Lumptectomy with Radiation or BMX- undecided/help!

mdp4

I am new to these boards, so I'm not sure if I've posted this in the right place, so forgive me if I have. I have surgery scheduled for a lumpectomy with radiation to follow, due to IDC, they think it's stage 1 but won't know for sure until after surgery. I am not afraid of the surgery part anymore, I am more concerned with all of the side effects I've heard about radiation. Some people think I am crazy because I am now considering a double mastectomy with immediate reconstruction (it would be nipple sparing) so I don't have to worry after surgery about getting cancer again in my breasts again. The thought of ever doing a mammogram again makes me feel sick. Is there anyone who has done a BMX when they could have had lumpectomy with radiation? I have done the brca testing and it was negative. I don't want to regret whatever I decide to do , so if anyone has advice to share on this, I would appreciate it so much!

deeplygrateful

dear mpd4:

I had a lumpectomy with sentinel node biopsy in late May 2015. IDC Grade 1a. I never considered a bilateral mastectomy because fear is not a good reason to me to remove a body part that may or may not develop cancer at some point in time. Until I received all the genetic testing and path reports, I did not feel that I could make a life altering decision like a mastectomy without some good reason to do so. My cancer was strongly estrogen and progesterone positive, so I was advised and chose to have whole breast radiation and 5 years on an aromatase inhibitor. When all was said and done, the oncologist told me that factoring in everything, I had a 97% cure rate. Yes I may develop the same cancer again BUT there is only 3% chance that I will and yes I may develop another different breast cancer in either breast but I will deal with that when and IF it happens. Meanwhile, I have two good breasts (one a little lumpy and scarred and tender) and can choose to have a mastectomy down the road if I ever really need one. Radiation was for me pretty easy...some radiation burn but nothing awful. The worse part of radiation for me was the sorrow I felt for women I came in contact with that had been through so much...chemo...mastectomy...radiation...metastasis...a life of dealing with treatments and uncertainty forever. I am grateful mine was caught so early and humbled for my great prognosis. I made the absolute best decision for myself as far as I'm concerned. Read everything you can and ask a lot of questions. Breast cancer treatments are improving every day. Don't let fear guide your choices.

Moderators

Hi mdp4 and deeplygrateful, and welcome to you both to our amazing Community! We hate that you're both here, but really glad you found us.

mdp4, you're sure to get some more very helpful answers here soon, in addition to deeplygrateful's response! In the mean time, you may want to check out the main Breastcancer.org site's page on Mastectomy vs. Lumpectomy.

We hope this helps, and look forward to hearing more from both of you!

--The Mods

Nightmareshope

hi I did a lumpectomy and a re-excision and then did not do radiation or hormones. I'm taking a protocol for estrogen blocker that's natural and cancer killing pills, natural from Life Extension out of Florida, USA. I had 1a ductal carcinoma. My surgeon said he got it all and it didn't go into my lymph nodes. I also had DCIS and he got that too. So with all the side effects from radiation and hormone therapy I decided to go natural with all the vitamins and cell if killers I could get.. If cancer returns it could happen with radiation and hormones too. They can't promise the cancer will never return. So I made my decision.

Sjacobs146

Having a BMX does not guarantee that you won't get BC again. That's what decided it for me. I was only 48 when diagnosed, I want to keep mine for as long as I can. Definitely read all the pros and cons of each treatment path. Good luck with your decision.

ruthbru

Beesie is one of the resident experts on the boards. I am copying a very well thought out post she did on this topic. Hope it helps:

"Some time ago I put together a list of considerations for someone who was making the surgical choice between a lumpectomy, mastectomy and bilateral mastectomy. I've posted this many times now and have continued to refine it and add to it, thanks to great input from many others. Some women have gone through the list and decided to have a lumpectomy, others have chosen a single mastectomy and others have opted for a bilateral mastectomy. So the purpose is simply to help women figure out what's right for them - both in the short term but more importantly, over the long term.

