Happy Satisfied Endings?!?!?!?

Iamladyt

Good Morning! OK, so this is my first post and I have to admit that I'm so overwhelmed. I'm a total type A personality who is NOT comfortable with spur of the moment decisions. I was diagnosed about a month ago and am meeting with a second surgeon this week for another opinion before I make a decision of what to do. There is so very much to consider/learn and I"m feeling rushed which stresses me right out! I'm told that pretty much any option is open to me so it's just a matter of choice. One minute I want a lumpectomy because they tell me that Lumpectomy V. Mastectomy has the same life expectancy. Then I jump to BMX without reconstruction because I have dense breasts and fear that if a relapse or new cancer occurs they won't see it. Also because HER2 was inconclusive so I won't know about that or chemo until AFTER the surgery. I could just use prosthesis... or maybe flat and fabulous. Then I look in the mirror and try to picture myself flat chested and though I really could care less about breasts....I'm pretty sure that without them my belly will look twice as big and that has always been a concern. So would I really consider reconstruction and additional risk/surgery for that reason? It makes me sound so vain... and yet... if I'm being honest I know I will have trouble adjusting to that. Then I read all the posts and it seems that no matter which way I go there are big issues! Lumpectomy leaves me even more lopsided than I am now and worried about density. Many women on here have trouble and complications from Mastectomy and even MORE so with reconstruction. So far I haven't found anybody who says that prosthesis work well. Everyone says they don't stay put, they are hot (I live in Florida) or that they don't work well in the pool. Flat and fabulous... maybe... but can I live with the belly thing? I'm already one month in, and seem no closer to a decision. I HAVE to decide next week after the second opinion. I need to get this out of me!! Any help or advise based on your story would be much appreciated!

Georgia1

Good morning. This is a really personal decision, dependent on stage, tumor size, family history and frankly, risk tolerance. But I will try to answer your questions about lumpectomy, which I chose. If you find an experienced breast surgeon odds are low you will look lopsided. And if you are ok with check-ups every six months, a regular schedule of mammograms and MRIs will reduce, but of course not eliminate, odds of missing a recurrence. Radiation and anti-hormone therapy (or chemo if that's what your eventual HER status calls for) will also reduce your chances of recurrence significantly.

But keep those questions coming and others will chime in soon.

---

Kristiina

Dear Iamladyt,

It is a very confusing time. I was in your shoes 15 months ago. I can give you my experience. I am the type who can talk pro's and con's on and on.

Despite the fact that one of my friends with the BRCA gene who had prophylactic mastectomy had recommended I have the mastectomy right away, I elected to have a lumpectomy., a much lesser operation. The chances of unclear margins was pretty small however, I went on to have 2 lumpectomies with unclear margins before finally going for the full mastectomy last February. I know I made the right decision at the time, with the information I was considering, having the lumpectomies, it was a much much easier operation. A mastectomy is a pretty big deal.

Looking back at it, I am very glad to have avoided radiation by have a mastectomy. Another thing to think about, alternative medicine people are very nervous about cutting cancer cells and allowing them to travel through the body during an incomplete lumpectomy. Maybe a MX right away could make sense but I think it was hard for me to choose such a radical operation straight away.

I did have reconstruction last September, I have a full mirror in my bathroom and did not want to be reminded every day of my loss. I am relatively happy with my new breast. It actually has a nicer shape that my natural aging breast. On that side I could get away without wearing a bra. I will eventually get a nipple tattoo. I had been to a topless beach in the Caribbean only once about 3 years ago. i am so glad I did it because i do not think I would be comfortable going again the way I am now.

People talk about getting a tummy tuck at the same time as/or a few months after the reconstruction (fat grafting) but i thought it was too much surgery after having 3 breast surgeries already and oddly enough my appendix out.

CindyNY

Iamladyt- I too chose lumpectomy. The consensus in the Lumpectomy Lounge posts seems to be, if your surgeon agrees to LX you should consider it. You can always go back and have more removed if necessary. But once a MX is done, it's done. Lumpectomy/LX recovery is much easier than MX. MX involves drain tubes and longer recovery time. As you get more information from surgeon, it will help with your decision. Best of luck & HUGS to you.

farmerlucy

My thought is if you are on the fence, you should do the least invasive procedure. You can always change your mind and have a more involved surgery later. I had implants six years ago. I was leaning toward flat but my DH and DD swayed me toward Implants. The expander process was extremely hard for me, and I'm a tough farm girl. I had no issue with healing, but some do. There have been changes in the shape, the scar line is tighter, the upper pole is a bit flat. Overall it is fine. I never wear a bra, and that is easy. Since the implant is behind the muscle hopefully I'd notice a recurrence.

