Meeting BS tomorrow: umx/bmx/reduction/nodes questions

reflect

Hello all, I'm new to this forum but have been active in others. Mid way through neoadjuvant Taxol and did 4 rounds of AC. The grand plan is surgery late August followed by radiation. I have 2 positive nodes found by fine needle biopsy. (possibly more of course).

I'm meeting the BS tomorrow. Met her once way back but of course it is a blur. Please help me think through questions and options.

I must have mx on R as cancer is multifocal. I may have some choices regarding axillary node removal as they are doing a study. I am afraid of lymphedema and would like the fewest nodes removed (safely). I will ask about u/s of nodes (new study shows u/s can ID nodes still suspicious) or ask for dye to ID SLN and a couple of others. My L breast had shown suspicious spots on MRI but then the radiologist said, nope, it's fine, no biopsy. Of course I am still concerned. I can have PMX on L if I choose. I am considering asking for a L reduction instead for 3 reasons: I could keep a healthy breast and get pathology from the tissue that's removed in case there is cancer there and have a breast size on L that could be matched by flap or implant (I am currently a G/H cup--ridiculous). Does this make sense? What are the pros and cons of each option? I don't want a G/H cup one side and flat on the other. Nope. Please chime in with your experiences and suggestions. What should I ask? What did you do ? What am I missing? Thanks to all.

ChiSandy

I'm with you on R mx and L reduction. I too am very large-breasted, but was fortunate to have a unifocal small (1.3 cm) tumor conveniently located on the upper outside of my R breast, so lx+external rads was what I chose. The seroma in the tumor cavity, while smaller than it was in Oct., is still large enough that nobody could tell I had lx on the R but for the scar. Before surgery & rads I was a 38 H/I, and the radiation (short double-strength tumor-cavity-only protocol) made the seroma swell to the extent I had to go up a size to 40 I (the cup being the equivalent of a 38 J, but needing the extra band size to prevent too much pressure or truncal LE). I'm finally back down to 38 I again. Had I not been obsessed with being able to be done with rads in time to go on our Mediterranean cruise (which was wonderful) I might have considered bringing up the question of bilateral reduction--say, down to a DD. It only occurred to me when my SNB seroma (the size of a tangerine) incision spontaneously ruptured 3 wks post-op, and the surgeon who squooshed it dry and sutured it (my BS' partner, because she was in the O.R. at the time) suggested it was the weight of my “oversize” (his word) breast that pulled it open. Just had my followup bilateral mammo--all clear except it shows the seroma is still there (would have been OK to wait till next June for the next one, but they want to take a look and see if the seroma's still there in Dec. and whether anything needs to be done about symmetry). Had, heaven forbid, another anomaly popped up, I would have had to have a mx because you can't irradiate the same breast twice (even with another PBR, there'd be overlap of the fields). And whether or not I were to choose reconstruction, I would definitely insist on a L reduction--since they don't make prostheses (and the bras that hold them) larger than DD, and I certainly wouldn't want to be reconstructed to my current Dolly Parton/Morgana the Kissing Bandit cup size.

reflect

Thank you ChiSandy, your experience is helpful. I can easily imagine my giant breast pulling open an incision. Why couldn't your surgeons I wonder? And while I love Dolly Parton, I don't want these huge breasts either. Ironically, I had just begun researching breast reduction when the cancer shit show started.

I am worried about down time following surgery as I have a job I love (and need) and a kid still at home--so lots to do! Wonder how much a reduction would add to mx down time. A question for tomorrow's meeting.

Thanks again.