MRIs after mastectomy

Runmommy

Hello all,

Apologies in advance for such a long post!

I was rediagnosed late last year with contralateral axillary metastasis to my lymph node (original cancer was on the left, positive node is now on the right). I'm on TCHP and will continue HP indefinitely, since genetic testing has shown that this cancer is very similar to my original one. I'm struggling with my surgical plan however. My surgeon will do a full axillary dissection, but feels that mastectomy on the right side would now be only preventative and is up to me. While I agree with this, I have one major concern. The positive lymph node was ONLY picked up as part of a routine MRI, and not in a clinical exam. If I go ahead with another mastectomy, I will not get any more MRIs (I had a left mx back in 2014) and I'm worried that another lymph node recurrence on either side will not get picked up. I also think that the chance of another recurrence in a lymph node or chest wall might be higher than a new cancer in the right breast... but both are a risk. One final concern... if I don't do the mx now, and I have radiation after the LN removal, I won't be able to reconstruct later if I decide to do a mx in the future. It may seem silly, but I had recon on the left, and if I have another mx I would want the same recon done. I'm only 38 and with possibly just one positive LN, hope that this can be contained for a very long time!

For a while I thought I would skip the mx completely. But now that it seems that this is my only window of opportunity for recon I am leaning towards doing the mx now, and simply paying for a yearly MRI out of pocket. Has anyone encountered this? Or have any insight or advice?

Thanks!