Before getting to that list, here is some research that compares long-term recurrence and survival results. I'm including this because sometimes women choose to have a MX because they believe that it's a more aggressive approach. If that's a big part of someone's rationale for having an MX or BMX, it's important to look at the research to see if it's really true. What the research has consistently shown is that long-term survival is the same regardless of the type of surgery one has. This is largely because it's not the breast cancer in the breast that affects survival, but it's the breast cancer that's left the breast that is the concern. The risk is that some BC might have moved beyond the breast prior to surgery. So the type of surgery one has, whether it's a lumpectomy or a MX or a BMX, doesn't affect survival rates. Here are a few studies that compare the different surgical approaches:

Lumpectomy May Have Better Survival Than Mastectomy

Twenty-Year Follow-up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of Invasive Breast Cancer

Twenty-Year Follow-up of a Randomized Study Comparing Breast-Conserving Surgery with Radical Mastectomy for Early Breast Cancer

Now, on to my list of the considerations:

• Do you want to avoid radiation? If your cancer isn't near the chest wall and if your nodes are clear, then it may be possible to avoid radiation if you have a mastectomy. This is a big selling point for many women who choose to have mastectomies. However you should be aware that there is no guarantee that radiation may not be necessary even if you have a mastectomy, if some cancer cells are found near the chest wall, or if the area of invasive cancer is very large and/or if it turns out that you are node positive (particularly several nodes).
• Do you want to avoid hormone therapy (Tamoxifen or an AI) or Herceptin or chemo? It is very important to understand that if it's believed necessary or beneficial for you to have chemo or take hormone therapy, it won't make any difference if you have a lumpectomy or a mastectomy or a bilateral mastectomy. (Note that the exception is women with DCIS or possibly very early Stage I invasive cancer, who may be able to avoid Tamoxifen by having a mastectomy or a BMX.)
• Does the length of the surgery and the length of the recovery period matter to you? For most women, a lumpectomy is a relatively easy surgery and recovery. After a lumpectomy, radiation usually is given for 6 weeks. A mastectomy is a longer, more complex surgery and the recovery period is longer.
• How will you deal with the side effects from Rads? For most patients the side effects of rads are not as difficult as they expected, but most women do experience some side effects. You should be prepared for some temporary discomfort, fatigue and skin irritation, particularly towards the end of your rads cycle. Most side effects go away a few weeks after treatment ends but if you have other health problems, particularly heart or lung problems, you may be at risk for more serious side effects. This can be an important consideration and should be discussed with your doctor.
• Do you plan to have reconstruction if you have a MX or BMX? If so, be aware that reconstruction, even "immediate" reconstruction, is usually a long process - many months - and most often requires more than one surgery. Some women have little discomfort during the reconstruction process but other women find the process to be very difficult - there is no way to know until you are going through it.
• If you have a MX or BMX, how will you deal with possible complications with reconstruction? Some lucky women breeze through reconstruction but unfortunately, many have complications. These may be short-term and/or fixable or they may be long-term and difficult to fix. Common problems include ripples and indentations and unevenness. You may have lingering side effects (muscle pain, spasms, itching, etc.) on one side or both (if you have a BMX). If you don't end up with symmetry (symmetry is not a sure thing by any means, even if you have a bilateral mastectomy with reconstruction done on both sides at the same time), will you regret the decision to remove your breasts or your healthy breast? Are you prepared for the possibility of revision surgery?
• How you do feel about your body image and how will this be affected by a mastectomy or BMX? A reconstructed breast is not the same as a real breast. Some women love their reconstructed breasts while some women hate them. Most probably fall in-between. Reconstructed breasts usually looks fine in clothing but may not appear natural when naked. They may not feel natural or move naturally, particularly if you have implant reconstruction. If you do choose to have a MX or BMX, one option that will help you get a more natural appearance is a nipple sparing mastectomy (NSM). Not all breast surgeons are trained to do NSMs so your surgeon might not present this option to you. Ask your surgeon about it if you are interested and if he/she doesn't do nipple sparing mastectomies, it may be worth the effort to find a surgeon who does do NSMs in order to see if this option is available for you (your area of cancer can't be right up near the nipple).
