no been an option (and I was originally told that it might not be an option because of the nipple issue, until my bs made the oncoplasty suggestion) I would have taken mx with no reconstruction. I went for lx not for looks but because it was less invasive surgery and my surgeon, who I had confidence in, was confident about doing it (and it all turned out great). Could a plastic surgeon who knew what they were looking for tell the difference? Probably, but I frankly don't care. And it sounds like you don't care either. So, my advice, FWIW, stands: If you are confused you should get a second opinion. If you don't want a second opinion I think at the least you should ask your surgeon: "I really don't care about higher or lifted breasts. Does that change your opinion as to what I need?" "Why or why not?"

I think you need to keep asking questions until you aren't confused, whether you ask them of this doc or another via a second opinion (or perhaps both). And frankly, I personally would be reluctant to put my surgical care in the hands of any doc who thinks they know what I'd like want cosmetically unless they first asked you what you would hope for and then explained the options.

Just my two cents and continued best wishes!

Octogirl

ElaineTherese

Hi!

During my lumpectomy, I had a golfball-sized amount of tissue removed from my right breast, just above the nipple. It left a small dent in my breast. After radiation, my right breast didn't seem that much smaller than my healthy left breast. In a bra, they look the same size. By the way, I'm a C-cup.

No one talked to me about cosmetic surgery to "fix" my breasts afterwards. My MO and surgeon have said that the dent may become less noticeable over time as tissue continues to shift around a bit.

Best wishes!

BrooksideVT

Sounds like you know exactly what you do and do not want, etnasgrl. Even better, you know your options for repair if you are not happy with how your breast looks after surgery. As to that, nearly everyone who posts here about post-lumpectomy appearance says the same thing--a thin, fading line of a scar marking the incision site, and that's it. Your surgeon can tell you what to expect, but he really won't just scoop out that golfball, leaving a hole-in-one. I know I posted this somewhere else today (maybe even here?), but I had two golfball-sized tumors removed from my less-than-C-cup breast and, except for that very thin line, you cannot tell at all.

etnasgrl

First, thank you all so much for your answers and for trying to help me make sense of all this mess! I appreciate it more than you know.

Okay...to answers some questions....
1) The tumor is 1.1cm x 1cm x 0.9 cm in the right breast at 11 o'clock, anterior depth 9cm from the nipple. So, looking straight at the breast as if you were standing in front of me, the tumor is on the top left hand side of the right breast, not too far from the armpit. (I hope this makes sense.)

2) I have NOT meet with the radiation oncologist yet and will not until after the lumpectomy. My lumpectomy is scheduled for Dec. 10th and my appointment with the radiation oncologist is Dec. 21st.

Please understand that I did not ASK for any type of plastic surgery/reconstruction/ lift etc. during or after the lumpectomy. This was presented to me in such a way where this is just what is done. I didn't think twice about it until I began to research lumpectomies and discovered that it's not really normal practice.

In my opinion, I do NOT want to mess with a perfectly healthy breast if there no medical need to. A medical need is much different than a cosmetic need. If, after the lumpectomy and radiation, I am not happy with how my healthy breast looks in comparison to my cancer breast, I would THEN consider some type of reconstruction on the healthy breast, (if reconstruction on the cancer breast was not an option due to radiation), in order to have it look more symmetrical to the cancer breast.
Sure, I would love for my breasts to look lovely and full....but that is NOT my priority right now. My priority is getting this cancer OUT, going through radiation therapy to ensure all the cancer cells have been destroyed, and move forward with my life, healthy and happy!

mustlovepoodles

Octogirl said: " So, my advice, FWIW, stands: If you are confused you should get a second opinion. If you don't want a second opinion I think at the least you should ask your surgeon: "I really don't care about higher or lifted breasts. Does that change your opinion as to what I need?" "Why or why not?" I think you need to keep asking questions until you aren't confused, whether you ask them of this doc or another via a second opinion (or perhaps both). And frankly, I personally would be reluctant to put my surgical care in the hands of any doc who thinks they know what I'd like want cosmetically unless they first asked you what you would hope for and then explained the options."

