Small breasted sisters! (A cup or less) LUMP & RAD? MASTECTOMY?

renbird

Hi small breasted (A cup and below) wonderfuls-

Renbird here. After meeting with 3 surgeons, 2 oncologists, 1 radiation oncologist, and a plastic surgeon... I'm STILL deciding (with 2 weeks left!) whether to get a mastectomy or a lumpectomy on my right breast. (The left one is pretty clear.) CAN YOU HELP?

Have any of my small-breasted sisters had any experience with this?

ABOUT ME:

-I have a 1.3 cm lump, Stage 1A, grade 2, ductal invasive, with DCIS and some calcifications. Hormone + HER2-. Genetic testing negative. My grandmother had breast cancer in her 60s? 70s? but lived to be 82.

-My little 1.3 cm lump is waaay off to the right, at 8 o'clock, by my ribs (the third round of mammos and biopsy was not fun! It's been a month and I'm still a tiny bit sore.)

-I am 48, married, and healthy. (I've never had surgery and I'm a scaredy cat.)

LUMPECTOMY & 5 WEEKS RADIATION THOUGHTS/QUESTIONS FOR YOU:

-My breasts are small, barely an A, and I'm not 100% sure what a lump/rad would do to them.

-The last surgeon I spoke with said "imagine taking a golf ball sized chunk out of a tangerine". She said the nipple would also likely be "off" a bit, and after radiation, maybe point down a bit? Ay! Ay! Ay! Will I be warped?

BUT!

Q: Having a lumpectomy seems like a waaaay easier surgery and recovery than a mastectomy! Right? That's the draw. I'm not really into 5 weeks of rad after surgery either. I just want this to be done. SO that's a negative on the old decision tree. I just want this to be done... I think.

Q: And what is this TATOO you get with rad that I keep hearing about?!? Is it a pin point? Is it permanent?)

Q: Last, how long is each zap? 4 minutes? 2 minutes?

Q: And how do they position us small breasted ladies? Face up, I hear, and you have to inhale deeply and hold your breath to put space between your breast tissue and your chest wall? Is that true? Sounds way more dangerous then face down with breasts dangling.

MASTECTOMY, NO RECONSTRUCTION:

My thinking is: I'm so small now, what am I really trying to save? I wear a bra with a shaped cup and a bit of padding now, so...?

Q: But mastectomy surgery and recovery sound REALLY painful and really hard. Like 6 weeks before you feel kinda like yourself again?

Q: And is it true that you are totally numb in the "eye-shaped bikini area" where your breast used to be? How high up does the numbness go?

Anything else I should consider?

Thanks, ladies! Any advice based on your own experience as a tiny ta-ta'd lady would be helpful.

XO -Renbird

beeline

Hi Renbird, I am small like you and had a mastectomy on my R breast with no recon. My surgeon said I wouldn't have a good aesthetic outcome from a lumpectomy (like the golfball and tangerine analogy. Someone else mentioned a shark bite). As it turned out, I had a lot of DCIS through my breast so it would have needed to come off anyway. I will just warn that your post-surgical pathology could change. I also went in to surgery as a stage 1A but ended up with 11 positive lymph nodes and stage 3C. No one ever mentioned the possibility to me. Anyway, recovery was pretty ok. The worst part was under my armpit for the ALND. My surgeon promised me I'd be able to attend my 5 y.o.'s birthday party 5 days later, and I did (though pretty drugged up!). I went back to work after 2 weeks. In retrospect, I would have taken another week off, but it was fine. You will hear from women here who only needed tylenol for the pain. I definitely needed the strong stuff, but not for very long. Also just to note I had no recon, so if you're having immediate recon, especially flap-based, the recovery time can be different.

In terms of rads, which I got to have, too, thanks to all those lymph nodes, the tattoos are literally pinpricks. Two of mine disappeared during the course of rads. There was no breath holding and they plan the rads sessions very carefully to limit exposure. Basically they don't shoot the radiation through you if they can help it, but rather at a glancing angle to get the surface or a few centimetres deep as required. The length of the zaps depends on how much area they're covering, but they were quite short as I recall. I had basically the max area covered, and would say I was on the table for less than 10 minutes each time.

Numbness varies. I was totally numb at the beginning nearly up to my collarbone. 2 years later, I have had a lot of feeling come back.

Good luck with your decision! As I'm sure you've heard many times already, it's all very personal and none of it is easy so be kind to yourself.

renbird

Hi Beeline-

Thanks so much for your response, and sharing your story. Wow. Sounds like they found a lot of surprises "under the hood" during surgery.

"I also went in to surgery as a stage 1A but ended up with 11 positive lymph nodes and stage 3C..."

I'm glad you were prepared for a mastectomy going in. Glad too your recovery was relatively smooth. Sorry you had to have radiation on top of it all... I sure am hoping to avoid that, but your story helps me to prepare for that possibility. Thank you!

-Renbird

cake8icing

Hi Renbird: I am a barely A, had 2.8 mm DCIS in my left breast. I chose mastectomy figuring that there wouldn’t be much left after lumpectomy, plus the fact that I was worried about damage to my heart from the rads. I did not reconstruct; my attitude was, I always had to wear a bra with some padding; adding a prosthetic would be no big deal, and I wanted the least amount of surgery I could get away with. My recovery was pretty easy. I had some weird skin sensations in the first couple of weeks(tingling, itching, strange sensations), and weirdly, terrible BO under my left armpit, which resolved after about a month. I needed some hands on PT for range of motion issues and scar tissue, but it fully resolved with just a few sessions. Now I am 5 months post-surgery and very happy with my choice and how it all worked out. I wish you all the best in your decision making.

renbird

Hi Cake8Icing-

Wow. You and I sound very similar in our diagnosis, bra size and thinking. I am not comfortable with implants, and if I go mastectomy, would likely go flat on my right side too. Thanks so much for sharing your story with me–– I will think about what you have shared as I make my decision by this Friday. Thanks again! -Renbird

Sunshine99

Renbird, I'm slightly larger than you, but I had a single mast on the right side with no reconstruction. I retrospect, I wish I had considered removing the left breast, too. I wear a soft bra, sometimes with a small insert, sometimes with no insert. I think it would be easier to "match" if both sides were flat. I have no desire to be any larger than I am, but it would be nice to have two little inserts of the same size and use those. Or, to just be able to go bra-less without one nipple showing through my tee-shirt. Just my perspective.

All the best to you with your treatments.

renbird

Hi Sunshine99-

Thanks so much for your input on this, very much appreciated. You have had quite a journey with this, I see. : (

I definitely get the "even" thing. My friend in Japan has a single mast 12 years ago, around when you did maybe? She was an A/B cup and feels the same way you do!

For me? I 'think' that even with a single breast, I could get away with a regular padded bra with no stuffing because I am so tiny. I can't even fill my A cup now on that side! But not loving the idea of a warped, toasted (after rads), crooked breast either.

But yes, the single nipple thing (or off-center nipple if I get a lumpectomy with no fat graft!) is kind of a bummer.

Would you ever go back for a cosmetic mastectomy?

-renbird