• If you have a MX or BMX, how do you feel about losing the natural feeling in your breast(s) and your nipple(s)? Are your nipples important to you sexually? A MX or BMX will change your body for the rest of your life and you have to be prepared for that. Keep in mind as well that even if you have a nipple sparing mastectomy, except in rare cases (and except with a new untested reconstruction procedure) the most feeling that can be retained in your nipples is about 20% - the nerves that affect 80% of nipple sensation are by necessity cut during the surgery and cannot be reconnected. Any breast/nipple feeling you regain will be surface feeling only (or phantom sensations, which are actually quite common and feel very real); there will be no feeling inside your breast, instead your breast will feel numb. For some, loss of breast/nipple sensation is a small price to pay; for others, it has a huge impact on their lives.
• If you have a MX or BMX, how will you deal emotionally with the loss of your breast(s)? Some women are glad that their breast(s) is gone because it was the source of the cancer, but others become angry that cancer forced them to lose their breast(s). How do you think you will feel? Don't just consider how you feel now, as you are facing the breast cancer diagnosis, but try to think about how you will feel in a year and in a few years, once this diagnosis, and the fear, is well behind you.
• If you have a lumpectomy, how will you deal emotionally with your 6 month or annual mammos and/or MRIs? For the first year or two after diagnosis, most women get very stressed when they have to go for their screenings. The good news is that usually this fear fades over time. However some women choose to have a BMX in order to avoid the anxiety of these checks.
• Will removal of your breast(s) help you move on from having had cancer or will it hamper your ability to move on? Will you feel that the cancer is gone because your breast(s) is gone? Or will the loss of your breast(s) be a constant reminder that you had breast cancer?
• Appearance issues aside, before making this decision you should find out what your doctors estimate your recurrence risk will be if you have a lumpectomy and radiation. Is this risk level one that you can live with or one that scares you? Will you live in constant fear or will you be comfortable that you've reduced your risk sufficiently and not worry except when you have your 6 month or annual screenings? If you'll always worry, then having a mastectomy might be a better option; many women get peace of mind by having a mastectomy. But keep in mind that over time the fear will fade, and that a MX or BMX does not mean that you no longer need checks - although the risk is low, you can still be diagnosed with BC or a recurrence even after a MX or BMX. Be aware too that while a mastectomy may significantly reduce your local (in the breast area) recurrence risk, it has no impact whatsoever on your risk of distant recurrence (i.e. mets).
• Do you know your risk to get BC in your other (the non-cancer) breast? Is this a risk level that scares you? Or is this a risk level that you can live with? Keep in mind that breast cancer very rarely recurs in the contralateral breast so your current diagnosis doesn't impact your other breast. However, anyone who's been diagnosed with BC one time is at higher risk to be diagnosed again with a new primary breast cancer (i.e. a cancer unrelated to the original diagnosis) and this may be compounded if you have other risk factors. Find out your risk level from your oncologist. When you talk to your oncologist, determine if BRCA genetic testing might be appropriate for you based on your family history of cancer and/or your age and/or your ethnicity (those of Ashkenazi Jewish descent are at higher risk). Those who are BRCA positive are very high risk to get BC and for many women, a positive BRCA test result is a compelling reason to have a bilateral mastectomy. On the other hand, for many women a negative BRCA test result helps with the decision to have a lumpectomy or single mastectomy rather than a bilateral. Talk to your oncologist. Don't assume that you know what your risk is; you may be surprised to find that it's much higher than you think, or much lower than you think (my risk was much less than I would ever have thought).
• How will you feel if you have a lumpectomy or UMX and at some point in the future (maybe in 2 years or maybe in 30 years) you get BC again, either a recurrence in the same breast or a new BC in either breast?Will you regret your decision and wish that you'd had a bilateral mastectomy? Or will you be grateful for the extra time that you had with your breasts, knowing that you made the best decision at the time with the information that you had?
• How will you feel if you have a bilateral mastectomy and no cancer or high risk conditions are found in the other breast? Will you question (either immediately or years in the future) why you made the decision to have the bilateral? Or will you be satisfied that you made the best decision with the information you had?