Spot on advice. Etnasgrl, if you are having second thoughts, you need to postpose surgery until you have all your questions answered and you are completely at peace with your decision. Breast cancer isn't a particularly fast moving type of cancer, so you certainly have a few weeks or months to get a second opinion. At the very least, your BS should explain to you in detail why you need to have this surgery on your perfectly good breast.

I had a lumpectomy and re-excision back in Aug. Mine was up high in the tail of the breast, almost under my arm. I have a 4" incision because my BS decided not to do an extra incision to get the SNB; most LXs are smaller. It has healed up nicely and the scar falls into the natural fold under the arm. There is no noticeable difference in the sized or shape of my breasts.

LisaAlissa

Talk with your surgeon about why s/he included a plastic surgeon in the plans. It could be that this surgeon always works with a plastic surgeon to get the best cosmetic result on closing. That's not necessarily a bad thing. But the decision to perform surgery on the "other breast" is quite another call.

Lots of questions, discussion and analysis about that seems to be in order...

HTH,

LisaAlissa

Ridley

etnasgrl - as others have mentioned, all of this is your choice, but that's especially true of the plastic surgery decision. I was a 38DD before surgery and my first surgery was a lumpectomy of the left side. My lumpectomy was huge - a quarter of my breast. My breast surgeon moved the tissue around so that you could not tell the outer upper quadrant was missing. In a bra, you really could not notice a difference in size. Undressed, you could.

A friend who is an oncologist advised me not to have any surgery than what was necessary to begin with. She advised that because more surgery would increase the risk of a post op infection, which could end up delaying any additional treatment ( e.g. Radiation, chemo). I thought that was good advice.

As it turns out, I ended up having more surgery, but do not regret starting out with a lumpectomy only.

Good luck with your decision.

QueenElizabethTheFaux

etnasgrl, I'm scheduled, on Dec 11, 2015, for the exact same surgery as you (lumpectomy immediately followed by reconstruction, reduction and lift...so both sides will match.) I got negative feedback regarding this "order" of surgeries, too.

But, since then, I've been giving it a lot of thought. No one on here knows (until now) that my cancer is in a very unusual position (7 o'clock position, right breast) nor do they know my exact breast size or my surgeon's experience with cancer removal and breast reconstruction. (Btw, I did get second opinions and the exact same surgery/reconstruction and treatment plans were recommended.)

I do love the many wonderful members here and the support system this discussion board provides. Breastcancer.org is a terrific place. But I'm going to leave the surgery part in the hands of the surgeons.

That said, if you feel uncomfortable about any part of your surgery, you should get a second opinion from a surgeon. Neither of my surgeons, nor my oncologist and radiologist, were the least bit offended about me getting a second opinion. In fact, they encouraged it.

Much love and good luck to you. xoxoxo

etnasgrl

The more that I think about this and gather as much info as I can, the more I just don't understand the point of having surgery on the healthy breast. At least not at this point.
There is no guarantee on what will happen to my breast due to radiation. It may shrink, it may swell, it may stay the same. The only way to know is to wait and see. Having surgery on a perfectly good breast "just in case" the breast with cancer DOES shrink from the radiation seems a bit silly to me. What if the breast doesn't shrink, but swells instead? The surgery I had on the healthy breast would be for nothing then. Or if it stays the same? Same thing.
I'm not looking to come out of this cancer journey a beauty queen....I'm looking to come out ALIVE and CANCER FREE. When I reach that point, I'll work on looking and feeling beautiful.

QueenElizabethTheFaux

Excellent points and excellent post! Now you know exactly what you need to do : )

etnasgrl

I'll tell you, this journey isn't for wimps, that's for sure!! LOL!

proudtospin

I had 3 lumpies till the BS got clear margins for my DCIS, BS suggested I speak to a PS but I elected not to do so. I am a DD or more and my left boobie is a dif shape than the right boobie but to be honest, unless I am naked, no one notices and I really do not feel like more surgery

and I also ended up with LE on that side so who knows what would happen with more chop chopping

NancyHB

Etnasgrl - our dx are very similar size-wise. My tumor was 1.3cm, located on my left breast in the 10:30 position, just to the right of the breast bone - not much tissue to work with there. I had two excisions to get clean margins, the second of which removed an area almost 4cm. I'm a full C-cup. My incision is visible in virtually all but high-necked shirts. At first my dent was very visible and pretty ugly. I had been told to expect breast shrinkage after rads (full-breast as well as targeted boosts). In the end my breast is actually a touch larger than my right. In the last 3 years the dent has evened out some so that only the surgical scar is visible, and even that looks pretty good. When I bend over towards the floor in Forward Fold I see a dimple, but it's not that bad.

