TNBC and surgery options

Veneruzc

Good morning.

I am triple negative and gene negative stage 2 (not even entirely sure of this) with no lymphnode imvolvement from my biopsy and mri scan. I’m 45 years old. Diagnosed in May 2021. My tumor was in my left breast 12 o’clock -4 cm. Invasive ductal.

I am currently undergoing chemotherapy. I have done 4 rounds of A/C and now currently doing taxol for 4 rounds. One more of taxol to go!!! Woot woot!

Next up is surgery. I have to make a decision by the end of this week and I am struggling. I will also be doing radiation for 3-5 weeks following healing from surgery.

My surgeon is recommending lumpectomy. Initially we had discussed bilateral masectomy with reconstruction. But he is now recommending lumpectomy. I was opting for masectomy due to reoccurrence but now I am more confused then ever. But it seems my options are lumpectomy or masectomy with expanders and spacers at this time. I am thinking lumpectomy with the notion that I can opt for surgery down the road. But can I if I am having radiation???

Anyone have any experience with the reconstruction: expanders? Or has anyone had a lumpectomy and it has reoccurred.

Thank you in advance for everyone’s input.

Colleen

NorCalS

Hi there.

First of all, congrats at almost finishing AC-T. I chose to have a lumpectomy after AC-T because I wanted fast recovery so that I could quickly move on to the next treatment (radiation). For me, the recovery from lumpectomy (I also had sentinel node biopsy and axillary dissection at the same time as lumpectomy) was really fast and easy. I don’t know if it’s because my surgeon and anesthesiologist were really good or whether I was just lucky, but I was able to go home after surgery and make dinner. I had no pain and the only discomfort was cleaning the drains for the few days after surgery. Prior to surgery, I thought recovering from surgery would be the worst part of the treatment, but it was the easiest. My surgeon recommended lumpectomy because the tumor had significantly reduced in size due to a good reaction to AC-T, and I was going to have radiation either way because the cancer was in the Supra-clavicular nodes at diagnosis

serendipity09

Hi Veneruzc! I was dx'd TNBC in March 2020. Like you, I did 4 AC, but then 12 Taxol with 3 Carbo. I decided on BMX with immediate reconstruction and TE's in Sept. 2020. The surgery was very easy for me, I was up and walking and feeling decent the same night of my surgery. I never really had pain per say, more soreness. The drains were more annoying than anything else. The TE's were doable, a bit uncomfortable and awkward at times, but nothing painful. I had them for 9 months.

I had my exchange to implants this past July and was dx'd with a recurrence four days later, but the physical evidence was already there back in Feb. I start radiation in about an hour.

The decision is very personal. I knew from the beginning that I was going to do a BMX. I had very dense breasts and I knew having to go through MRI's and waiting on results and being called backed was going to drive my anxiety through the roof. Regardless, here I am again with this beast inside of me.

I will say this, I am glad I made the decision I did, but the possibility of a reoccurrence is higher for those of us with TNCB lumpectomy or mastectomy. it's going to come down to what your prefer. It's your decision and no one should pressure you into one or the other. My breast navigator tried to pressure me into a lumpectomy and tried to make me feel like a terrible person because I was choosing to have both my breasts removed versus just the one.

None of this easy and I pray everything goes well for you!

moth

So, a thing you should consider as you make your decision:

-there are 2 recent studies now showing *better* OS (overall survival) from lumpectomy + rads vs. mastectomy

Here's one of them: https://jamanetwork.com/journals/jamasurgery/fulla...

This is the write up the BCO editors did of that study https://www.breastcancer.org/research-news/lumpect...

(I can't find the link to the second - will come back when I do...... update, Here it is: https://www.mdpi.com/2072-6694/13/16/4044

(There are incrasingly more of these analyses being done as large data sets become available to researchers we can really see how the outcomes play out)

-a mastectomy doesn't prevent a distant/metastatic recurrence & that is the type that is terminal

-a mastectomy doesn't prevent (but does reduce risk) of locoregional recurrence in the remaining breast tissue (because they can't just cant get rid of every cell so women do experience occasional local recurrence in the remaining tissue)

There may still be good reasons for a more radical surgery so I'm not saying do not do the UMX or BMX. It might be right for you for other reasons. but it is a large surgery with longer recovery times and more possibility of complications. Lumpectomies are usually day surgery, usually do not require drains and heal up quickly. And you can always change your mind *after* the lumpectomy and decide to pursue a prophylactic BMX at a later point...

best wishes!

serendipity09

Exactly what moth said and the info she shared is very informative.

I was coming back to correct my post to indicate that my recurrence is a local recurrence and that I did not have rads the first time around, had I had it I may not be where I am right now, or maybe I will be?!

Veneruzc

Thank you Serendipity!

I’m so sorry to hear that you have a reoccurrence:(. I will be praying for you!

Colleen

Veneruzc

Thank you so much Moth for all of the information.

I appreciate it!!

Colleen

AlwaysMeC

Hi Colleen, I am not triple neg, but I am ER/PR neg and Her2 pos, which is often cited as second to TNBC as far as aggression goes, and it seems treatment is similar. I also have to decide which surgery option to pick by next Friday.

I was leaning towards at least a unilateral mastectomy, but having read that study that Moth posted, and talking to my breast surgeon, I am torn as well. That study has some pretty significant gaps in percentages. My breast surgeon is also young and has been keeping up with the latest information regarding breast cancer, as he is only one of a few certified breast cancer surgical specialists in our state. He said that considering my age (40s), a lumpectomy may be the better option, especially since I am getting rads regardless.

I hope you are able to come to a decision and feel comfortable with it.

Veneruzc

Thank you so much for responding.

It certainly is a challenging decision and I’m still undecided.

I appreciate everyone’s feedback! 💕

Wishing you the best

Colleen