Surgical activation response and MBC recon

jensgotthis

I am considering DIEP FLAP reconstruction in late January following a unilateral mx. I was diagnosed stage 4 de novo with only a couple of mets to bones and have had a very good response to treatment so far. In my meeting with the PS he indicated that MBC patients (but really all patients) should consider the potential surgical stress (or activation) response of a big procedure and what they may for progression or not. I'm trying to find stats on this and any other information as a consider my decision. Thanks in advance for anything you can share. If you've had DIEP FLAP while Stage 4, I'd love to hear your story too. Would you do it again or not? I'm currently on Letrozole and Ibrance, and would need to go off my Ibrance for 4 weeks (half before and half after surgery).

ShetlandPony

Wow, Jen, this is an important question and a difficult decision. I wish I could go right to some journal articles for you. I have seen articles discussing whether surgery to remove mets is advisable, and I'm sure you know that there are professional opinions on both sides, and also that it depends on each patient's situation. But you are talking about an elective surgery.

The thread linked below has many links to articles that may relate to your question. It is called "TORADOL (Ketorolac) linked to Recurrence Prevention"

https://community.breastcancer.org/forum/73/topics...

I have not faced this particular situation, as my stage 1 surgery was lumpectomy, and I did not have any surgery for stage iv. I did ask my onc about mastectomy since one of the recurrence sites was the same breast, different quadrant. She said something to the effect that she has seen too many times where a mets patient was doing fine until they had surgery, even for something non-cancer, like a hip replacement. She said surgery affects our cells in ways that promote cancer. She is not one to speculate, so she must really think there is a risk. (She is at an NCCN center.)

ABeautifulSunset

Jen, here is my story. I was dx in 2011 stage 4 de novo. After chemo and bmx with recon, I was completely NED. 2 years later,unhappy with my implants, I decided to embark on a pretty intense reconstruction that involved four surgeries over the course of about 14 months. Nobody warned me of the danger that you have been informed of. Sometime after the third surgery, I had progression. I truly, truly believe that I put my body through so much stress, with the anesthesia and the inflammation, that is what brought on the progression. I did do the fourth surgery because i needed to. I've been fairly stable since then, but no longer NED. I do need a fifth surgery to make a correction. I cant say I'll never take that risk again...because I might, but not anytime soon. MY ONC says the data regarding surgery is more experiential than scientific, but there is definitely talk about it among the experts.

And, as a side note, after all of that I'm still unhappy with my breasts. I can't win this one

gonegirl

I did double mastectomy with immediate reconstruction with silicone implants. my goal was to decrease tumor load. if I could go back, I'd choose no reconstruction-lots of pain from that. but I don't regret the bmx. based on some studies, I saw cutting tumor load as a benefit. I was discouraged from a diep due to real concerns regarding complications and infection. I wanted the surgery but chose paths that would cut risk of possible infections. that's why I didn't do tissue expanders since they can tend to infect. good luck with this. we're all working with little info in some areas and do the best we can