Augmented breasts and DCIS?

Anonymous

Augmented breasts and DCIS?

Ammie

Hello everyone, I am new here, was just diagnosed with DCIS, intermediate grade, ER+ / PR+, in left breast. I have 3 palpable lumps in the 7-8 o’clock area, spanning about 3 cm total area.

Because I have breast implants and barely any natural tissue (after having breastfed 2 kids), my dr is recommending unilateral mastectomy.

Has anyone here been treated for DCIS, but with prior implants? What was your experience? Did you choose lumpectomy + radiation, or mastectomy? If you did reconstruction, did you get implants again, or use autologous tissue?

How does the mastectomy + reconstructed breast (with implant) compare to cosmetic implants? If you already had implants, are tissue expanders still necessary?

So many questions. Thanks for your help.

Beesie

Ammie,

I did not have prior implants, so I can't address most of your questions. I do have implant reconstruction, and I will say that from everything I've heard, implant reconstruction is quite different from cosmetic implants. With cosmetic implants, you still have natural breast tissue in front of the implant, so the look, feel and movement closely resembles that of a natural breast. With reconstruction, the implant becomes the breast.

It is quite unusual for DCIS to form as a lump - that only happens in about 10% of DCIS diagnoses. Did you have a stereotactic biopsy, and were all 3 lumps biopsied? And have you had an MRI? In about 20% of cases where DCIS is found through a needle biopsy, the final diagnosis is upgraded to invasive cancer after surgery. I believe that the risk is a bit higher for those who have DCIS that presents as a palpable lump. That's not to scare you, but to just to make you aware, in case your surgeon has not mentioned this to you. Hopefully in the end your final diagnosis will be pure DCIS, Stage 0.

Good luck with your surgery decision. It's never easy!

Ammie

hi Beesie,

Thank you so much for your insight, and for the many incredibly helpful and informative posts you have shared throughout these forums. I found this forum just a couple days ago, and can’t stress enough how much your input to other members has helped me sort through my thoughts, fears, emotions and more.

I, too, am very concerned with how I have three palpable lumps. I would not be surprised if the surgical pathology report reveals IDC, because from what I understand, DCIS is usually microscopic. I’ve had 2 core needle biopsies, and the first one was actually discordant (Benign) because the radiologist wasn’t able to pull enough of the calcification area in fear of puncturing my implant. The second biopsy pulled from my largest lump, but the drs were unable to get the tissue sample from the smaller lumps for the same reason of risk to the implant.

i did get a breast MRI on Thursday, so hopefully I’ll get the results from that soon.

Beesie

Ammie, glad to hear you've had the MRI. And glad that my posts have been helpful to you. Hopefully your MRI results don't show anything that would indicate invasive cancer although of course nothing is certain until you have the final surgical pathology.

With regard to your questions about reconstruction, I know I've seen posts in the past from those who have had cosmetic implants prior to their breast cancer diagnosis and having reconstruction. I did find these two old threads in the Reconstruction Forum. Not sure how relevant the information is because these days pre-prectoral reconstruction is very common not just for cosmetic implants but also for reconstruction.

Topic: Breast reconstruction post subpectoral implants/cosmetic surgery

Topic: Cosmetic Implants Now Breast Cancer Question

You might want to post your question in the Reconstruction forum to see if you get more responses.

LivinLife

Hi Ammie and welcome! I cannot answer many of your questions either... sounds like you are well on your way to knowing what's actually going on. I hope you get the MRI results quickly! Please check back in once you get results, ok?

Ammie

Thanks Beesie, for finding those old threads. My cosmetic implants are subpectoral, so I will ask the reconstructive surgeon whether he would re-use the old muscle “pockets", or if there is a reason to switch to prepectoral.

I received my MRI report and learned that the extent of the DCIS is pretty large - spanning about 8cm, and that it reaches from .3cm from the nipple to my chest wall behind the implant. They want to do SNB to check for spread, even though the MRI didn't detect anything unusual in my axilla.

Very worried now. My surgery likely won't happen until February because I still need to meet with genetic counselors, radiation oncologist, and reconstructive surgeon in January, and the hospitals here are backed up with appointments running less frequently, due to Covid running rampant here in CA. Sigh.

Ammie

thank you LivinLife, for your welcome and support. I have been sad and overwhelmed but finding this forum so helpful.

LivinLife

Of course you are sad and overwhelmed!!! This is a lot, esp. with the news about how large. Mine was initially 5 cm by MRI. They expected invasion. There was none. I hope that is true for you.... You're just taking all this in as you schedule appointments where you will get even more information. this really is a difficult time for most (if not all). Once you meet your team and get a plan it will help. Do what you can to do more for relaxation and enjoyment to help distract in between as difficult as that is.....

Ajp

I had silicone implants under the muscle when I was diagnosed. I decided to have a bilateral mastectomy with direct to implant reconstruction. My surgeon added the amount of breast tissue removed to the implant size I had before my surgery to determine the new implant size. My implants now are over the muscle and it is a much different feeling than what I was used to. My understanding is if you want to increase your size, you will need to have expanders. I was fine with being the same size so I didn’t need expanders.