I hope you're able to take your time to make the decision that's best for you. Every one of us is different, and while my surgeon told me to prepare for disfigurement, I really must say that that never happened for me.

labelle

I'm not sure how anyone can know what might happen to your breast with RADS. I had a pretty good sized lumpectomy. Due to scar tissue and swelling from RADS my treated breast is actually now larger and firmer than my non-treated one. You can't tell with a bra and clothes, so it isn't a lot, but the difference is clear when undressed. I finished RADS 9 months ago. My doctors say you just never know what RADS are going to do-shrinking or swelling are both possible. I'd definitely want to finish treatments before trying to achieve symmetry

BethL

I had a lumpectomy in 2005, labeled a segmental mastectomy. The tissue removed was above the nipple, so when I was closed the nipple was much higher. I then had rads. I waited for repair because honestly I just didn't care. However about 3 years later my bad breast started getting smaller, a lot smaller. My doc said this was not unusual to have changes years later. I opted to have an implant on that side and a mastopexy on the other to even things up. 2 different surgeries. My insurance covered both, even the mastopexy which was done separately. I'd ask more about the reduction on the good side when you're not even sure what your cosmetic results will be yet.

ChiSandy

My tumor was 1.3cm, in the 10:00 position on the right breast. Surgeon took out a chunk about the dimensions of a Double Stuf Oreo, plus 2 sentinel and 2 non-sentinel lymph nodes. My scar is crescent-shaped on the outside and fading fast. I am normally (abnormally?) a 38I or 40H. Before the surgery, my right breast was slightly smaller and higher, but I didn’t really need to pad that cup unless I wanted absolute symmetry (used the removable pads from a too-small Genie bra). I have my last rad treatment coming up this aft., and the right breast is now MUCH larger but still sits higher, thanks to the seroma occupying the tumor cavity. I now have to wear 38J or 40K. The seroma compresses more than does pure fat, so both breasts look almost the same when I’m dressed (you can see my cleavage skew slightly to the left when I’m in my underwear, a shelf-cami or a swimsuit). Point is, I don’t know how long I will have that seroma, and when it resorbs how much of it will be replaced by scar tissue. Another consideration is that even though my left breast showed no anomalies on my recent screening mammo (the one that first spotted my right breast tumor), it isn’t a given that it will always remain that way. No point in trying to even things up yet---or ever. Who knows whether my right one will stay larger or shrink?

But the thing about your story that I found most disturbing was that your surgeon wanted to optimize cosmetic results before your full pathology report was in--frozen sections aren’t always accurate as to the extent of margins. Having to go back in to achieve clean margins is not uncommon, and in that case you’d need further surgery on both breasts to achieve symmetry. I opted for lumpectomy not just because it was available to me, but also that I was unwilling to go through the longer surgery & recovery period of mastectomy--especially the added complications, regardless of reconstruction or corrective mastipexy/reduction on the healthy breast.

etnasgrl

Yes, ChiSandy, I have to agree with you.

I've spoken to various women who have used MD Anderson for their cancer care and they all said the same thing. While they are excellent in what they do....they do tend to press for you to look exactly how you did before cancer. (Meaning they press for reconstruction immediately, tending to put the cart before the horse.) I don't like that. I do however, like my surgical oncologist and feel that she is highly capable and qualified to perform this lumpectomy....which right now, is my main concern....getting this cancer OUT!
I will only be her patient for just a few more weeks before I move forward with the radiation oncologist, so while I don't like their methods on dealing with this lumpectomy, I do feel that I am in good hands. (Not to mention, she comes VERY highly recommended from several different doctors.)

What I really don't like is that I have found out 90% of my info from here and my Dr Love's Breast Book and NOT from MD Anderson. Yes, they have given me info.....but more in a "This is what we're going to do and that's it" method as opposed to telling me options.
I'm hoping that when this lumpectomy is over and I meet with the radiation oncologist, it will be a better experience.