Questions about the timing/order of surgery, reconstruction

MyJourneys

I hope someone can help me think through the timing of things. I have multi-focal ILC, LCIS, ALH, microivasive areas in my left breast. All thought to be small, and all biopsies were too small to even grade. Because it's multi-focal, and lobular cancer, and therefore sneaky, they're recommending a mastectomy on that side. They biopsied my right side and found a small area of atypical lobular hyperplasia, but they say the rest of the breast looks fine.

They want to do a lumpectomy on the right side when they do the mastectomy on the left. Then, if there's any evidence that it's something more than ALH, we'll figure out what to do afterwards. Before the ALH was discovered, they planned to do a lift on the right after the swelling goes down on the left (about 3 months) to make it better match the left, which will have an immediate reconstruction after mastectomy.

One part of me says that we're going at it backwards... we should do the lumpectomy on the right, see what the pathology says, and if there are any signs of lobular cancer, the go ahead and do bilateral mastectomies and reconstructions at the same time.

But another part says, do the left first, hope for the best on the right, and at least I'll have better use of my right side while my left is recovering.

For those of you who have been there, what do you recommend?

Thank you for your advice.

Journey

debiann

Personally, if it were me, I'd skip the lumpectomies altogether and go straight for the bi-lateral mastectomy. I only had an issue with my left and had a bmx for two reasons, first to eliminate frequent scans and worry on the non-cancer side. Second, for symmetry. My breasts may look different than they did originally (actually better, the originals were saggy), but at least they look the same. Of course the reconstructed nipples have no sensation, but if you do a lift they move your nipple, so you may lose sensation anyway.

What kind of reconstruction are you considering? If you are doing some type of flap, like DIEP, you will need to know for sure 1 breast or 2, because they can't go back and harvest more tissue from the same area if you want the other one done down the road. In that case they would need to use another area of your body, which would be a lot of surgeries.

If keeping one natural breast is really important to you then a lumpectomy on one side is a good solution. Ask if your lumpectomy is likely to deform the breast at all. I'd do it the doctor's way if you are reconstructing with implants. Worry about the second mx when and if it is necessary. But if you are reconstructing with a flap, I'd want the lumpectomy first to know for sure how many mounds need to be made, 1 or 2.

Good luck to you.

MyJourneys

Thank you for your comments. We're planning on an implant right now, and the lift 3 months later after swelling goes down so they can better match the left. They said that I'll have little to no disfiguration from the lumpectomy on my right.

I think I'm leaning toward the implant/lift now. If I need radiation or something different down the road (if they find cancer in the right), then I'll have the option (hopefully) of a DIEP at that time for both breasts.

Does that sound like a good strategy?

debiann

Sounds like a good plan. Getting your plan together will help you to feel so much better. This is such a difficult time, but once you know what you are doing, things do get easier. Wishing you the best outcome possible!