Does radiation make reconstructive surgery difficult?

dumfound

I just had my lumpectomy three days ago - within a month from the date I noticed a lump. I pushed it to happen so fast because I was very worried that my cancer would spread. So far I only know it's 1.8 cm, DC. Still waiting for the pathology result and stage.

I read that extremely dense breasts have higher risk of BC. Also, the chance of BC on the other breast is higher too. This led me to think if the pathology shows that my cancer has not spread to the lymph nodes, should I consider double mastectomy and reconstruction? In a brief discussion with my breast surgeon he said mastectomy would be an overkill, and lumpectomy plus radiation is just as effective as mastectomy. But he did not compare the chance of recurrence of both options. He also said if I had mastectomy I would not need radiation. But do I need chemo after double mastectomy?

Does insurance pay for reconstruction after mstectomy?

What are your experience and opinion? Thanks.

sbelizabeth

Dumfound, sorry you're here, but glad you found us.

Your treatment and options will depend on your pathology report. Your care team should present all your options to you, despite their professional bias toward one course of treatment or another. Remember it's YOUR body and YOUR choice. If your team tells you a mastectomy would be "overkill" and you feel strongly that you want to avoid radiation treatment it's perfectly OK to push back and insist on a mastectomy. Just don't let the "get it out of me, get it off me!" gut response make your decision.

Chemo treatment is not based on the type of surgery chosen, it's based on whether or not, and how much, cancer is found in places other than the breast, such as lymph nodes.

YES insurance must, by law, pay for reconstruction. Every insurance is different, of course, but recon surgery is paid for like an appendectomy or heart surgery.

Read, read, read, not on Dr. Google, but here on BCO. Educate yourself so you'll be a well-informed part of your team.

LeslieMemsicMD

Sorry about your recent breast cancer diagnosis. You do have options! If your mammogram is negative for other suspicious abnormalities but your breast are dense (making mammogram sometimes less accurate ) ask your doctor if a MRI would be helpful. If that study demonstrates no other suspicious abnormalities, then you can choose lumpectomy with radiation (and sentinel lymph node biopsy) or mastectomy with or without reconstruction (consult with a plastic surgeon before you decide). The advantage of mastectomy is generally you do not need radiation but the disadvantage is you loos your breast. Reconstruction can look great with current techniques, especially if you preserve your nipple but you do loose normal sensation which can be a bummer. The decision to remove the opposite (noncancer) breast is tricky. Once a patient develops cancer in one breast, she has a lifelong risk of getting a new primary in the opposite breast compared to a patient who has never had cancer, but it isn't very high of a risk and generally doesn't justify mastectomy. It is a very personal choice and may make sense for some but not for others. Don't be afraid to demand it if your peace of mind and your risk factors (including dense breasts, history of breast biopsies - even if negative for cancer) and family history) mandate it; however do not be railroaded into doing more surgery than you need or want out of fear. Get a few opinions from breast cancer specialists and determine exactly what your risk is and exactly what makes sense for you. Radiation does make reconstruction more difficult but not impossible. There are options that look great and that issue should not dissuade you from proceeding with radiation after lumpectomy if that is the best choice for you. Chemotherapy is recommended based upon the aggressiveness of your tumor and risk of spread outside the breast and is independent of the surgery you choose. Good luck and Take care.