BrooksideVT

I couldn't decide either, and I just wanted the thing out, and out immediately if not sooner, so I chose lumpectomy, secretly considering it an excisional biopsy.  If I didn't like the pathology I could then have a mastectomy and a little extra time to deal with the flat/double flat and the prosthesis/implant/transferred tummy fat issues.  As it happened, the lumpectomy was the correct choice.  It wasn't until quite a while after surgery that I realized I was happy to still have my breast/s (I'd always considered them sort of disposable).  It was quite a while after that that I realized how happy I was to have avoided all the additional risks, discomforts, and issues pertinent to mastectomy with or without reconstruction. 

It is my understanding that health insurance has to pay for a mastectomy after a lumpectomy if that's what we choose.  Please do not take my word for this, but check with your insurance company.

And yes, the belly issue is a concern.  I have a hard enough time camouflaging my tummy now, and I don't have big boobs.  The one woman I know who chooses to go flat makes sure everyone knows that she is a survivor.

Lula73

I chose BMX with immediate DIEP flap recon. I went into surgery with breasts and a somewhat rounded tummy and came back out with breasts and a flat tummy. Just had the second surgery (where they lift, reduce, fat graft if needed) in Nov and extremely pleased with the results. I can and do look at myself in the mirror in awe of what I see. I compared my before BC pics (topless & pantyless) to a pic I took last week and I have to say I look better than I did before all this started (and I looked pretty darn good for being in my 40s worth 2 breast fed kids) BC was just a lousy way to get there. No regrets whatsoever on the path I chose.

Sjacobs146

I mainly decided to choose LX because my surgeon recommended it, I wanted the least invasive surgery, same survival rate, and because I knew I could change my mind and have MX later if necessary. One you have an MX you can't go back.

Iamladyt

Thank you soooo much for sharing your stories with me ladies! I'm feeling better today and some of the anxiety has subsided. I have a full list of questions to ask when I meet with the BS and PS at Moffitt in Tampa on Wednesday. Hopefully I will have a better idea after that. You have all been most kind to take the time to attempt to help me out here! I am truely grateful and will keep all of my pink ribbon sisters in my prayers!

NotVeryBrave

I could have had LX and ended up choosing BMX. As a matter of fact - both my initial BS and my MO were very much against MX. And I had a lot of time to think it over because I didn't have surgery until after chemo was completed.

After the initial thoughts (like yours), I had settled on LX. But when the time got closer, I started to debate again. My cancer was fast growing - I found the lump about 4 months after a normal mammogram. It was Stage 2 and HER2 positive. I had some areas in the other breast they were watching - some disappeared with chemo and some needed to be checked again in 6 months. I couldn't stand the thought of doing all of this again.

Nothing is a guarantee. In my case - I felt like I would sleep better at night with the majority of breast tissue gone. I was lucky to be able to avoid radiation by choosing the BMX and I could keep both my skin and nipples and do a "direct to implant" surgery - no TE, no more surgery.

I was still second guessing myself for quite a while afterwards - I'm just like that, I guess. I miss having normal sensation in my breasts and there are a number of things that I'm not thrilled about. I could (and might, one day) have revision surgery to correct a few things and contour with fat. Right now - I'm glad to be done.

I think LX is a good choice depending on the size of the breast and the location of the tumor. My breasts weren't very large (B/C cup) and the tumor was at 12 o'clock. They were talking about taking a significant amount of tissue for LX and that rads would further shrink what was left so that I would most likely need surgery later on the other side to match. Ugh!

I would definitely get at least two opinions with specifics for you with either surgery. And I recommended MRI if you haven't had one yet and have dense tissue. Good to be as sure as possible about what you're dealing with ahead of time.

I hope you'll find a moment of clarity. This back and forth stuff sucks - neither choice is what we want to do. Feel free to PM me if it's helpful.

SajeScents

Can minor fat grafting after lumpectomies (yes, bilateral) be done under local anesthesia? I'm not looking for augmentation, just smoothing out the indentations, puckering and creases which developed after seromas drained and tissue healed in creases. Before the seromas, the surgical scars were smooth and tissue wasn't puckered, One breast looks like a hacky sack (like it's partly adhered to chest wall, yet doctor tells me it's not adhered)!

I'd love to have it smoothed out, (I can live with the slight indentation and crease in the other boob), yet I don't relish undergoing a general anesthetic for medically unnecessary procedure for the hacky sack. Am I just being vain? Hubby says it's up to me, but I think he's just being "sensitive".

I will see the surgeon in about 2 weeks for an initial consult. If it can't be done under a local, I'm wondering if I should simply cancel the consult. Anyone know?

Thanks in advance,