.I hope that this helps. And remember.... this is your decision. How someone else feels about it and the experience that someone else had might be very different than how you will feel about it and the experience that you will have. So try to figure out what's best for you, or at least, the option that you think you can live with most easily, given all the risks associated with all of the options. Good luck with your decision!"

ruthbru

I will add that I had a lumpectomy. My thought was that if I wasn't happy, I could do a mastectomy later but once my breast was gone, it was gone forever. As time has gone on, I am even more glad that I made that choice. This is just me, but I would have had a hard time being flat, but the more I have learned about the problems with reconstruction, the less I think that I could ever go through that process (and it is a process, not a one shot and you're done type of thing). Here is another post beesie did later with her thoughts on her reconstruction experience:

"What I've learned from having my MX is that a MX affects you for your lifetime. I'm more than 7 years out and there are days when the affect of my MX and reconstruction is still very noticeable to me - muscle aches, sore ribs, etc.. There are activities that I no longer do, or try to avoid, because of the reconstruction. How I felt about my MX and reconstruction when I first had my surgery (elated!), how I felt about it two years later (surprisingly disappointed), 5 years later (it is what it is) and now 7 years later (occasionally frustrated) has continued to change and evolve. I think that's important to understand because so much of what you read on this board is from people who have just completed the process, or who are still in the middle of the process. Whether they feel good about it or bad about it at this point in time could easily change as time goes on."

mdp4

nightmareshope thank you for your reply, I've not heard of this before. Did you receive this from a medical doctor or online? I would like to look into all the options available, thanks so much

mdp4

Ladies, thank you all for your help with sharing your experiences and information! There is so much to weigh and consider., I just can't believe it. Just when I think I've made my mind up I get more information that changes my mind. It's great to hear from those who've been in the same or similar shoes, thanks again for taking the time to share!

mdp4

For those who had radiation, what creams or oils did you use during treatment?

ChiSandy

I chose lumpectomy and radiation after learning that the survival rates for it and mx are identical (though it has a slightly higher ipsilateral--i.e., same breast--recurrence rate, 6% vs. 3% for mx). Never did I consider prophylactic mx on my healthy breast unless I were found BRCA-positive; my genetic test turned out negative. And when I found out that bmx is absolutely protective only for those who don't have cancer at the time, that iced it for me. (Again, I was warned that radiation might still be needed if cancer were found outside the breast removed). My lump was small (1.3cm), ideally located (shallow, upper right quadrant toward the armpit) and my breasts are very large. Even though the right one is the smaller one, it still fits into my pre-cancer bras just fine. My clothes still fit the same as before.

Recovery took a few days. No drains. No infections. No restricted arm movement. No fatigue. Almost no pain--and even that was gone after the third day. The sentinel-node biopsy incision did rupture and the seroma beneath it leaked, but it was because of the size of my breast pulling it open. I then had it sutured instead of glued and Steri-Stripped, and it has healed fully (and said axillary seroma is almost gone). I formed a small seroma at my tiny biopsy site, so if I had opted for mx, I'd have developed a much, much bigger one--and if I chose autologous reconstruction rather than implants, an even larger one at my harvested-tissue site.

Radiation was a breeze for me. Because of my age and the size, location, clean margins and negative nodes, and non-aggressive nature of my tumor, I didn't get the 6 weeks of whole-breast radiation but rather 3 weeks + one day of more intense but partial-breast radiation to the tumor cavity and a margin around it. The only side effects I had were painless slight pinkness and tanning of the radiated portion, and an enlargement of the breast on the surgical side due to the seroma that naturally occurs after a lumpectomy to occupy the tumor cavity enlarging--but though the treated side is wider it still sits higher than “lefty," which hangs lower, so they're both the same cup size and fill out a swimsuit evenly. (If you are over 70, you may not even get radiation). I used and needed no pills. The radiation team gave me samples of Aquaphor, which I applied protectively immediately after each treatment. I applied 100% pure clear unscented aloe vera gel (Fruit of the Earth) at night, twice on weekends, and still twice daily now. (Just feels good). Once or twice I used calendula cream, but the gel works better and has no smell.

I am flying to Rome next week for a Mediterranean cruise. Not sure whether that'd have been possible after mx, especially bmx and/or reconstruction.

My philosophy, as well as that of my care team (especially my PCP) is that when it comes to treatment of small early-stage non-aggressive tumors--especially in older women--less is more. If necessary, you can always go back in and remove the breast--but you can never put it back, only reconstruct a facsimile that may not look and won't feel the same. Yes, I know I could get a contralateral cancer, but though bmx would have eliminated the necessity for mammograms, for me it wouldn't have eliminated the worry.

I will be taking endocrine therapy, but conventional--those “natural remedies" give me the heebie-jeebies, not just because of the lack of organized and scientifically verified clinical trials but because of the lack of regulation of the purity and amount of their contents.

ruthbru

I did chemo first so found radiation to be a breeze. I used Aquafor. My breast got red and hot at the end (like a sunburn from the inside out) but it never blistered or anything. I haven't had any after-effect problems from radiation, and in fact that breast actually is somewhat rounder and more perky than the 'good' one.